Rosacea can have a similar appearance to acne but the two conditions are unrelated. Rosacea does not produce the blackheads, deep cysts or lumps that are symptomatic of acne. It mostly affects fair-skinned Caucasians (especially those of Celtic origin) aged 30–60 years.
Signs and symptoms
Rosacea often begins with episodes of flushing of the skin. As the condition progresses the skin become persistently red and spider-like veins (telangiectasia) become visible on the skin. Other symptoms characteristic of rosacea include:
- Pimples that may be hard (papules) or pus filled (pustules).
- Dry and flaky facial skin.
- Burning and stinging of the skin.
- Red, sore eyelids and a tendency to develop styes and conjunctivitis.
- Swelling of the face and eyelids.
- In advanced cases, the pores of the skin may become prominent and the nose may become enlarged and unshapely (rhinophyma) due to skin thickening.
The exact cause of rosacea is not known but may be due to a combination of hereditary (genetic) and environmental factors. It is known, however, that a variety of factors can trigger an overreaction of facial blood vessels and increased blood flow to the skin surface, causing skin flushing and inflammation.
Factors are known to trigger or aggravate the condition, include:
- Excess alcohol
- Hot drinks and spicy foods
- Application of topical steroids
- Excessive exposure to sunlight or extreme hot or cold temperatures
- Strong winds
- Some facial creams and cosmetics.
Once the symptoms are under control, an antibiotic ointment may be prescribed on a long-term basis. Other treatments that may be used include:
- Isotretinoin – a vitamin A derivative that may be recommended in cases of rosacea that have not responded to antibiotics, or where antibiotic treatment is not well tolerated. Taken orally, isotretinoin can help to reduce the papules and pustules that occur with rosacea. This medication must not be used by pregnant women however as it can cause birth defects
- Azelaic acid – a topical cream or lotion, often used to treat acne, which has proven effective in treating rosacea
- Brimonidine helps to reduce the facial redness caused by rosacea. Applied to the face once a day as a gel, brimonidine works by restricting the widening (dilation) of the blood vessels in the skin
- Vascular laser treatment – this can be effective in treating persistent telangiectasia
- Other medications – Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, can help to reduce redness and discomfort of the skin. Clonidine and carvedilol, which are used to treat high blood pressure, can help to reduce flushing of the skin
- Surgery – this can help to treat rhinophyma by reshaping the nose.
When treatment is followed correctly, there is gradual improvement. In some cases rosacea can recur and in others it can clear up completely. If left untreated, rosacea will worsen and become more difficult to treat. The success of treatment depends upon how early rosacea was diagnosed and if the full course of treatment is followed correctly.
Skin care / self help
To help prevent further irritation of rosacea and promote healthy skin, these general steps can be taken:
- Gently clean your skin twice daily using a gentle, soap-free, non-abrasive cleanser
- Avoid oil based cosmetic products that require solvents for removal.
- Use alcohol-free facial products
- Quit smoking and avoid second hand smoke.
- Avoid alcohol, hot beverages and hot spicy food
- Protect against exposure to extreme hot and cold temperatures e.g. hot baths or showers
- Use a non-irritating sunscreen with a sun protection factor (SPF) of 30+ to protect your skin from the sun
- Reduce stress levels.
NHS Choices (2016). Rosacea (Web Page). Redditch: National Health Service (NHS). http://www.nhs.uk/Conditions/Rosacea/Pages/Introduction.aspx [Accessed: 28/09/17]
Ngan, V., Oakley, A. (2014). Rosacea (Web Page). Hamilton: DermNet New Zealand. https://www.dermnetnz.org/topics/rosacea/ [28/09/17]