We hope the following in depth article regarding rosacea provides you with enough information to make an educated choice on how best to treat this skin condition. Please always seek advice from your doctor before undertaking any treatment.
The information below is for educational purposes only. We do not advocate the use of any products recommended in this article, and we are firmly against products containing artificial ingredients, those which are tested on animals, and those produced by companies who still carry out animal testing outside of the EU.
What Is Rosacea?
Rosacea is a chronic skin disease that affects more than forty million people worldwide. According to western medicine the cause of rosacea is still unknown, and there is no cure. However, research has allowed doctors to develop a course of treatment that effectively controls rosacea by minimizing its symptoms.
There are four subtypes of rosacea. Each subtype has its own set of symptoms. It is possible to have more than one subtype of rosacea at a time.
Rosacea’s trademark are small, red, pus-filled bumps on the skin that are present during flare-ups. Typically, rosacea affects only skin on your nose, cheeks, and forehead.
Flare-ups often occur in cycles. This means that you will experience symptoms for weeks or months at a time, the symptoms will go away, and then they will return.
Types of Rosacea
Subtype one, known as erythematotelangiectatic rosacea (ETR), is associated with facial redness, flushing, and visible blood vessels.
Subtype two, papulopustular (or acne) rosacea, is associated with acne-like breakouts and often affects middle-aged women.
Subtype three, known as rhinophyma, is a rare form that is associated with thickening of the skin of your nose. It usually affects men and is often accompanied by another subtype of rosacea.
Subtype four is ocular rosacea, and its symptoms are centered on the eye area.
Symptoms of Rosacea
Rosacea symptoms are different between each subtype.
Signs of rosacea ETR:
- flushing and redness in the center of your face
- visible broken blood vessels
- swollen skin
- sensitive skin
- stinging and burning skin
- dry, rough, and scaly skin
Signs of acne rosacea:
- acne-like breakouts and very red skin
- oily skin
- sensitive skin
- broken blood vessels that are visible
- raised patches of skin
Signs of thickening skin:
- bumpy skin texture
- thick skin on nose
- thick skin on chin, forehead, cheeks, and ears
- large pores
- visible broken blood vessels
Signs of ocular rosacea:
- bloodshot and watery eyes
- eyes that feel gritty
- burning or stinging sensation in the eyes
- dry, itchy eyes
- eyes that are sensitive to light
- cysts on eyes
- diminished vision
- broken blood vessels on eyelids
What Causes Rosacea?
According to western medicine the cause of rosacea has not been fully determined. It may be a combination of hereditary and environmental factors. It is known that some things may make your rosacea symptoms worse. These include:
- eating spicy foods
- drinking alcoholic beverages
- having the intestinal bacteria Helicobacter pylori
- a skin mite called demodex and the bacterium it carries, Bacillus oleronius
- the presence of cathelicidin (a protein that protects the skin from infection)
Risk Factors for Rosacea
There are some factors that will make you more likely to develop rosacea than others. Rosacea often develops in people between the ages of 30 and 50. It is also more common in people who are fair-skinned and have blond hair and blue eyes.
There are also genetic links to rosacea. You are more likely to develop rosacea if you have a family history of the condition or if you have Celtic or Scandinavian ancestors. Women are also more likely to develop the condition than men. However, men who develop the condition often have more severe symptoms.
How Do I Know if I Have Rosacea?
Your doctor can easily diagnose rosacea from a physical examination of your skin. They may refer you to a dermatologist who can determine whether you have rosacea or another skin condition.
How Can I Control My Symptoms?
According to western medicine rosacea cannot be cured, but you can take steps to control your symptoms.
Make sure to take care of your skin using gentle cleansers.
Avoid products that contain:
- menthol
- exfoliating agents
These ingredients may irritate your symptoms.
Your doctor will work with you to develop a treatment plan. This is usually a regimen of antibiotic creams and oral antibiotics.
Keep a journal of the foods you eat and the cosmetics you put on your skin. This will help you figure out what makes your symptoms worse.
Other management steps include:
- avoiding direct sunlight and wearing sunscreen
- avoiding drinking alcohol
- using lasers and light treatment to help with some severe cases of rosacea
- microdermabrasion treatments to reduce thickening skin
- taking eye medicines and antibiotics for ocular rosacea
Self-help measures
There are a number of things you can do yourself to help keep the symptoms of rosacea under control, including:
- avoiding things that trigger your symptoms– for example, by using sun cream and covering yourself up if direct sunlight makes your symptoms worse
- taking good care of your skin– for example, by using products suitable for sensitive skin
- using make-up– patches of persistent red skin can be disguised using specially designed camouflage make-up
- keeping your eyelids clean– if rosacea is causing your eyelids to become inflamed (blepharitis)
Read about self-help measures for rosacea.
Treating papules and pustules
If you have round red bumps that rise from your skin (papules) and pus-filled swellings (pustules) caused by rosacea, there are a number of different medications that can be effective.
These can be divided into topical treatments that are applied to the skin, or oral treatments, which are taken by mouth.
