Rosacea: Symptoms, causes and prevention

While a subtle, rosy glow to the cheeks lights up a face and reflects good health and inner radiance, the persistent ruddiness experienced by more than 3 million Canadians with chronic rosacea is not the glow they’re looking for. Typically affecting fair-skinned individuals over the age of 30, and more prevalent in women than men, this chronic inflammatory dermatitis is underdiagnosed, causes significant discomfort and is often mistakenly associated with alcoholism.

People who suffer from rosacea feel the effects both physically and emotionally; nearly 75 percent of people who have rosacea report that it has a negative impact on their self-esteem and on their careers. While there is no cure, the good news is that there are new developments in treatment for this skin condition.

What are the signs and symptoms of rosacea?

The first signs of rosacea often appear in adulthood, typically between the ages of 30 and 50. At first, the symptoms may be intermittent, with periodic redness and a burning sensation in the face. Over time, the redness becomes more permanent and dryness of the skin typically follows.

There are four subtypes of rosacea, the severity of which may be variable:

  1. Erythemato-telangiectatic rosacea (often called “couperose”), which is characterized by permanent redness and dilated blood vessels
  2. Papulo-pustular rosacea (or acne rosacea), characterized by lesions similar to acne
  3. Phymatous rosacea, a rare form of rosacea characterized by thickening of the skin
  4. Ocular rosacea, which involves the eyelids and/or conjunctiva, typically causing burning and itchy eyes and often accompanied by rosacea of the skin

What causes rosacea?

The origins and causes of rosacea are only partially understood — rosacea is a complex disease and active subject of scientific research — but we know that it is caused in part by a genetic predisposition. This can lead to a defective skin barrier and a complex inflammatory cascade involving several naturally occurring skin micro-organisms.

Rosacea is not caused by alcoholism — a common and unfair misconception. Alcohol is, however, one of many triggers that can prompt or aggravate rosacea flare-ups in some patients (other triggers include sunlight, heat and environmental stress).

Is there a cure?

There is no cure for rosacea; however, several effective measures for both rosacea prevention and treatment exist. If you have rosacea, dermatologists recommend gentle skin care with an emphasis on year-round sun protection and avoidance of possible triggers such as stress, exposure to extreme temperatures (hot or cold), spicy foods, coffee, alcoholic beverages and very hot drinks. The impact of these lifestyle factors on rosacea vary from person to person.

Many topical cosmetic products that aid in rosacea management are available over the counter. Mild, fragrance-free and alcohol-free skin products are recommended for rosacea sufferers, and products with abrasive or skin-irritating ingredients should be avoided. For redness concealment, choose a green-tinted foundation for the affected areas and layer a skin tone-matching product on top. Hypoallergenic make-up is recommended.

It is important to keep the skin well moisturized, especially in the more extreme cold and hot months. Since sun exposure can worsen its symptoms, rosacea sufferers should use a broad-spectrum sunscreen with an SPF of 30 or more on a daily basis. Stress management and a healthy, balanced diet also play a role in preventing rosacea flare-ups.

Effective medical treatments for rosacea include:

  • Topical treatments (ivermectin, metronidazole, azelaic acid and brimonidine)
  • Oral treatments (antibiotics of the tetracycline family, isotretinoin)
  • Laser therapies

The once-a-day topical treatment Brimonidine (Onreltea) is a potent vasoconstrictor and temporarily reverses the redness caused by dilated blood vessels. The conventional topical therapies, metronidazole and azelaic acid, do reduce redness to a degree, although their main role is reducing acnelike skin lesions. Oral tetracyclines have been another cornerstone of treatment primarily used to treat the lesions. They are antibiotics but are thought to work via an anti-inflammatory mechanism.

To avoid disruption of the gut flora or contribution to global antibiotic resistance, they can be given at sub-antimicrobial doses (for example, Doxycyline is used at the sub-antimicrobial dose of 40 mg instead of the usual antibiotic dose of 100 mg). While the new Bimonidine is expected to be an important weapon in the arsenal against rosacea, energy-based treatments such as vascular laser and Intense Pulsed Light (IPL) are the most powerful methods for common forms of rosacea. This method treats the telangiectasia (tiny spider veins), which the conventional methods cannot, and also reduces background redness. Repeated treatments are required for optimal improvement.

Think you may have rosacea? Have questions or concerns about your previously diagnosed rosacea? Consult with a virtual care provider with Medisys On-Demand if you’re suffering from any skin condition, including rosacea.