Rosacea – The Facts

By October 31, 2016Education

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


  • 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.