What is rosacea?
Dr Stephanie Munn, Bupa Consultant Dermatologist, 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 pustules can appear across your nose, cheeks and forehead.
“Other symptoms include potentially serious eye conditions like blepharitis, where the eyelids become red and swollen. Men are also prone to thickening skin around the nose (rhinophyma).”
This photo shows what rosacea looks like:
When it comes to rosacea triggers and causes, Dr Munn says: “Rosacea can be made worse by sunshine, stress, exercise, alcohol, spicy food and extremes of temperature. 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, but we do know rosacea isn’t contagious.”
How rosacea starts
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 the 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.
What’s it like having 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 the nose, slow breaths out of the mouth) to calm myself down. Or, if I see people noticing, I explain the condition.
Chalazions (lumps in the eyelid which are not styes) can become much more frequent. This sometimes painful irritation can often be controlled with regular eyelid hygiene. You can use over-the-counter eyelid cleansing lotion, which comes in liquid form or wipes, to wipe your eyelids top and bottom in the morning and evening. It’s good for taking off makeup too if you’re a woman.
My optician recommended daily eye drops to combat dryness. They’re a tears-substitute containing a lubricant called carmellose sodium and they work a treat for me.
Medical treatments 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.
Dr Munn says this is a common treatment path, although as you’d expect in the ever-progressing world of dermatology, some things have changed slightly since my treatment began. “We would often now prescribe a once-daily tetracycline antibiotic (such as doxycycline or lymecycline) instead of oxytetracycline. And metronidazole gel is now used less frequently, with azelaic acid or another gel called ivermectin prescribed in its place.”
The redness can also be treated. For me, a dermatologist has 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 Munn says that mirvaso gel is one that can work, although it can cause irritation for some people. Some people may be given a prescription for beta blocker tablets.
Treating rosacea at home
There’s also plenty you can do yourself to combat rosacea. Here are some tips and suggestions.
- Use a daily gentle redness-reducing cleanser.
- Avoid perfumed soap and alcohol-based products.
- 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.
- Moisturise with an anti-redness moisturiser.
- Avoid alcohol, stimulants such as caffeine and spicy foods, all of which can trigger rosacea.
- Camouflage the skin with green-tinted make-up.
My best advice to anyone beginning on their rosacea journey is to start by making a diary tracking your triggers so you can avoid them. Rosacea may be embarrassing and distressing, but you can keep it at bay.