Is your red skin really rosacea?

If you suffer from red facial flushing on your nose, cheeks, chin and forehead it could be caused by a skin condition called rosacea.

1 in 10 people between the ages 30-60 are estimated to suffer from this inflammatory skin condition. There’s no cure, says consultant dermatologist Dr Walayat Hussain, but be reassured that there are treatments that can help you manage the condition.

Redness may fluctuate but may become more noticeable and persistent the longer you have rosacea, resulting in the appearance of visible blood vessels or spider veins. Other symptoms may include permanent redness of the skin, pustular acne spots or thickened and swollen skin on the nose and forehead. Your skin may also become dry and flaky.

Dr. Wayalat Hussain, spokesman for the British Association of Dermatologists, notices the effect it can have on his patients:

‘It may seem a trivial problem but rosacea can have a really big effect on a person’s confidence especially now everyone is so much more aware of how they look.

Rosacea patients regularly tell me how embarrassed they are about having a red face or flushing and how they have been accused of being drinkers because of their flushed appearance; it can cause a lot of distress.’

Further to this, rosacea can be mistaken for acne. It is crucial to recognise that whereas acne involves blackheads and blocked pores, rosacea does not. It is paramount to make this distinction so as not to delay the appropriate treatment for you.

Who gets it?

Rosacea affects a variety of skin types but is most common in people with fair-skinned complexions. It is more common in women but men tend to suffer more severe symptoms. Importantly, rosacea is not contagious or related to poor hygiene.

What causes rosacea?

The exact causes of rosacea are still not fully understood, but there are a number of theories, including:

  • Widening of blood vessels – the common denominators of flushing and redness are thought to be caused by vasodilation (or widening) of blood vessels in the face. This can be triggered by environmental factors including sunlight, spicy food, alcohol, hot drinks, extreme temperature, hot baths and saunas; or equally intense exercise, emotional stress, cosmetics, skincare products or long term use of facial steroids. 
  • Spider mites -there is no concrete evidence to support this theory, but a study published in the Journal of Microbiology proposed that rosacea may be caused by spider-like mites that live in the pores of the skin called demodex. Researchers from the University of Ireland say that although everyone has demodex mites living on their skin, people with rosacea actually have ten times as many. The theory is that skin irritation is caused by a reaction to the faeces produced by demodex.  Although antibiotics don’t kill the mites they improve rosacea symptoms because they kill the bacteria that is left behind in their faeces.

Treatments of rosacea

Rosacea can’t be cured but there are a variety of treatments available to control the symptoms. 

Treatment options include:

  • Lifestyle changes – ‘Avoiding triggers can’t stop you getting rosacea completely but they can lessen the severity’, advises Dr Hussain. He continues to say that ‘wearing sun cream may help; and avoiding alcohol, caffeine, spicy food, some cosmetics and overheating may also be beneficial.’
  • Antibiotics – these can help reduce some inflammation and treat infected spots, but they do nothing to reduce facial flushing. Antibiotics include topical gels or creams which contain either metronidazole or azelaic acid; oral antibiotics such as tetracyclines, erythromycin and clindamycin. Doxycycline is also prescribed at a low dose in combination with metronidazole gel or cream.
  • Brimonidine Tartrate Gel (brand name Mirvaso) – known by its brand name Mirvaso, this prescription-only gel is a treatment designed to reduce redness and flushing. It works by causing facial blood vessels to narrow and reduces facial redness within 30 minutes. The effects last for up to 12 hours. Dr Hussain cautions that ‘this treatment works well for some but not others so it’s not a game changer. It’s also not suitable for people who have heart disease or vascular conditions.’
  • Camouflage makeup – this thick makeup can cover up facial redness but can be time-consuming to apply. 
  • Lasers – ‘Intense pulse lights or pulse-dye lasers are both used to reduce redness and CO2 lasers are used to remove layers of excess skin that can develop as a complication of rosacea,’ says Dr Hussain.

Complications of rosacea

If rosacea is left untreated it can sometimes result in complications. These include:

  • Ocular rosacea -this is where the cornea, the transparent layer at the front of the eyeball becomes inflamed and damaged. Your eyes may feel sore and gritty resulting in affected sight, in which case urgent medical attention is needed.
  • Rhinophyma – this is the medical name for skin thickening and excess tissue growth on the face, usually the nose but sometimes the forehead. ‘The nose can become bulbous and people wrongly associate it with excessive alcohol intake ‘, says Dr Hussain.’ This can be treated with dermabrasion or lasers to remove the upper layers of the skin.’

Whilst rosacea is not curable, don’t forget that it is completely manageable and preventative measures can be taken to lessen the severity of the symptoms. 

Dr Hussain maintains that although rosacea is a chronic condition, ‘it can be improved with treatment but intermittent flare ups may occur. No single treatment can treat all the symptoms. It’s a question of finding out which works for your different individual symptoms.’

Page last reviewed on 11/08/2016