Rosacea Care

 


Rosacea is a common, chronic skin condition which may affect up to 10% of the population.

It is more common in fair-skinned individuals and females.

 

Criteria for diagnosing Rosacea

One or more of:

-       Flushing (transient erythema/redness)

-       Persistent erythema/redness

-       Telangiectasia (facial thread veins)

-       Papules/pustules

 

Additional Symptoms & Signs:

-       Burning/stinging

-       Facial swelling

-       Facial dryness

-       Plaques

-       Eye symptoms

-       Phymatous changes (enlarged bulbous nose)

 

Risk factors / Causes

Sun damage, flushing tendency and genetic predisposition are all risk factors for acquiring rosacea.

Other possible factors in rosacea development:

-       Demodex folliculorum mites – this may relate to the associated increase in gelatinase (MMP-9) and resultant inflammation

-       Helicobacter pylori infection

-       Sunlight and heat

-       Alcohol

-       Spicy food

Subtypes

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Subtype 1: Erythemotelangiectatic Rosacea

Characterised by redness (erythema) of the central face, in addition to telangiectasia (thread veins) and flushing.

Patients often describe worsening symptoms following hot drinks, spicy food, heat etc.

They have a sensitive skin type and often complain of burning and stinging with application of topical products.

Subtype 2: Papulopustular “classic” Rosacea

Presents with episodic papules and pustules on the background of persistent erythema on the central face. Sometimes mistaken as acne, it presents later, and presence of telangiectasia may help to distinguish one from the other.

Subtype 3: Phymatous Rosacea

Presents with thickened, uneven skin with an irregular surface and nodularities. It usually affects the nose but may affect the cheeks and chin. It is much more common in men.

 

Subtype 4: Ocular Rosacea

Most patients with ocular rosacea complain of burning, stinging, itching and watering. Symptoms often go undiagnosed or are misdiagnosed as allergies.

Symptoms of ocular rosacea may precede skin changes.

 

Rosacea is associated with connective tissue damage in the dermis layer of the skin, as well as pilosebaceous (hair & sebaceous gland) abnormalities.

All subtypes share one common feature – inflammation.

 

It should be remembered that other conditions may mimic rosacea.

Some conditions include:

-       Allergic contact dermatitis

-       Menopause

-       Lupus 

 

Treatment

Antibiotics

Depending on severity, oral (tablet) or topical (cream/gel) antibiotic may be used. Such treatments will control the inflammatory element and help prevent a flare up, but they cannot improve the telangiectasias (thread veins).

Tetracyclines are the most commonly used antibiotic tablet, with low dose Doxycycline being an excellent option for facial rosacea. This medication can be used daily for up to 16 weeks continuously.

Metronidazole is the only topical antibiotic recognised to help the papules, pustules and erythema of rosacea.

 

Brimonidine

Normally provided under the brand name Mirvaso, this topical gel can be used daily to treat erythema (redness). Usually started as a very light application to a limited area, the amount can be gradually increased.

 

Azelaic Acid

Also used to treat acne, Finacea gel is antimicrobial and also combats comedone formation. Anti-inflammatory properties ensures it is suitable for sensitive skin.

 

Ivermectin

Possibly better known by the brand Soolantra, this cream can be used very effectively on a daily basis to treat papulopustular rosacea. It can be used for up to 4 months before having a break from treatment.

 

Botanicals/ Cosmeceuticals

Considered a more natural approach, plant extracts like green tea, liquorice extract and feverfew are just some of the ingredients found in the wide range of cosmeceutical treatments available to purchase from registered clinics.

These are invariably very soothing products, and may be used in combination with other approaches.

 

Lasers and IPL

Generalised redness and telangiectasias (thread veins) are very receptive to treatment with light-based therapies.

Depending on the individual presentation, Pulse-Dye (PDL), Nd:YAG or KTP laser may be most appropriate. IPL, technically not laser, uses a flash-lamp with special filters to best target the individual presentation. IPL was previously seen as a mild alternative, but some more modern devices are actually high-powered – one example being the Sciton BBL device.

Phymatous rosacea may be treated with CO2 laser with significant benefit to the overgrown glandular tissue.

 

Camouflage

Camouflage can be very helpful to disguise the generalised erythema of rosacea. Usually a green tint is applied which masked the redness.


If you have any questions about the treatment or would like a callback to discuss, please complete the form below.

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