The Truth about Rosacea: 19 key Rosacea questions answered by an experienced dermatologist

Rosacea is a very common skin condition that causes redness and visible blood vessels on the face. I had the pleasure to chat with Fiona from the Harley Street Emporium in a Live Instagram session where we talked about Rosacea, its causes, its treatments and answered some of the most popular questions regarding this skin condition.

 

Check out all the questions we addressed during the Live Rosacea talk below.

 

1) To start what is the simple definition of Rosacea and what causes it?

Rosacea is a skin disease. We don’t know specifically what causes it. Various theories talk about its causes however nothing is proven. Rosacea is basically a skin disease that typically affects more commonly women between their thirties and fifties. It can also affect men as well however it is more common in women. It affects the face. The disease is manifested with very sensitive skin, flushing and extra vessels in the outer layer of the skin that are super sensitive to many triggers ( will be talked about later). It starts with flushing and it can progress to papular pustules, which are pimples that are pus-filled that are similar to acne. In very late stages, more commonly in men, it can cause changes in the nose structure and thickness of the nose skin.

2) Does Rosacea affect the eyes?

Yes, rosacea in any form can affect the eyes. When it affects the eyes, it is actually a very serious disease. It’s not just the dryness of the eyes. It actually affects the eyes with lid inflammation as well as affect the eye itself like the conjunctiva and even the cornea. If you start to see ocular changes you need to be referred to an ophthalmologist (an eye doctor).

If you only suffer ocular rosacea we will typically be referred directly to an ophthalmologist so a dermatologist will not be involved. Dermatologists get involved when the rosacea happens on the skin.

Ocular rosacea is very painful and very annoying to patients. Your eyelid becomes inflamed, you can get secretions on the lid, and may have a gritty sensation and burning in your eyes. Your eyes become very red and will feel quite painful.

 

3) What are the classifications of Rosacea on the skin?

Rosacea is classified into four subtypes that may overlap. 

  1. Erythematous Rosacea – patients, from an early age flush. When they take a hot shower or are embarrassed, go out in the sun or use some harsh topical products their skin will flush. It spares the skin around the eyes and affects the cheeks, forehead and nose. These casual flushings become more permanent. The telangiectasias and facial veins become more persistent. When patients get exposed to the triggers, the veins dilate, the blood flows in them and they flush even more making the patient feel the heat and hotness. But even when they don’t have these symptoms, they are still red.
  2. Papulopustular Rosacea – This is a later stage that appears very similar to acne pimples but the difference is that Rosacea pimples lack the blackheads and whiteheads. Which is a good sign to differentiate between it and acne.
  3. Glandular Rosacea – This type is more common in men with swelling, puffiness of the face, the lesions are bigger and it also starts affecting their nose. These patients don’t have a lot of flushing but they have those permanent changes on their face.

4) What are the causes of Rosacea?

Rosacea is a skin disease with unknown causes. It could be due to the person’s ethnicity ( Irish or Scandinavian origins).

 

5) Can Rosacea occur in Asian and darker skin coloured people or is it only known to affect people of an Anglo-Celtic background?

Rosacea can be seen in people of Asian and darker skin colour, however, because it is so rarer it can be misdiagnosed.

 

6) Why is Rosacea commonly misdiagnosed as Acne?

Because rosacea produces pimples on the face similar to those of acne (and it also affects the same areas), it can be misdiagnosed as acne. When misdiagnosed and treated as acne, the prescribed creams will sting and burn and cause the rosacea to worsen. That is why it’s essential to have any pimples checked by an experienced dermatologist.

 

7) What triggers and flares up Rosacea?

Heat for example from the oven, sun, alcohol consumption, spicy food and also stress.

 

8) A question from a woman who uses cleansers for Rosacea and she has oily skin but she says that she finds that the cleansers that are mild leave her skin feeling sticky. Would she be alright on something with a mild salicylic acid in it? Should she avoid cleansers that are glycerine based? What would be your advice?

Yes, she can use salicylic acid-based cleansers if she doesn’t have rosacea or eczema.

 

9) What type of skin products do you recommend to Rosacea patients?

There are some products formulated for rosacea-prone sensitive skin like the Bioderma SensiBio range of products and the EUCERIN sensitive skin anti-redness range.

 

10) What type of sunscreen is good for patients with Rosacea?

I recommend Eucerin sensitive protect SPF 50.

 

11) What prescriptions are used to treat Rosacea?

We use multiple topical  products such as

  • Metronidazole
  • Topical antibiotic
  • Ivermectin (anti-mite products)
  • Medications called tacrolimus and pimecrolimus
  • A recent medication that helps if they have flushing by shrinking their blood vessels is called Brimonidine nitrate. (https://en.wikipedia.org/wiki/Brimonidine)
  • Azelaic acid

Dermatologists also prescribe oral antibiotics in severe cases for 3 to 4 months. When the pimples calm down, we stop the oral and continue with topical treatment.

 

12) Is there any over the counter medication for Rosacea?

No, they are all prescription

 

13) Is Rosacea curable or do you have to continually use some maintenance treatments?

It does need maintenance treatment and avoidance of triggers and using sunscreen all the time, also treating the facial veins with IPL laser will help avoid flareups.

 

14) A question regarding the worsening of Rosacea during menopause. Can Rosacea be trigged by hormones?

It is not typically a disease of menopause and we see it more in premenopausal women.

 

15) Can you use antibiotic treatment for Rosacea multiple types a year?

Yes as needed.

 

16) What are the steps you might follow to get a patient’s skin normalised?

At Dermasurge Clinic, we have a special Rosacea Clinic dedicated to diagnosing and treatment Rosacea. The steps are simple – Diagnose, treat, using laser treatments to reduce redness, identifying and avoiding triggers as well as creating a maintenance programme. 

17) The role of dairy in Rosacea? Is there any kind of dietary triggers patient need to avoid?

Diary is implicated in acne, not rosacea, patients with rosacea should avoid spicy food and alcohol if they feel they worsen their condition

 

18) Would you recommend chemical peels for Rosacea?

 No, I wouldn’t recommend chemical peels for Rosacea.

 

19) What can be used to treat the inflammatory component of Rosacea?

Topical and oral antibiotics, Isotretinoin, and prescription creams

 

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