Rosacea

Rosacea is a skin condition causing inflammation of parts of the face. Typically it starts as a redness affecting the nose and cheeks. The redness may spread to other parts of the face and acne-like spots may appear. About 1 in 10 people in the UK develop rosacea, usually in middle or later life. Most people are treated effectively with antibiotics. Some people develop complications that may need specialist treatment.

What causes rosacea?

The cause of rosacea is unclear. Although treated with antibiotics, no bacterium (germ) has been proved to cause rosacea. A germ called demodex follicularum found on the skin may be involved. Immune reactions in the skin (possibly to this germ) may play a part. Damage from sunlight may have some part to play but this is not clear. Rosacea is more common in fair skinned people. Women are more commonly affected than men but why this is so is not clear.

What are the symptoms of rosacea?

Symptoms may first appear in the early twenties but often do not start till middle life. Frequent flushing of the face and blushing may be the first signs. In time, a redness may persist over the nose and cheeks. The redness may spread to other parts of the face. A redness of parts of the face is all that most people with rosacea develop. However, lumpy red spots (papules) and small cysts (pustules) may appear on the face in some people. These tend to come and go at first. The spots and cysts look similar to acne. However, unlike acne, rosacea usually affects people older than thirty and usually affects the area around the nose and cheeks rather than the outer parts of the face. Tiny blood vessels under the skin (telangiectasia) sometimes become quite prominent on the face. Rosacea is not usually painful or itchy. Rarely there may be a burning pain over the reddened skin. You do not usually feel ill with rosacea and serious complications are uncommon. However, rosacea can be unsightly.

What can I do about rosacea?

There is little you can do to prevent rosacea from starting. However, some things may aggravate the skin and make the flushing worse. These include: alcoholic drinks, some fruits and vegetables, spicy foods, chocolate, strong winds, strong sunlight, oil-based make-up, scented soaps and alcohol based skin cleansers. If any of these seem to aggravate the flushing then avoiding them seems sensible.

Sunlight - avoid strong sunlight. A sunblock cream with a high protection factor (15 or higher and with UVA and B protection) should be used on the face when out in strong sunlight. A wide brimmed hat would also help to protect the face from the sun.

What are the treatments for rosacea?

• Antibiotic tablets are the common treatment. They usually work well, but it is not clear why they work as there is no proven germ causing rosacea. Some antibiotics reduce inflammation in the skin as well as kill germs and this may contribute to their effect. Some improvement may be noticed after 2-3 weeks of treatment but it commonly takes a 6-12 week course of antibiotics to work well. Antibiotics will usually clear any spots and cysts but may not completely clear the redness on the face. They will usually prevent eye complications and rhinophyma if taken before these develop (see below). A common reason why antibiotic treatment may appear to fail is that some people give up taking the tablets after a few weeks without completing the full course. A 6-12 week course of antibiotics every now and then may be required to keep the condition away. Once a course of antibiotics has worked, some people take a reduced 'maintenance' dose of an antibiotic for months or years to keep rosacea from recurring.
• Topical ('rub on') antibiotic is an alternative treatment for mild rosacea or if side effects from tablets are troublesome.

Are there any complications of rosacea?

• Rhinophyma - this is an excessive involvement of the nose causing an unsightly bumpy nose. This is uncommon. Treatment of rosacea early will usually prevent this. Surgical or laser treatment is usually effective if a rhinophyma develops.
• Eye complications - people with rosacea quite commonly develop an inflammation of the eyelids (blepharitis) and/or conjunctiva (conjunctivitis). These are not usually serious. A serious inflammation of the cornea (the front of the eye) rarely develops which, if left untreated, can scar the cornea and affect sight. Tell a doctor if eye symptoms develop. Eye problems are unlikely to develop in people taking antibiotic tablets for rosacea. Treatment with steroid eye drops is usually effective if eye inflammation does occur.
• Telangeiectasia (tiny blood vessels under the skin) - sometimes become quite prominent on the face. They can be treated with laser or electical cautery if such specialist equipment is available.

Further help and advice

The Acne and Rosacea Support Group, 1st Floor, Howard House, The Runway, South Ruislip, Middlesex, HA4 6SE
Tel: 0870 870 2263 Web: www.m2w3.com/acne/
Provides independent information and advice to people affected by acne or rosacea.