Rosacea is a chronic disorder primarily of the facial skin. It typically begins after age 30 years as redness on the cheeks, nose, chin or forehead that may come and go. Occasionally, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become more persistent, skin swelling and visible tiny blood vessels appear and small bumps often develop. In some patients the eyes are also affected and may be watery or bloodshot.
Rosacea is characterized by flare-ups and remissions. In long standing and severe cases the nose may grow swollen and lumpy from excessive tissue (rhinophyma).
Although rosacea can affect all sections of the population, lighter skinned individuals who flush or blush easily are believed to be more susceptible. The disease is more frequently diagnosed in women, but more severe symptoms tend to be seen in men.
The exact cause of rosacea is unclear. There is no permanent cure for rosacea, however medical therapy is available to control or reverse its signs and symptoms.
Figure 1: Papulopustular rosacea
Figure 2: Ocular Rosacea
Exposure to sunlight, alcoholic drinks, spicy foods, and hot drinks such as coffee and tea can cause flushing and trigger rosacea. Other triggers include exercise, vasodilators (drugs that dilate blood vessels), stress, anxiety and temperature extremes. The use of topical steroids on the face can worsen the condition. Demodex mites are thought by some experts to be a contributory factor. Strong drying facial washes, fragrance, acetone or alcohol-containing hair sprays and cosmetics can irritate the skin.
Various oral and topical medications may be prescribed to treat the bumps and redness often associated with the disorder.
1. Avoidance of triggering factors
Sun exposure is one of the most common triggers causing a flare of rosacea. Avoidance of direct sun exposure, usage of broad-brimmed hats and umbrellas and application of sunscreens should be carried out. The sunscreens should have a high SPF (sun protective factor) of 30 and above. Avoidance of alcoholic beverages and application of topical steroid creams should also be advised.
2. Topical Therapies
Topical antibiotics (e.g. metronidazole gel 0.75%, clindamycin gel 1% and erythromycin 2% or 4% gel or lotion) may be useful in controlling symptoms and maintaining remission.
3. Oral Antibiotics
In more severe cases, a course of oral antibiotics (usually doxycycline or erythromycin) may be prescribed to control symptoms. These oral antibiotics may exert an anti-inflammatory effect and are usually taken for several months. However, repeated courses may be necessary for patients with frequent recurrences.
In patients unresponsive to oral antibiotics, oral isotretinoin may be prescribed with good result. Adverse effects of isotretinoin include dry lips and skin, muscle aches, hair loss, abnormal liver function tests and raised lipids, muscle inflammation and depression. Female patients should not become pregnant while on therapy as it can affect the developing fetus.
5. Laser and Light Therapies
The Pulsed Dye Laser and the Intense Pulse Light (IPL) machine can be useful in reducing persistent redness and treating the prominent blood vessels of rosacea. For patients with an enlarged swollen nose (rhinophyma), the Carbon Dioxide Laser can be used to reduce the thickness of the skin.
A gentle skin-care routine can be useful. Patients are advised to clean their face with a mild and non-abrasive cleanser, then rinse with lukewarm water and blot the face dry with a cotton towel. Never pull, tug or use a rough washcloth.
Certain cosmetics may be used to conceal the effects of rosacea. Green makeup or green-tinted foundations can be used to counter redness. This can be followed by a skin-tone foundation with natural yellow tones, avoiding those with pink or orange hues.