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This month we are going to delve deeper into an inflammatory skin condition that we see a lot of in our clinic in Canberra: Rosacea.
Rosacea presents itself in different ways and affects people generally after the age of 30. The chronic skin disorder usually affects the central aspects of the face (cheeks, nose, chin and forehead). It presents itself in numerous ways with clinical features including flushing, persistent redness, telangiectasia (capillaries), papules (small raised lesions), hypertrophy, and ocular issues. Many patients suffer from invisible symptoms as well such as burning, warmth and stinging.
There are four subcategories of rosacea, some people suffer with one subtype whilst others may have a combination of two or more. There is an incomplete understanding to the cause of this skin condition. Studies have shown that the main factors involved in the development of rosacea include the immune system, microbes and the cathelicidin axis, neurovascular processes and inflammation in the nervous system, and genetics. With the destruction of the skin’s barrier (stratum corneum) sensitivity is often seen regularly in patients with rosacea (Deng et al., 2022; Wang et al., 2022; Schaller et al., 2021; Ozturk et al., 2022; Noguera-Morel et al., 2021).
The four subcategories of rosacea include:
Erythematous Rosacea: centralised redness, flushing and telangiectasia (capillaries).
Papulopustular rosacea: same presentation as erythematous but also presents with raised lesions such as papules and pustules.
Phymatous Rosacea: thickening of the skin and enlargement of an area, commonly seen on the nose known as rhinophyma.
Ocular Rosacea: affecting the eyes characterised by a foreign body sensation in the eye, burning or stinging, dryness, itching, photosensitivity, blurred vision, telangiectasia of the sclera or other parts of the eye, or intense swelling around the eyes known as periorbital oedema (Schaller et al., 2021; Ozturk et al., 2022; Hilbring et al., 2022).
What Can Trigger Rosacea?
There are certain known triggers that seem to spur on the symptoms of this condition and are reported by patients we consult in clinic. These main triggers include temperature change, spicy food, stress, alcohol, and caffeine. Some people report one of these as a trigger whilst others report more.
Who Can Get Rosacea?
Often, I find people with rosacea have other underlying health issues such as rhinitis, dermatitis, issues with digestion (IBS or reflux), food intolerances, and issues with overall gut health affecting absorption of necessary nutrients for good skin health. In research sensitivity to nickel and gold have also been reported in rosacea patients (Wada-Irimada et al., 2022).
With this condition affecting the face, it can be debilitating for many affecting people’s quality of life causing discomfort, low self-esteem, depression and even leading to isolation of social activities (Hilbring et al., 2022).
How Do You Treat Rosacea?
This is where technology around light-based devices and laser therapies have evolved and grown over time. In our clinic for Erythematous and Papulopustular Rosacea, Healite (LED) and our Excel V + laser device are our work horses for the treatment of rosacea.
LED is used to combat inflammation and repair the stratum corneum to reduce the burning and stinging. Doing this will equate to more hydration in the skin and improved overall skin health. The Excel V + laser targets the vascular components of the condition addressing flushing, telangiectasia, and background superficial redness.
Medications are commonly given to patients by dermatologists and GPS for the treatment of rosacea. Common ones include rozex and oral antibiotics such as doxycycline. Some patients do not find these treatment methods overly successful, and this is when we usually will see someone when they are looking for different alternatives for the long-term management of the condition (Wang et al., 2022).
Skincare Tips for Rosacea
With rosacea the common symptoms of stinging and burning is often reported by our patients, and this is where my general advice regarding skincare is to stick to the general rule of thumb ‘less is best’ and only use very gentle skincare, avoiding irritating ingredients (Li et al., 2021).
In our clinic we use a doctor only skincare range called ‘Aspect Dr’. They have a selection of skincare products to assist with calming and repairing the skin to help reduce inflammation before we perform any laser treatments.
As you can see this common skin condition can be debilitating and embarrassing for many. When we are looking at inflammatory skin conditions it is important to not only look at what’s happening on the surface of the skin, but it is also imperative to look at the skin with a holistic view as there can be other contributors affecting the skin. We must remember the skin is an organ and it does show what is happening within.
If you are struggling with your skin and would like further information, our dermal therapists & clinicians at the MyGenesis clinic are here to help and assist you on your skin health journey. To organise an appointment, you can call 6282 1155 or if you have any questions regarding this blog post feel free to email: mygenesis@capsclinic.com.au.
Brooke Worthy
Dermal Clinician
References
Deng, Z., Yan, S., Li, J., Yao, Y., Li, G., Hong, Z., & Huang, Y. (2022). The association between rosacea and the condition of low tolerance to skincare of the facial skin: a case-control study in China. Journal of Cosmetic Dermatology, 21(3), 1171–1177.
Hilbring, C., Augustin, M., Kirsten, N., & Mohr, N. (2022). Epidemiology of rosacea in a population-based study of 161,269 German employees. International Journal of Dermatology, 61(5), 570–576.
Li, G., Wang, B., Zhao, Z., Shi, W., Jian, D., Xie, H., Huang, Y., & Li, J. (2021). Excessive cleansing: an underestimating risk factor of rosacea in Chinese population. Archives of Dermatological Research, 313(4), 225–234.
Noguera-Morel, L., Hernández-Martín, A., & Torrelo, A. (2021). Childhood rosacea and related disorders. Clinical and Experimental Dermatology, 46(3), 430–437.
Ozturk, T., Kayabasi, M., Ozbagcivan, O., Ayhan, Z., & Utine, C. A. (2022). Common ocular findings in patients with acne rosacea. International Ophthalmology, 42(4), 1077–1084.
Schaller, M., Dirschka, T., Lonne-Rahm, S.-B., Micali, G., Stein Gold, L. F., Tan, J., & Del Rosso, J. (2021). The Importance of Assessing Burning and Stinging when Managing Rosacea: A Review. Acta Dermato-Venereologica, 101(10), adv00584.
Wada-Irimada, M., Yamamoto, H., Terui, H., Omori-Shimada, R., Yamazaki, E., Kikuchi, K., Aiba, S., & Yamasaki, K. (2022). Characterization of rosacea patients in Tohoku area of Japan: Retrospective study of 340 rosacea cases. The Journal of Dermatology, 49(5), 519–524.
Wang, B., Xie, H.-F., Deng, Y.-X., Li, J., & Jian, D. (2022). Efficacy and safety of non-surgical short-wave radiofrequency treatment of mild-to-moderate erythematotelangiectatic rosacea: a prospective, open-label pilot study. Archives of Dermatological Research, 314(4), 341–347.
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