Rosacea, Symptoms & Treatment
Rosacea is a very common skin condition, and very prevalent here in the West of Ireland, we love our beautiful Wild Atlantic Way but the climate here can be very harsh on our skin. There has been a huge increase in numbers of rosacea patients to my Clinic. Partly because I am known for being a rosacea expert but also because people are becoming more aware of the existence of the condition and want help in managing the condition.
My typical rosacea patient is between 35 – 55 years of age and is split 50/50 male and female. They usually arrive to my Clinic after a misdiagnosis as acne, purely because they presented with pimples. Or they had a High Street facial and were told their skin is ‘dehydrated’ sensitive skin and should use rich, calm moisturisers. This, of course, is likely to trigger more inflammatory lesions.
The most common forms of rosacea are:
Vascular rosacea is very common and its characteristics include telangiectasias (visible blood vessels/threadveins), erythema and the coming and going of flushing. This is most commonly seen in the mid-face, but it can be broadly anywhere on the face, and in some patients it can extend to the neck and chest, but this is in a minority of cases.
Triggers for flushing include spicy food, alcohol, stress, exercise, extremes of hot and cold and other environmental influences, but these are just triggers, and not the actual cause of the disease. There is also a close link between rosacea and excess bacteria in the skin (demodex mites), which can cause inflammation. The cause of rosacea is usually genetic predisposition and rosacea is not contagious.
Vascular rosacea is not actually caused by drinking alcohol for example, but it is true that certain types of alcohol may trigger a flare-up in certain people, with red wine being a common culprit. Certain food, such as spicy dishes can also have the same effect of triggering a flare-up, as well as the sun, hot environments, cold winds or rapid changes in temperature, such as during the Winter when you may come into a warm room after being outside in the cold.
This is often mistaken as adult acne, because it presents as papules, which are raised inflamed ‘bumps’, and the pustules have a little pus-filled head on top. Typically there are no comedones (whiteheads or blackheads) in rosacea, as you would see with acne. However, some patients do have overlapping conditions and may present with both rosacea and adult acne, in which can you may see comedones in the rosacea patient. Commonly, if a patient has inflammatory rosacea, they also often have vascular rosacea features too.
Not as common as inflammatory or vascular, there is a thickening of the skin, often on the nose and the pores appear enlarged. The thickened area of skin can less commonly affect other areas of the face as well and may be noted on the cheeks or the forehead. This rosacea subtype is more common in men than in women, with rhinophyma of the nose being the most common localisation.
This is more common than you might think as patients don’t usually volunteer information about eye issues, because the symptoms may be mild or the patient thinks the eye issues are not related to their skin condition. Ocular rosacea includes blepharitis – visible inflammation of the eyelids, or a frequent feeling of having something in the eyes, a gritty, dry, irritated feeling. Its not always visible, but rosacea patients often have an association with frequent irritation of the eyes. This type of rosacea I cannot treat in this Clinic.
One of the main features of neurogenic rosacea is a strong sense of discomfort with the skin. They may report a constant stinging or burning feeling on the skin, sometimes even going as far as noting throbbing or painful sensations. Neurogenic rosacea patients often don’t just suffer with flushing, but often report the flushing as being painful and extremely uncomfortable.
Treatment at Laser Clinic Galway
I usually see patients who have been treated by their GP already, and all too often have tried the anti-inflammatory antibiotic Rosex, but found it only worked for a short time or didn’t work at all. Sometimes they have been prescribed steroid cream, which can actually aggravate rosacea and long term use can thin the skin, which can trigger an even stronger negative response.
I start with a thorough consultation and try to pin down the triggers that cause flareups. Educating the patient is vital; reiterating that whilst rosacea is not a curable condition, patients who actively manage their rosacea with the help of a professional, will typically be happier and suffer fewer emotional consequences to having ‘perceived bad skin’. I educate them on what ingredients topically are the best to reduce symptoms, as a lot of redness targeting skincare available on the high street are unsuitable for rosacea patients. They are often too lipid-rich, targeting the (incorrect) concept of dry skin, when in fact the rosacea patient has microinflammation and not really dry skin. One skincare item important for rosacea is a broad-spectrum, oil and silicone free SPF 30-50 sun protection moisturiser like the AlumierMD Clear Shield SPF42, which is a mineral/physical SPF containing zinc oxide and titanium dioxide, which causes less stinging compared to chemical/organic filters.
If the barrier of the skin is compromised or has papules or pustules on their skin, I aim to get the skin barrier functioning correctly before I start IPL treatments. I recommend a stripped back basic skincare regime consisting of 1-4 AlumierMD (medical grade skincare) products aimed at healing their skin, and once all inflammatory lesions have cleared, we can commence treatments with IPL. When treating the erythema of vascular rosacea a longer-term reduction is gained by treatments of IPL (intense pulsed light). Treatments are typically done as a course of between 4 and 8 sessions, once a month. IPL uses short, safe bursts of intense pulsed light (called SWT®, but often referred to as a laser) are directed at the skin. The system filters the light to ensure the wavelengths used are absorbed by haemoglobin in the blood in your problem vessels. The light is converted to heat, which destroys the protein in the wall of the blood vessels, causing the vessels to gradually disappear after treatment. To ensure the best light transmission, a thin layer of gel (like that used in ultrasound examinations) is applied to your skin before treatment. The result is a significant reduction in redness, erythema and acneiform lesions.
Skin supplementation can also offer enhanced, holistic benefits to maintain skin health and target skin concerns, so this is also something we look at when treating rosacea. Feeding the skin from within as well as applying proven, results-driven products topically, is my inside-out approach that leads to radiant, healthy skin. The Clinic works with the Advanced Nutrition Programme which is a premium range of beauty food supplements which support healthy skin and help enhance your overall wellbeing.
Although very little is known regarding the cause of rosacea, it is a common condition that affects a large majority of the population. In the absence of patient understanding and support, the condition can have a significant impact on an individual’s biological, physiological and sociological well-being.
To successfully manage and treat rosacea, a combination of medical-grade IPL treatment (Nordly’s IPL & Laser by Candela is used in Clinic) on-going skincare and sometimes supplementation can greatly reduce the impact rosacea has on a patient’s appearance and confidence.