Rosacea symptoms, triggers, and effective treatments explained

Rosacea is a common skin condition that can have a significant impact on a person’s confidence and quality of life.

Dr Stephanie Jane Arnold, renowned dermatologist, provides an expert insight into rosacea, answering questions about its symptoms, triggers, and treatment options.

What is rosacea?

Rosacea is a chronic skin condition that causes persistent redness, visible blood vessels, and occasionally small, acne-like bumps. It most commonly appears on the cheeks, nose, chin and forehead, but it can also affect the eyes in some cases.

Common signs and symptoms of rosacea include:

• persistent facial redness
• small, red bumps or pustules that resemble acne
• visible blood vessels
• easy flushing or blushing
• dry or sensitive skin
• thickened skin, particularly around the nose

Is rosacea genetic?

The exact cause of rosacea is still unclear, but it’s thought to result from a combination of genetic and environmental factors. Rosacea mainly affects adults between the ages of 30 and 50 and is more common in people with fair skin, particularly those of Northern European heritage. People with a family history of rosacea are at a higher risk of developing the condition themselves.

What can trigger rosacea flare-ups?

Rosacea symptoms tend to be intermittent, with periods of remission and flare-ups. Some patients find that the redness becomes more permanent as time goes on. Here are some of the most common factors that can provoke a flare-up, although they don't affect every patient all the time:

• Environmental conditions: Sun exposure, temperature extremes, humidity.
• Dietary triggers: Spicy foods, alcohol, hot beverages.
• Emotional factors: Stress, high levels of anxiety, embarrassment, frustration.
• Skincare products: Products containing alcohol, fragrances or astringents; 'anti-ageing' or 'anti-acne' products. Many patients with rosacea report having 'sensitive' skin that seems to react to any new product applied to the skin.

How is rosacea diagnosed and treated?

The diagnosis of rosacea is done by a specialist, such as a dermatologist, who will evaluate the patient’s skin and ask about their symptoms and medical history. A physical examination is usually sufficient. During the process, the dermatologist may rule out other skin conditions, such as acne, eczema, lupus, or sun damage, which can sometimes present similar symptoms.

Although there is no cure for rosacea, its symptoms can be effectively managed with various treatments. Treatment plans are personalised to address the individual needs of each patient.

What can I do to help myself?

It is important to use very gentle products on the facial skin. Many patients with rosacea wash only with water, or a non-foaming gentle cream cleanser. A bland, non-fragranced moisturiser should be used once a day to calm down irritation caused by skin dryness.

One of the most helpful things you can do to reduce the symptoms of rosacea is to wear a broad-spectrum sunscreen every day (even on cloudy days). 'Mineral-based' sunscreens (those containing zinc dioxide or titanium dioxide) are often gentler for rosacea-prone skin, compared to 'chemical' sunscreens, which can sometimes cause irritation. Look for a sunscreen that is SPF30+ and broad spectrum. Apply every day, even in winter. Reapply every 2-4 hours if you are outside and don't forget to wear a hat and sunglasses!

There are types of foundations / concealers that have a greenish tint to help reduce the appearance of redness, and many sunscreens now come in tinted formulations that can also help.

Topical medications are often the first-line-treatment for managing rosacea. Commonly-prescribed topical medications include Metronidazole, Azelaic acid, and Ivermectin. These creams and gels are applied directly to the whole area (not just the spots, for example) to reduce redness and inflammation.

Brimonidine cream is another prescription medication that can help reduce the redness associated with rosacea for short periods of time, for example if needed for social events.

For more severe cases, the dermatologist may recommend oral medications. These include antibiotics and low-dose isotretinoin.

Lastly, for patients with visible blood vessels, laser therapy or intense pulsed light treatment can be an effective option. These treatments work by targeting and shrinking the blood vessels, reducing redness and improving the appearance of the skin.

Can rosacea change over time?

Yes, rosacea can change over time, and without treatment, it may worsen. The condition typically starts with episodes of flushing or blushing, but if left untreated, it can progress to more persistent redness and more easily visible blood vessels.

Not all patients with flushing and blushing go on to develop the more severe forms of rosacea where there are inflammatory bumps, pustules or thickening of the skin.

Similarly, many patients find that simple measures such as wearing sunscreen and reducing exposure to triggers, keeps their condition under good control.

Consistent treatment is key to preventing rosacea from progressing. Equally, daily application of broad-spectrum sunscreen with an SPF of 30 or higher is also essential for protecting the skin from UV radiation.

If you would like to book an appointment with Dr Stephanie Jane Arnold, head on over to her Top Doctors profile today.