Rosacea is a very common condition that causes facial flushing, redness and spots. It can affect both men and women, however tends to be more severe in men. The good news is that safe and effective treatments are available.
The earliest symptoms of rosacea are flushing of the face which can be associated with skin sensitivity and a stinging or burning sensation.
Over time this can progress to redness which is present all of the time and is associated with broken blood vessels (capillaries) on the face. This is known as telangiectatic rosacea.
Rosacea can also cause tiny red bumps 'papules' and fluid filled bumps 'pustules' that can be mistaken for acne. This is referred to as papulopustular rosacea.
Rosacea is more common in those with lighter skin types, particularly those with blond hair and blue eyes, however it can also affect those with darker skin types. In this case the appearances are more subtle and may be missed.
It often fluctuates in severity over time flaring up for a few weeks or months and then settling down.
The cause of rosacea is poorly understood. It tends to run in the family suggesting the role of genetic factors. There is some evidence that rosacea is associated with blood vessel inflammation and the present of skin mites 'demodex', however a causal relationship has not yet been proven.
Rosacea is worsened by the use of topical steroids. This can be a particular issue where rosacea co-exists with facial eczema or is misdiagnosed as facial eczema.
When rosacea has been present a long time it can lead to progressive thickening and enlargement of the nose 'Rhinophyma'. This is more common in men and generally rosacea has been present for many years.
Rosacea can be associated with redness and inflammation of the eyes and eyelids 'ocular rosacea'.
It is generally straightforward to diagnose rosacea, however it can be confused with several other conditions including facial eczema, seborrhoiec dermatitis, contact allergy, acne and lupus. Occasionally facial redness can be caused by an overlap of more than one condition, for example rosacea and eczema which requires careful tailoring of treatment.
I see many patients with rosacea, and in almost all cases it can be effectively treated. I will begin the consultation by asking you about how long the condition has been present, what triggers you have noticed and how it affecting your life. I will examine the skin carefully to ensure that the diagnosis is correct and to check that there are not co-existing causes for facial redness - such as eczema or acne.
Having established the diagnosis I will discuss the various treatment options with you. I will begin by reviewing your skin care routine. It is important to use a daily sun block and non-greasy moisturiser. Where possible you should avoid trigger factors.
Mild rosacea can often be controlled with topical treatments (creams, ointments and gels). I often use these in combination according to the appearance of the skin.
Where rosacea does not respond to topical treatments and particularly where there are papules (spots) or skin thickening tablet treatments can be very effective - often in combination with topical therapies. Occasionally patients need long term tablet treatment to supress rosacea.
Where the main symptom is flushing or redness, this can be controlled with either topical or tablet treatments.
Often facial redness will persist - due to the persistence of dilated blood vessels - even when rosacea has been treated. Laser and light treatments play an important role here. I find pulsed dye laser to be a safe and effective treatment and, if required, this can be started concurrently with other treatments.