What is rosacea?
Rosacea is a common disorder that causes facial skin and eye symptoms, typically the areas around the nose and inner cheek. Symptoms may flare up for weeks to months, presenting as persistent redness or flushing, with pus-filled bumps, thickened rough skin and telangiectasia (fine spider-like veins). Other individuals may complain of the swollen face and dry scaly skin. Eye involvement occurs in more than 50% of cases, with symptoms such as red eyes, irritation, photosensitivity and telangiectasia on the eyelid. Rosacea is diagnosed more frequently in women with fair skin and over 30 years old. It rarely occurs in children. Rosacea also occurs in populations with greater skin pigmentation but is not often diagnosed. There is no cure for rosacea, but the best rosacea treatment can help prevent permanent damage to the eyes and skin.
What is the cause of rosacea?
The exact cause and its development are still not fully understood. A few mechanisms have been proposed, such as an abnormal immune system, oversensitive blood vessels, microorganism and ultraviolet radiation from sun exposure. It may be genetic as individuals with a family history of rosacea are more likely to get the disorder.
How do you know if you have rosacea?
A clinical assessment of the signs and symptoms of your skin is usually sufficient for a dermatologist to diagnose rosacea. Skin biopsy is rarely done, and no blood work is needed. If you have eye symptoms, see an ophthalmologist for further evaluation.
How to treat rosacea?
At the moment, there is no cure. Treatment is mainly symptomatic relief and prevention. To prevent rosacea from flaring up, avoid potential triggers which include:
- Exposure to extreme temperatures and sunlight
- Hot drinks, spicy food, alcohol
- Exercise
- Medications or chemicals
- Feelings of anger or embarrassment
Proper skincare is crucial for individuals with rosacea because the skin is often dry, rough, scaly and oversensitive. Gentle skincare practices help to reduce symptoms.
Practice gentle skin cleansing. Despite sensitive skin, individuals with rosacea should clean their face at least once a day. Use lukewarm water and your fingers to wash gently. Avoid mechanical scrubbing. Choose cleansers that match the skin pH (around 4.0 to 6.5) because certain alkaline cleansers can be too strong for the skin.
Moisturise the skin. Individuals with rosacea are advised to apply moisturiser twice daily after cleansing. Use your fingers and apply it in an upward manner to “lock” the moisture in the skin. Emollients are also shown to repair and maintain skin integrity, improving skin symptoms.
Avoid potentially irritating skincare practices. Toners, astringents and exfoliating agents that contain alpha-hydroxy acids are usually harmless to normal skin but should be avoided if you have rosacea. Do not exfoliate your skin with rough sponges. Besides, it is better to use skincare products in the forms of foam, powder or cream. Choose cosmetics that can be easily removed.
Sun protection. It is recommended to apply sunblock daily, with a sun protection factor (SPF) of at least 30. Sunblock that is cream or lotion-based is more preferred over alcohol-based. Apply it after applying moisturiser. In Addition, avoid going out in the noon when the sun exposure is at its peak. If sun-exposure is not avoidable, wear sun-protective clothing like long-sleeves shirt and a hat. A pair of sunglasses are helpful to reduce light sensitivity. An additional benefit to wearing sunglasses is a delay in cataract by 10 years.
When individuals cannot achieve satisfactory improvement from lifestyle changes, medications are usually prescribed. Topical brimonidine and topical oxymetazoline act by constricting the blood vessels on the face, thus improving facial redness. However, there are side effects like redness, skin burning sensation and contact dermatitis. For skin with pus-filled bumps (pustules and papules), metronidazole, azelaic acid, topical ivermectin and sulfacetamide-sulfur are usually the drugs of choice.
Another intervention to treat rosacea, especially telangiectasia is the laser and intense pulsed light therapy. During treatment, light energy is absorbed by the haemoglobin, heating up the blood vessels, leading to coagulation. This clots up the fine spider-like veins, thus reducing telangiectasia.
