Rosacea: symptoms and treatment of common skin condition
Rosacea is a skin condition affecting the face. It is really common - an estimated one in 10 New Zealanders will develop rosacea at some point in their lives. Although not life-threatening, rosacea can be extremely distressing for sufferers, especially in more severe cases.
The symptoms of rosacea tend to come and go, with flare-ups commonly followed by periods where the skin is much clearer.
The symptoms vary between individuals but can include: Periodic redness or flushing of the skin.
Raised red spots or bumps on the skin, especially around the forehead, eyes, cheeks and nose.
Dryness of the skin.
Visible tiny blood vessels, known as telangiectasia, especially over the cheeks and nose.
Thickening of the skin, which in extreme cases leads to a bumpy, bulbous nose known as rhinophyma
Eye symptoms - most commonly dry eyes, inflamed eyelids (blepharitis), and a sensation of burning or stinging eyes; occasionally rosacea can cause inflammation and infection of the cornea of the eye, a potentially serious problem - so if you have disturbance of your vision or pain in your eye, seek urgent advice.
The exact cause of rosacea is not known, but it is very likely to be due to a combination of environmental and genetic factors. We do know that the following people are more likely to get rosacea:
Women, although men seem to suffer more severe symptoms
Thirty-60 years old, although occasionally it will appear in younger people.
People with a history of rosacea in their family.
Flare-ups of rosacea can be triggered by many things. Working out the trigger for you is the first step in managing your symptoms. Triggers might include:
Extremes of temperature.
Saunas or hot baths.
Vasodilators - a group of drugs, including some blood pressure medication, that dilate the blood vessels in the skin.
Once you have worked out what is exacerbating your rosacea, avoiding it may be all you need to do to get relief. However, if that's not enough, discuss with your doctor other possible treatments. It is not possible to "cure" rosacea and make it disappear completely, but there are several options for managing your symptoms.
Use a strong sunblock at all times of year.
Keep the skin on your face moisturised with a hypoallergenic, non-perfumed emollient, such as aqueous cream. This will reduce inflammation and help ease your symptoms. Your doctor can prescribe this for you, which is a significantly cheaper option.
Eye symptoms can be bothersome, but using artificial tears or lubricants will help.
Antibiotics are the mainstay of rosacea treatment, although their mechanism of action in this condition is poorly understood. They are used either in topical form, typically as metronidazole gel or cream, or as oral tablets. Unfortunately, the use of topical antibiotics does bring with it significant long-term risk of antibiotic resistance, so I tend to avoid it where possible and encourage the use of oral tablets instead. The most commonly used oral antibiotics for rosacea are tetracyclines, such as minocycline or doxycycline, and erythromycin. These treatments do require a degree of patience as a course of 12 weeks or longer is often required to achieve good relief from symptoms. It is likely that you will need to repeat the treatment at some stage, as symptoms do tend to recur.
If antibiotics haven't worked, a dermatologist may recommend a trial of an acne medication called isotretinoin. This potent drug, not without side-effects, can be effective in more resistant cases.
Cathy Stephenson is a general practitioner and medical forensic examiner. If you have a question or topic for her, write c/o Features Editor, the Dominion Post, PO Box 3740, Wellington 6140, or email firstname.lastname@example.org
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