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How to combat rosacea
Rosacea is a common skin condition that mainly appears on the face. It usually affects those between the ages of 30 and 60, and is more common in women and those with fair skin.
I fall into all those brackets and have had rosacea for many years. In this article, I share my story of developing rosacea, how it’s affected me and what treatments have worked. We also get advice from Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics.
What is rosacea?
Bupa’s Dr Rogers explains: “If you have rosacea, the skin on your face (or sometimes elsewhere on your body) may tend to flush easily. The skin can become red and sore to the touch. A rash of bumpy spots (papules) and pus-filled bumps (pustules) can appear across your nose, cheeks, chin and forehead.
“Other symptoms include potentially serious eye conditions such as blepharitis, where the eyelids become red and swollen. Although rosacea affects more women, it tends to be more severe in men. Men are prone to thickening skin around the nose (rhinophyma).”
This photo shows what rosacea looks like:
When it comes to things that can cause or trigger rosacea, Dr Rogers says: “Rosacea can become worse for many different reasons. These include sunshine, stress, exercise, alcohol, spicy food and temperature extremes (being very hot or very cold). Its cause is unknown. But there are theories that reactions to tiny mites that live on your skin, or to bacteria in your gut, may be involved. Nothing has been proven yet. What we do know for sure is that rosacea isn’t contagious.”
My story
Rosacea often starts with flushing. As a teenager, I’d be embarrassed by going red at the slightest thing. Then around 15 years ago, when I was 38, I started getting a rash as well. It was probably in response to the stress of starting a new business.
A tactless client spurred me to do something when she said: “Did you know you’ve got a rash across your face?” Like many people, my reaction was to buy a basket-load of different creams from the chemist, including witch-hazel and eucalyptus oil, which stung terribly.
But nothing worked. Finally, I turned to my GP, who took one look at my face and diagnosed mild rosacea.
Living with rosacea
Like many people who live with rosacea, the biggest issue for me is the embarrassment the redness causes. This is especially true when you’re middle-aged and you thought blushing was behind you.
You go to a social event and suddenly look as if you’ve had too much wine after one small glass. Or your face is still bright red an hour after a gym workout. You feel the flush happening and there’s nothing you can do about it.
I sometimes try yoga breathing (deep breaths in through your nose, slow breaths out of your mouth) to calm myself down. Or, if I see people noticing, I simply explain the condition.
Managing chalazions
Chalazions – lumps in the eyelid which are not styes – are more common if you have rosacea. This irritation can sometimes be painful, but usually controlled with regular eyelid hygiene. You can use over-the-counter eyelid cleansing lotion, which comes in liquid form or wipes. Wipe your eyelids top and bottom in the morning and evening. It’s good for taking off makeup too.
My optician recommended daily eye drops to combat dryness. A tear substitute containing a lubricant called carmellose sodium works a treat for me.
Treatment for rosacea
The good news is that long-term treatments can be very effective against the rash and spots. My doctor put me on a course of an antibiotic called oxytetracycline to clear up the initial rash. That was followed by a topical (applied to the skin) gel called metronidazole for eight weeks.
Since then, I’ve also been prescribed azelaic acid, a cream that treats the papules and pustules of rosacea. But when there’s the occasional serious flare-up, it’s back to antibiotics.
Current treatment advice
Dr Rogers explains that some treatment guidance has changed slightly since my treatment began. “We now often prescribe a once-daily tetracycline antibiotic, such as doxycycline or lymecycline, instead of oxytetracycline. Metronidazole gel is now used less frequently, with azelaic acid or another gel called ivermectin prescribed instead.”
Redness can also be treated. For me, a dermatologist recommended laser treatment, which shrinks the blood vessels that are visible without hurting the skin around them. There are also topical treatments to reduce redness. Dr Rogers says that brimonidine (mirvaso) gel is one that can work, although it can cause irritation for some people. Some people may also be given a prescription for beta blocker tablets.
Rosacea self-care tips
There’s plenty you can do yourself to combat rosacea. Here are some tips and suggestions.
- Use a daily, gentle redness-reducing cleanser. Don’t rub or scrub your face when cleansing.
- Avoid perfumed soap and alcohol-based products.
- Use an unperfumed moisturiser if your skin is dry or sensitive.
- Blot your face dry or let it dry naturally.
- Use a sun block with an SPF (sun protection factor) of at least 30 and wear a hat on sunny days.
- Avoid alcohol and see if cutting out stimulants, such as caffeine and spicy foods, helps.
- If you’re self-conscious, camouflage your skin with suitable cosmetics (make-up). The British Association of Skin Camouflage and Changing Faces have lots of information on this.
My best advice to anyone trying to combat rosacea is to start by keeping a diary and tracking any triggers so you can avoid them. Rosacea may be embarrassing and distressing, but you can keep it at bay.
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Sources Sources
- Rosacea. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2021
- Rosacea. British Association of Dermatologists. www.bad.org.uk, last reviewed August 2018
- Blepharitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2019
- Meibomian cyst (chalazion). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2020
- Mirvaso 3mg/g gel. emc. www.medicines.org.uk, last updated July 2021
- Logger JGM, Olydam JI, Driessen RJB. Use of beta-blockers for rosacea-associated facial erythema and flushing: A systematic review and update on proposed mode of action. Journal of the American Academy of Dermatology 2020; 83(4):1088-97. doi: 10.1016/j.jaad.2020.04.129
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