Topical treatments
Topical medications are usually prescribed first. These include:
- metronidazole cream or gel
- azelaic acid cream or gel
- ivermectin cream
Ivermectin is a relatively new medicine. There’s some evidence to suggest it may be more effective and perhaps less irritating to the skin than metronidazole, although it’s not currently available on the NHS everywhere and may only be recommended if the other treatments don’t work.
You’ll usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms.
Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin.
Natural creams containing tea tree oil and other botanical ingredients and essential oils can provide significant relief from these symptoms and can cure them. Tea tree oil has been clinically proven to kill demodex mites, which are now thought to cause rosacea in a high number of sufferers. When demodex mites die, they decompose inside of your skin and cause infection. Some people react to this more than others and it may be that you are one of these people.
Oral antibiotics
If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduce inflammation of the skin.
Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin.
These medications are usually taken for four to six weeks, but longer courses may be necessary if the spots are persistent.
For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term.
Common side effects of these medications include:
- feeling and being sick
- diarrhoea
- bloating and indigestion
- tummy (abdominal) pain
- loss of appetite
Some of the medications used can also make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds.
As with the topical treatments mentioned above, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.
Oral isotretinoin
Isotretinoin is a medicine often used to treat severe acne, but at lower doses it’s also occasionally used to treat rosacea.
As isotretinoin is a strong medication that can cause a range of side effects, it can only be prescribed by a specialist in treating skin conditions (dermatologist) and not your GP.
Common side effects of isotretinoin include:
- dryness and cracking of the skin, lips and nostrils
- inflammation of your eyelids (blepharitis) or eyes (conjunctivitis)
- headaches
- muscle or joint pain
- back pain
- blood in your urine (haematuria)
- mood changes
Isotretinion can also cause birth defects if taken during pregnancy.
Treating facial redness
Treating facial redness and flushing caused by rosacea is generally more difficult than treating papules and pustules caused by the condition.
But as well as the self-help measures mentioned above, there are some medications that can help.
Natural topically applied skin creams
Natural creams containing tea tree oil and other botanical ingredients and essential oils can provide significant relief from these symptoms and can cure them. Tea tree oil has been clinically proven to kill demodex mites, which are now thought to cause rosacea in a high number of sufferers. When demodex mites die, they decompose inside of your skin and cause infection. Some people react to this more than others and it may be that you are one of these people.
Brimonidine tartrate
Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of a gel that’s applied to the face once a day.
The medication works by restricting the widening (dilation) of the blood vessels in your face. Research has shown it can start to have an effect about 30 minutes after it’s first used, and this can last for around 12 hours.
Common side effects of brimonidine tartrate include itchiness and a burning sensation where the gel is applied.
Less common side effects can include:
- a dry mouth
- headaches
- pins and needles
- dry skin
A rebound effect, where flushing becomes worse, has also been reported with this medication.
Oral treatments
Alternatively, there are a number of oral medications that may help improve redness caused by rosacea.
These include:
- clonidine – a medication that relaxes the blood vessels
- beta-blockers– medications that decrease the activity of the heart
- anxiety medications – medications sometimes used to help calm the person and reduce blushing
It’s not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist.
Laser and intense pulsed light (IPL) treatment
Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing.
A referral to a dermatologist is usually required before having these treatments and they’re not usually available on the NHS, so you may need to pay for them privately. Around two to four treatments may be needed, so the overall cost may be significant.
Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so they’re no longer visible, with minimal scarring or damage to the surrounding area.
Laser treatment can cause pain, but most people don’t need an anaesthetic. Side effects of laser treatment are usually mild and can include:
- bruising
- crusting of the skin
- swelling and redness of the skin
- blisters(in rare cases)
- infection (in very rare cases)
These side effects usually only last a few days and are rarely permanent.
Treating thickened skin
In some people with rosacea the skin of the nose can become thickened. This is known as rhinophyma.
If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon to discuss ways the appearance of your skin can be improved.
A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape.
This may be done with a laser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion.
Natural creams containing tea tree oil and other botanical ingredients and essential oils can reduce skin thickness. As the old thickened, rosacea affected skin sheds away, this can reveal smoother, healthier skin. Aloe Vera Extract contains salicylic acid which removes dead skin cells and dissolves them unblocking pores.Simply put, salicylic acid aids in the process of exfoliation by eliminating surface skin cells and opening up pores.Tea tree oil has been clinically proven to kill demodex mites, which are now thought to cause rosacea in a high number of sufferers. When demodex mites die, they decompose inside of your skin and cause infection. Some people react to this more than others and it may be that you are one of these people.
Treating eye problems
If rosacea is affecting your eyes (ocular rosacea), you may require further treatment.
For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis.
If initial treatment isn’t effective or you develop any further problems with your eyes, you’ll need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment.
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The videos below are for educational purposes only. We do not advocate the use of any products recommended in the videos, and we are firmly against products containing artificial ingredients, those which are tested on animals, and those produced by companies who still carry out animal testing outside of the EU. Nonetheless, we feel these video’s may still prove beneficial to rosacea sufferers, and provide some valuable information.
