The Red Face of Rosacea

One of the commonest inflammatory disorders, it spares no-one, from famous comedians (WC Fields) to world-leaders (see left), frequently chronic…..and is the cause of tremendous distress and embarrassment on a day-to-day basis. It’s commonest in those between 30 and 6o and typically affects us light-skinned Celts. It can be surprisingly tricky to eliminate altogether, but with a few simple tips, should become a lot easier to handle.

The earliest signs are often subtle-a tendency to a prolonged blush after a hot drink or spicy food; this may then progress to the erythemo-telangectatic phase, with fixed central facial redness, typically on the nose and cheeks that doesn’t go away. Acne-like lesions with red spots and white-headed pustules may be superimposed upon this-but what is distinct about rosacea as opposed to ordinary acne, is the absence of blocked pores or comedones. Also the inflammatory spots themselves are often dome-shaped, rather than ‘pointy’ (if that doesn’t sound daft!), which is what you typically see with whiteheads in acne.The sebaceous glands of the nose and chin may over-grow, resulting in a condition called rhinophyma-but this is more common in men. Finally, a symptom that is often overlooked is that of dry,gritty, red eyes, which may be part of the disorder-ocular rosacea. It can affect as many as 1 in2 patients so is an important aspect of the condition.

The exact cause of rosacea is unknown but we know genetics are important, and the trigger may well be immunological, possibly due to over-production of a protein involved in protecting us against bacteria called cathelicidins. Topical steroid use on the face (for conditions like eczema) can also trigger rosacea, and given that redness is also a feature of this condition, can make diagnosis challenging.

I think one of the most important aspects of managing rosacea is knowing what to avoid and using the right type of skincare, something busy physicians often forget to discuss. Know your dietary triggers, be very cautious about sun exposure and take care with environmental extremes of temperature like saunas. Certain ingredients like alcohol will often sting, due to a defect in the barrier function of skin afflicted by rosacea; similarly, oil-free, water-based cosmetics and sunscreens are better tolerated. Cetaphil Gentle  Cleanser and Moisturising Lotion (which are non-comedogenic) are generally well-tolerated and soothing. I also find patients like Avene and Eucerin’s anti-redness ranges.

Medically, oral anti-inflammatory agents like Efracea (which is a low-dose of Doxyxcycline, avoiding its anti-bacterial effect) and Finacea (15% azelaic acid) tend to be effective at managing the ‘spotty’ aspect of the disease. Treatment is usually needed for 8-12 weeks, sometimes longer. Finally, for persistent redness and broken capillaries, light sources like IPL are invaluable (and really the only sucessful option for this aspect of the disease).

As with most inflammatory skin problems affecting the face, unpredictability is one of the most vexing aspects of this condition-so know your triggers, avoid irritants like aggressive scrubs and astringents, use gentle skincare/broad-spectrum sun protection and medicate when needed….life should get a little less testing.

  1. Thanks for sharing such a pleasant opinion, piece of writing is
    pleasant, thats why i have read it completely

  2. Dr Sam, Tremendous article on this increasingly common condition. Excellent.

    One question I have concerns treating a sudden inflammatory spotty rosacea breakout before a social occasion or event for example – what would you tend to recommend other than topical steroids?

    • So glad you enjoyed it. Now, I would never use topical steroids in the context of rosacea. They can exacerbate or even trigger the condition. I would utilise a topical azelaic acid-based preparation. Epionce is a skincare system that uses this and can be helpful. On prescription, Finacea works well. But unfortunately I don’t think there are any overnight solutions. Long-term stabilisation through a good maintenance regime is key.
      Dr Sam

  3. Hello, I enjoy reading through your article. I
    like to write a little comment to support you.

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