Rosacea is an inflammatory facial skin disease characterised by flushing, redness, papules (small firm lumps), pustules and telangiectasia (visible dilated blood vessels). Here are some facts about Rosacea:

• Rash affects the nose, cheeks, forehead and chin
• Women mainly affected, age 30-60, with fair skin
• Often starts with temporary facial flushing generally progresses to more obvious permanent redness and swelling
• Early diagnosis and treatment can prevent progression and permanent skin changes
• Multiple triggers exacerbate condition – sunlight, hot weather, hot drinks, spicy food, alcohol, stress and some medications.
• Diagnosis requires at least one of the following primary features:
  • Transient redness (flushing)
  • Non-transient redness
  • Telangiectasia
  • Papules or pustules

Secondary features of Rosacea are:

• Scaly, rough, dry skin
• Burning/ stinging sensitive skin
• Oedema
• Phymatous changes (thickened, nodular skin often on nose)
• Inflammation of eyelid and eye

Cause unknown but there is evidence of:

• Overactive immune response with high levels of antimicrobial peptides, cathelicidins, which are inflammatory
• Increased counts of the common skin bacteria – Staph epidermidis and of the hair follicle mite, Demodex folliculorum. These organisms stimulate skin pathogen receptors which increase inflammation
• UVR worsens symptoms of rosacea due to its pro-inflammatory effects

Treatment:

• Avoiding triggers and protecting facial skin are important, particularly as most of the pharmacological treatments for rosacea are unsubsidised or unapproved.

Non pharmacological

• Avoid hot showers, hot drinks, spicy foods, alcohol
• Use non-greasy moisturisers and make-up
• Use a light zinc based sunscreen everyday, like Dermaquest Sheer Zinc SPF 30
• For mild rosacea the addition of an anti-redness serum should be considered, like Aspect Dr Redless Serum
• For persistent red veins can usually be improved with vascular laser treatment
• Warm compresses and massage to affected eyelids and preservative free ocular lubricants to dry eyes
• Surgery often required for phymatous disfigured noses

Pharmacological Treatments

Topical Treatments

• Topical Treatments should be trialled first
• Metronidazole cream (antibiotic cream with anti-inflammatory properties) – applied twice daily for 3-4 months. An improvement in symptoms can be expected in 3-6 weeks and remission may last for 6 months

Oral Treatments

• Oral antibiotics particularly tetracyclines are approved and partially subsidised. They are used to reduce the papules, pustules and eye symptoms of rosacea due to their anti-inflammatory effects. Tetracyclines at lower doses than required for antimicrobial treatment are often very effective eg doxycycline 50mg daily for6-12 weeks
•  Medicines to reduce flushing are unapproved but can be helpful eg carvedilol and clonidine.