ROSACEA: WHAT YOU NEED TO KNOW

What is Rosacea?

Rosacea is a common, chronic, inflammatory skin condition characterized by persistent facial flushing or facial redness. It usually affects the central portion of the face, appearing on the nose, cheeks, forehead, and chin. Sometimes, the facial redness is associated with some pimple-like bumps on the face, and small, thin, visible blood vessels on the superficial layer of the skin. Other cases report thickening of the skin on the nose or chin, and some cases present with eye symptoms.

Who can get affected by Rosacea?

Rosacea is more common in:

• Females more than males
• Fair-skinned individuals
• Those with blonde hair or blue eyes
• Celtic or Northern European descent
• Those with a family history of rosacea or acne

What are the causes of Rosacea?

The cause of Rosacea is still unclear. It is believed to be brought about by a combination of factors: genetic, environmental, immune system overreaction, and the presence of demodex mites. Rosacea is not contagious. Flare-ups of rosacea may be triggered by:

• Ultraviolet (UV) light exposure
• Temperature changes
• Spicy food
• Alcoholic beverages, hot drinks
• Heightened emotions (such as anger, embarrassment)
• Exercise
• Some cosmetic products

What are the symptoms of Rosacea?

The most common symptoms of Rosacea include:

• Facial redness or facial flushing
• Visible thin blood vessels (telangiectasias)
• Acne-like lesions
• Thickened skin with a bumpy texture
• Enlarged nose (rhinophyma) or chin (gnatophyma)
• Dry skin
• Eye problems: irritated, itchy, stinging, or swollen eyes and eyelids

Rosacea is a long-lasting skin condition; therefore, it can be a source of psychological burden and can decrease the quality of life of those affected by it. Studies have shown that rosacea can lead to low self-esteem, anxiety disorders, and depression.

Rosacea Types

There are 4 subtypes of rosacea, and each subtype entails a different treatment.

1. Erythematotelangiectatic rosacea – With persistent redness or flushing of the face, telangiectasias.
2. Papulopustular rosacea – with persistent redness or flushing of the face, acne-like lesions, telangiectasias.
3. Phymatous rosacea – a rare subtype. Presents with thickening of the skin with a bumpy texture on the nose, forehead, or chin in addition to facial redness and telangiectasias.
4. Ocular rosacea – with red, irritated, swollen eyes and eyelids which can be accompanied by itching or stinging sensation as well as vision problems, and sensitivity to light.

What are the treatment options for rosacea?

The treatment for rosacea should focus on trigger avoidance, proper skincare, pharmacologic therapy, and procedural interventions.

Trigger avoidance

Rosacea flare-ups often occur when triggered. Therefore, it is important to determine specific aggravating factors which can prompt the appearance of symptoms. The most common triggers are sun exposure, hot and spicy food, and intense, heightened emotions. It helps to be aware of these factors so that you can learn and figure out ways to avoid them.

Gentle skincare

Rosacea-affected skin was found to have a reduced ability to retain moisture; therefore, non-occlusive moisturizers are important to maintain the integrity of the skin barrier. Mild, fragrance-free cleansers should also be utilized. Using a broad-spectrum sunscreen that is SPF 30 or higher may also help protect the skin from the sun. Sunscreens containing zinc oxide or titanium dioxide are preferred. Other sun-protective behaviors such as wearing wide-brimmed hats and sunglasses, seeking shade, and using an umbrella may also be helpful. Cosmetics with a green or yellow tint may give a camouflage effect and can reduce the appearance of redness. It is important to avoid any products that can cause irritation, burning, itching, or stinging sensations.

Pharmacologic therapy

The topical medications for rosacea approved by the United States Food and Drug Administration include azelaic acid, ivermectin cream, metronidazole, and sodium sulfacetamide. These can help reduce facial flushing, improve acne-like lesions, and treat demodex mites, which can aggravate rosacea. Other topicals with off-label use for rosacea include permethrin cream, topical calcineurin inhibitors, benzoyl peroxide, and topical retinoids. Topical agents approved for persistent facial erythema include brimonidine and oxymetazoline.

For more severe cases of rosacea, systemic medications may be given by your doctor. These include oral antibiotics or retinoids such as tetracycline, doxycycline, minocycline, and oral isotretinoin. These medications can offer anti-inflammatory effects, reduce facial flushing, treat the pimple-like lesions, and improve thickening or bumpy looking skin on the nose, chin, or forehead. These medications are not recommended for pregnant patients; therefore, it is imperative to check with your doctor to see which treatment regimen is best for you.

Ocular Rosacea

For ocular rosacea, it is important to have good eyelash hygiene. Cleaning the eyelashes twice a day with baby shampoo and a wet washcloth and applying a warm compress can help relieve symptoms. Medications that may be given include topical and oral antibiotics, or topical calcineurin inhibitors, depending on the severity of symptoms. A referral to an ophthalmologist may also be warranted.

Procedural interventions

Lasers may also be used in the treatment of rosacea. Currently, there are 2 types of lasers utilized in treating rosacea: pulsed-dye laser and potassium titanyl phosphate laser. These lasers can reduce the appearance of visible blood vessels, but multiple treatments may be needed to maintain the appearance of the skin.

There are other devices that may be used to treat the symptoms of rosacea. Intense pulsed light (IPL) can reduce facial flushing, and ablative lasers such as carbon dioxide laser, erbium yag laser, and radiofrequency may be used to treat rhinophyma.

Take-Home Messages

Rosacea is chronic skin disorder; therefore, there is no cure available. Management of the disease requires proper patient education, gentle skincare, the use of topical and oral medications, lasers, and other light devices. It is recommended to visit your dermatologist to determine the type of rosacea you have and which treatment regimen will suit you best. Rosacea is triggered by many factors, so avoidance of significant triggers can help manage symptoms. Rosacea can bring about feelings of low self-esteem, embarrassment, anxiety, and depression; therefore, seeking comprehensive treatment and support is recommended.

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References:

• Rosacea - Symptoms and causes - Mayo Clinic. (2021, September 22). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815#:~:text=Rosacea%20(roe%2DZAY%2Dshe,go%20away%20for%20a%20while.
• Rosacea Resource Center. (n.d.). American Academy of Dermatology. Retrieved April 13, 2022, from https://www.aad.org/public/diseases/rosacea
• Rosacea: Symptoms, Causes, and Management - DermNet. (n.d.). DermNet NZ – All about the Skin  | DermNet NZ. Retrieved April 13, 2022, from https://dermnetnz.org/topics/rosacea
• Thiboutot, D., Anderson, R., Cook-Bolden, F., Draelos, Z., Gallo, R. L., Granstein, R. D., Kang, S., Macsai, M., Gold, L. S., & Tan, J. (2020). Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology, 6, 1501–1510. https://doi.org/10.1016/j.jaad.2020.01.077
• Two, A. M., Wu, W., Gallo, R. L., & Hata, T. R. (2015a). Rosacea. Journal of the American Academy of Dermatology, 5, 749–758. https://doi.org/10.1016/j.jaad.2014.08.028
• Two, A. M., Wu, W., Gallo, R. L., & Hata, T. R. (2015b). Rosacea. Journal of the American Academy of Dermatology, 5, 761–770. https://doi.org/10.1016/j.jaad.2014.08.027
• website. (20 C.E.). Rosacea  - NHS. Nhs.Uk. https://www.nhs.uk/conditions/rosacea/

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