What is rosacea?
A large proportion of the patients I see have rosacea. This is a chronic condition with a large psychological impact. Rosacea is most commonly characterised by background redness (affecting the forehead, nose, cheeks, chin), some patients also experience spots/bumps in the centre portion of the face. Ongoing inflammation can lead to facial oedema and a feeling of dryness. Burning, stinging and flushing are also reported by people with rosacea.
What about rosacea in skin of colour?
Rosacea can be difficult to diagnose in skin of colour (SOC) or deeply pigmented skin, the reason for this is the widely recognised symptoms of ‘flushing’ or ‘redness’ look different in pigmented skin. Some of the symptoms are very similar.
What are the symptoms?
- Sensitive skin (i.e. sensitive or reacts easily to skincare products)
- Feelings of burning, stinging or hot/warm skin
- Feeling of dryness or oiliness in the skin
- Pus-filled spots/pimples (acne-like breakouts)
- Common triggers are sunlight, stress, anxiety, exercise, changes in temperature, spicy food or alcohol
- A severe presentation of rosacea is with ‘rhinophyma’ – this is where skin around the nose thickens and can cause changes to its shape
- Symptoms of itching, a burning or sore feeling, excessive tearing or dry eyes, feeling of grit in the eyes, sensitivity to light and ulceration in severe cases
With regards to SOC:
- SOC is more likely to look dusky or have a violet tone in deeply pigmented skin. Discoloration may develop in areas of inflammation
- There is a higher chance that there will be added issues like hyperpigmentation or changes to skin texture
- Skin can feel ‘swollen’ or ‘thick’, it may differ in texture from unaffected areas
- Skin coloured or yellow/brown bumps
What causes rosacea?
The root causes of rosacea are not fully understood. It is likely multifactorial and includes immune dysregulation, neurovascular changes, microbial imbalance and genetics. A study by the National Rosacea Society identified the following triggers: UV exposure (81%), emotional stress (79%), hot weather (75%), wind (57%), intense physical exercise (56%), alcohol consumption (52%), hot baths (51%), cold weather (46%), spicy foods (45%), humidity (44%), skincare products (41%), hot drinks (36%), cosmetics (27%), medicines (15%), and medical conditions (15%). Stress is also thought to play a role in causing or worsening facial flushing through the sympathetic nervous system response (i.e. preparing the body for ‘fight or flight’).
How common is it?
Rosacea is a common skin condition affecting about 10% of the population, however prevalence has been reported from 2% up to 22% in fair skinned populations. The global prevalence has been estimated at 5.46%.
Can rosacea affect my mental health?
Rosacea can be a psychologically devastating condition. Rosacea patients have an increased risk of developing depression and anxiety and tend to avoid socialising, other reported problems include social anxiety disorder and body dysmorphia. Low self-esteem, embarrassment and emotional distress are also reported. Psychological factors, such as stress and anxiety, aggravate flushing in rosacea, leading to a vicious circle. Patients report issues with lack of confidence, social isolation and reduced quality of life.
How do you treat rosacea?
Management of rosacea is complex, it is usually a combination of medical, skincare, lifestyle and psychological management. Although there are some differences in the signs of rosacea in SOC, the treatments are largely similar:
- Antibiotic creams
- Anti-parasitic creams – act against a commonly occurring mite on the skin (thought to cause or aggravate symptoms) and reduce inflammation
- Azelaic acid – reduces redness and inflammation
- Oral antibiotics – used at low doses as an anti-inflammatory
- Topical alpha agonist gel – narrows blood vessels to reduce redness temporarily
- Topical retinoids – can be used with caution as anti-inflammatories for the treatment of rosacea
If these do not lead to improvement, low dose oral retinoids are a long-term option, low-dose antihypertensives for flushing, as well as light-based therapies (e.g. pulsed dye laser or intense pulsed light) or laser.
Can skincare treat rosacea?
It is possible that a person with rosacea may not need prescribed products and can be managed with skincare only. It will depend on the severity of the rosacea and most importantly how much it affects the individual. I see many patients with rosacea, their treatment is usually on a spectrum ranging from no treatment to skincare only, to skincare + medical treatment, to medical treatment only. The type of rosacea and associated symptoms will typically dictate the treatment options.
Do you treat neurogenic rosacea?
People with neurogenic rosacea in my experience do respond to treatment but often require more of an individualised approach. This is definitely not a ‘one hat fits all’ treatment plan. It is also very possible that it will take some time before large improvements can be seen, but they certainly are possible.
Please see my blog to learn more about this under-recognised subtype of rosacea: All about Rosacea … and what you didn’t know about Neurogenic Rosacea (thepsychodermatologist.com)
If your skin is not improving or if you are having frequent flares, consider reviewing treatment with your dermatologist. It is always worth discussing the way your skin condition is making you feel and the impact it has on your life.