Rosacea is a chronic rash involving the central face that most often affects those aged 30 to 60. It is common in those with fair skin, blue eyes and Celtic origins. It may be transient, recurrent or persistent and is characterised by its colour, red.
Rosacea results in red lumps that look like red pimples but there are no blackheads, whiteheads or nodules. Rosacea may also result in flat red areas, scaling and swelling.
Characteristics of rosacea include:
- Frequent blushing
- A red face due to persistent redness and/or prominent blood vessels – telangiectasia
- Red papules and pustules on the nose, forehead, cheeks and chin
- Dry and flaky facial skin
- Aggravation by sun exposure, exercise and hot and spicy food or drink (anything that reddens the face)
- Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreen and other facial creams
- Red, sore or gritty eyelids including papules and styes, and sore or tired eyes
- Enlarged unshapely nose with prominent pores and fibrous thickening
- Where possible, reduce factors causing facial flushing.
- Avoid oil-based facial creams. Use water-based make-up.
- Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).
- Protect yourself from the sun. Use light oil-free facial sunscreens.
- Keep your face cool to reduce flushing: minimise your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.
- Some people find they can reduce facial redness for short periods by holding an ice block in their mouth, between the gum and cheek
Oral antibiotics for rosacea
Tetracycline antibiotics including doxycycline and minocycline reduce inflammation. They reduce the redness, papules, pustules and eye symptoms of rosacea. The antibiotics are usually prescribed for 6 to 12 weeks, with the duration and dose depending on the severity of the rosacea. Further courses are often needed from time to time, as the antibiotics don't cure the disorder.
Anti-inflammatory effects of antibiotics are under investigation. They have been shown to inhibit MMP function and in turn reduce cathelicidins and inflammation. The effective dose of tetracyclines in rosacea is lower than that required to kill bacteria, so they are not working through their antimicrobial function.
Disadvantages of longterm antibiotics include development of bacterial resistance, so low doses (eg 40-50mg doxycycline daily) that do not have antimicrobial effects are preferable.
Topical treatment of rosacea
Metronidazole cream or gel can be used intermittently or long-term on its own for mild inflammatory rosacea and in combination with oral antibiotics for more severe cases. Ivermectin is another prescription cream that can help with certain types of rosacea.
Persistent telangiectasia can be successfully improved with vascular laser or intense pulsed light treatment. Where these are unavailable, cautery, diathermy (electrosurgery) or sclerotherapy (strong saline injections) may be helpful.