Rosacea Treatments

What is Rosacea?

Rosacea is a common chronic skin condition that causes long term facial flushing and redness. Acne rosacea can also result in small pustules better known as pimples. The facial flushing is a result of small blood vessels (capillaries) in the face enlarging. These visible blood vessels are par of what gives rosacea its characteristic blushing or flushing.

Rosacea most commonly affects the face around the nose and the cheeks just under the eyes. It is a chronic condition that goes through periods of activity, called flares, and dormancy where the condition go away. It tends to occur more often in females than males and mostly develops after the age of 30.

As a rosacea flare can cause small red pimples to form with facial redness, it is often mistaken for other skin problems such as acne.

Types of Rosacea

There are four main types of rosacea. Each may cause slightly different symptoms and require different management. The four types are:

• Papulopustular rosacea - can cause facial flushing and breakouts of acne-like pimples.
• Phymatous rosacea - can cause thickened and bumpy facial skin
• Ocular rosacea - results in eye problems such as redness and irritation
• Erythematotelangiectatic rosacea - causes skin discolouration, flushing and visible blood vessels.

Rosacea Symptoms

Depending on the type and severity, symptoms of rosacea can vary from person to person although there are some common traits.

Symptoms of rosacea can include:

• Facial redness and flushing - Persistent redness and flushing on the skin, particularly on the face, is the most common symptom.
• Acne-like pimples - Pimples appearing when the face is persistently red or with other rosacea symptoms can indicate papulopustular rosacea.
• Visible blood vessels - bright red web-like like lines.
• Warmth - Warmth in the affected areas due to inflammation of the skin.
• Eye irritation - bloodshot eyes, eye irritation and swollen eyelids.
• Thickened bumpy skin - generally occurs on the nose.
• Flares that occur after exposure to triggers.

Rosacea Causes & Triggers

The exact cause of rosacea is still being investigated. Leading experts believe that a combination of environmental factors, family history (genetics), bacteria, the immune system, and the abundance of a microscopic mite could all play a role in causing the condition. It is important to note that people with rosacea do not develop it due to poor hygiene and cannot pass it to others.

The condition may flare up in response to a number of triggers. These can differ from person to person, but it is important that patients take note of their triggers and attempt to avoid them. Some common triggers for rosacea are:

• Spicy foods
• Hot foods or drinks
• High UV exposure
• Exposure to extreme weather (heat, cold & wind)
• Alcohol
• Heavy exercise
• High blood pressure
• Some blood pressure medicines
• Skin care products
• Emotional distress (anger, stress & anxiety)

Diagnosis

To diagnose rosacea, a doctor or dermatologist will examine the skin and ask a number of diagnostic questions to differentiate it from other skin conditions. Rosacea can share symptoms with many other skin diseases. Because of this, it is important that a health professional adequately assesses the condition for diagnosis.

Rosacea Treatments

There is no cure for rosacea however various treatments can relieve the condition and resolve flares. Not treating a flare may result in the condition worsening over time. A combination of medicines and lifestyle changes make up best practice treatment for rosacea.

Rosacea creams & gels

A doctor can prescribe a topical cream or gel to manage rosacea. The active ingredient can vary based on the areas affected and the severity of the condition. Typically these topical creams and gels are applied to the affected areas and will have an acne rosacea clearing and anti-inflammatory effect.

Medicines that clear acne rosacea can take longer to have an effect (4-6 weeks) while medicines that reduce flushing can show noticeable results within 12 hours. While rosacea is active as a result of a flare, the condition may require regular application of the medicine in order for the condition to be controlled.

Oral antibiotics

In more severe cases of ocular or acne rosacea, a doctor may prescribe oral antibiotics. These tend to show results faster than topically applied antibiotics however may result in more side effects.

Retinoids

In severe cases of the condition, a powerful oral retinoid treatment can be considered by a doctor. While effective, typically this is reserved for when other treatments are not effective as these treatments can cause more side effects such as dry skin, skin flaking, UV sensitivity, and dry eyes. This treatment can also cause birth defects when used during pregnancy and therefore adequate contraceptive measures must be used during treatment.

Laser Treatment

Laser therapy involves a dermatologist using a pulse laser to shrink the visible blood vessels. It can cause mild to moderate pain, bruising, tenderness and swelling. Depending on the severity of the condition, multiple treatments may be required to show benefit. This treatment is usually only used on light skin as when used on darker or tanned skin it can cause long term discolouration.

Lifestyle management of Rosacea

As rosacea is a condition that flares due to triggers, often the best management of rosacea comes from making the right lifestyle changes.

The following changes should be made to either prevent rosacea flares or assist in reducing their severity:

• Avoid triggers - First, identify what triggers rosacea and then make active changes to avoid known triggers.
• Avoid touching and rubbing the affected areas - aggravating the area can worsen inflammation and the condition.
• Use gentle cleansing products - Avoid using skin products and soaps with fragrance or irritants such as alcohol.
• Protect yourself from the weather - Use UV protection and avoid weather extremes such as extreme heat, wind, or cold.
• Reduce emotional triggers - Use stress management techniques to lessen emotional triggers when possible.

Frequently Asked Rosacea Questions

How do you clear rosacea?

Rosacea will generally clear after treatment. Treatment duration can vary depending on the medicine used and the severity of the condition. For specifics on your therapy duration, speak to your prescribing doctor.

What are the different types of rosacea?

The four types of rosacea are papulopustular, phymatous, ocular and erythematotelangiectatic. If you are unsure which type you have, consult your doctor or dermatologist for confirmation.

Can you cure rosacea?

Currently, there is no cure for rosacea. It is a chronic condition that will come and go depending on exposure to triggers and treatments.

Does rosacea cause pimples?

Acne rosacea or more accurately papulopustular rosacea can cause breakouts that look very similar to acne. These can be treated by your doctor who manages your rosacea.

What triggers rosacea?

Rosacea has a number of common triggers but they can differ based on the individual. Common triggers include spicy foods, alcohol, weather exposure and emotional distress.

What are natural rosacea treatments?

Natural rosacea treatments are often lifestyle changes that reduce the symptoms of the condition or allow you to avoid triggering a rosacea flare. These are changes such as changing skincare products, avoiding irritants, protecting the skin against the weather and managing emotional stresses.

Written by Clinical Pharmacist Tyson Wilkman