ROSACEA.

New Topical Treatments have popped up over the last couple of years.

Rosacea diagnosis and treatment

What is Rosacea?

Rosacea occurs usually over the age of 30. The flushing or spots typically occur on the cheeks, chin, nose or forehead. The condition may last for years with times when the skin is much better.

Rosacea is thought to be caused by a reaction to the skin’s infection-fighting proteins called peptides.

What is the typical story of someone with Rosacea?

Some people find that the skin is worse with triggers such as spicy food and red wine. Sunlight almost always makes rosacea worse. It can be tempting to try to get a tan to make the redness less visible but it has the opposite effect.

Occasionally, tests such as blood tests and/or a skin biopsy is required to exclude other skin conditions (particularly lupus).

What are the different types of Rosacea?

The different types of Rosacea look different and are treated differently.

  1. The inflammatory type with spots on the forehead, cheeks, nose and around the eyes. These spots are red and look inflamed like acne spots (red spots or red spots with pus in called pustules). The difference is that blackheads and whiteheads (comedones) are not found in rosacea.
  2. The flushing type with a permanent redness of the skin. The redness can be diffuse or you may see specific tiny red blood vessels in the skin (capillaries). People who get intermittently flushed facial skin easily at a younger age (ie. going flushed) are more likely to develop rosacea. In addition, the flushing type of Rosacea often becomes the inflammatory type.
  3. The nose can be involved on its own. Sometimes, the changes on the nose involve a deep inflammation and thickening of the skin called a Rhinophyma which is commoner in men and occurs at a later stage. The skin is often swollen.
  4. Ocular Rosacea involves the eye and may cause a burning or stinging sensation, dryness, itching, or sensitivity to the light. The eyelids may become inflamed (blepharitis). The condition can cause conjunctivitis. More severe Rosacea can affect other parts of the eye such as the sclera or the cornea.

What can I do myself to help Rosacea?

Around 80% of people with Rosacea report worsening with sun exposure. Using sun protection is essential.

Skin Care should be gentle:

  • Use cleansers with a mildly acidic to neutral pH. Use a cleanser that is free of soap, fragrance and is alcohol-free.
  • Avoid camphor, menthol, and sodium lauryl sulphate.
  • Avoid toners and astringents.
  • Wash with lukewarm water – not hot or cold water.

Use daily moisturiser containing glycerin. Moisturiser containing Petrolatum also helps to reduce water loss. Light moisturizer is probably better than heavy moisturizer.

Cosmetic foundation with a green base will mask the redness. Avoid heavy or waterproof foundation.

What treatments are available?

Different treatments are available through your GP for different types of Rosacea.

First line treatments commonly used  for the pustular-type of Rosacea are:

  • Metronidazole gel or cream (an antibiotic). The cream might suit sensitive skin better.
  • Ivermectin 1% Cream was introduced into Australia in 2015.
  • Antibiotic tablets – the same ones used to treat acne (eg. Doxycycline) – which may be combined with topical therapy to maintain remission once the antibiotics are stopped.

Clindamycin 1% cream combined with benzoyl peroxide 5% is another option.

Remember that topical products should be applied to all areas of skin where you get Rosacea – and not just as spot treatment.

Severe pustular Rosacea may respond well to Isotretinoin which is usually prescribed by a dermatologist.

The flushing-type of Rosacea may be treated in two main ways:

  • Until recently there has been no effective topical treatment for the flushing-type of Rosacea. Topical Bromonidine gel was introduced in 2014. The gel constricts the blood vessels of the skin with Once daily application. The gel starts to work after 30 minutes and has a peak effect for 3 to 6 hours, returning to baseline 12 hours after application.
  • Laser Treatment may be used when the capillaries are permanently enlarged. Both pulsed dye laser (595 nanometres wavelength) and intense pulsed light devices may be used. This treatment is generally provided through a dermatologist.Note that laser is often effective for flushing caused by fine capillaries called telangiectasia. However, laser is less effective at reducing persistent redness caused by smaller blood vessels.

Where else can I get support?

Australia has a good online Rosacea support group.

WRITTEN BY: Dr Richard Beatty
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