WHAT IS ROSACEA?Rosacea is a common chronic facial skin condition. The main characteristic of rosacea is redness in the center of the face. Rosacea literally means "red as a rose." Small dilated blood vessels (also called couperose) are often visible, as well as bumps and pimples.
Rosacea can resemble acne, the well-known teenage pimples. However, rosacea occurs later in life than acne, usually around the age of 30. Sometimes it develops in childhood. It is equally common in men and women.
Eye abnormalities often occur with rosacea and can range from mild to severe. Rosacea is a persistent condition that is easily treated. However, after discontinuing treatment, it often slowly returns. It is not a serious condition, but it is cosmetically disturbing. Rosacea is not contagious.
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WHAT ARE THE SYMPTOMS OF ROSACEA?Rosacea primarily affects the cheeks, nose, forehead, and chin. The main symptoms are excessive flushing (temporary redness) with a feeling of warmth, which can occur in attacks, persistent redness, bumps, pimples, dilated blood vessels (couperose), a burning sensation, and sometimes itching. The color is usually pinkish-red, sometimes a bit purplish-red. Blushing can be triggered by, for example, emotions, heat, sunlight, hot or alcoholic beverages, hot or spicy foods, and menopause.
Eye complaints such as dry eyes, a burning or stinging sensation, watery eyes, and a feeling of something in the eye (a "grain of sand" feeling) are also common. Inflammation of the eyelids (blepharitis) and of the cornea and conjunctiva (keratoconjunctivitis) can also occur.
Sometimes swelling due to fluid retention (edema) occurs, especially on the cheeks and under the eyes. This usually resolves on its own, but in rare cases, the swelling is permanent due to lymphatic vessel blockage (lymphedema). This is also called Morbihan's disease.
After prolonged rosacea, the nose can change shape, with significant thickening of the skin and lumpy growths. This is called rhinophyma. Rhinophyma is caused by enlargement of the sebaceous glands in the nose and an increase in connective tissue. Rhinophyma occurs almost exclusively in older men. In everyday language, it is also incorrectly called cauliflower nose or drinker's nose, as rhinophyma is not caused by alcohol consumption.
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HOW DOES IT COME ABOUT?The cause of rosacea is unknown. External factors can influence the severity of rosacea, which can worsen symptoms. Examples include heat, sunlight, emotions, cosmetics, skin care products, and some medications. Medications containing corticosteroids (adrenal cortex hormones) can cause or worsen rosacea, both when taken internally and when applied topically. A causal role of diet has never been demonstrated; however, drinking alcohol and eating spicy foods can (temporarily) worsen redness.HOW IS THE DIAGNOSIS MADE?The diagnosis can usually be made based on the symptoms and visible skin lesions. Sometimes it's difficult; there are also other skin lesions that can cause facial redness. If there is any doubt, a skin biopsy may be necessary for microscopic examination. A skin biopsy involves removing a small piece of skin a few millimeters in diameter under local anesthesia. In some cases, the dermatologist will perform allergy tests to rule out a related allergy to products, for example, cosmetics.WHAT TREATMENTS ARE THERE FOR ROSACEA?Rosacea is treatable, but not definitively curable. Within six months of stopping therapy, half of the patients experience a relapse. For mild rosacea, a cream or gel is the initial treatment. If this is insufficient, treatment with tablets or capsules is added. Severe rosacea is treated directly with both tablets or capsules and a cream or gel.
Treatment with a cream or gel:
Rosacea can be treated with anti-inflammatory creams such as ivermectin cream, metronidazole cream or gel, or azelaic acid cream. Ivermectin cream is applied once daily. Metronidazole cream or gel and azelaic acid cream are applied twice daily. Brimonidine gel (Mirvaso® gel) can be used to treat facial redness. This causes the blood vessels to constrict, temporarily reducing facial redness. The effect occurs after about thirty minutes, peaks after three to six hours, and then gradually diminishes. If you are trying to conceive or are pregnant: metronidazole can be used safely during pregnancy, but the other products mentioned above cannot.
Treatment with tablets or capsules:
Antibiotics such as doxycycline, minocycline, or tetracycline are effective against skin and eye conditions caused by rosacea. Rosacea is not an infection, but these specific antibiotics have anti-inflammatory properties in addition to their effect on bacteria. A reduction in redness and the number of pimples/spots is usually observed after one to two months. This treatment is often given for two or three months. These antibiotics are suitable for long-term use and have few side effects. They should not be used during pregnancy. There are other antibiotics that can be used if you cannot use the above-mentioned medications. For example, azithromycin, which can be used during pregnancy. If antibiotics are not effective, isotretinoin can be tried. This is used for acne, but is also effective against rosacea. Isotretinoin must absolutely not be used during pregnancy and should be stopped at least one month before a potential pregnancy.
Treatment for redness (couperose).
The dilated veins in the face can be treated with laser therapy or a flash lamp. The treatment often produces good results, but is not covered by insurance. Two to three treatments are usually sufficient. In the long term, new blood vessels may develop.
Treatment for eye disorders
For dry eyes and irritation, artificial tears such as Systane or OptiFree Pro can be used to prevent eye dehydration. These are not covered by insurance. Artificial tears based on hypromellose, methylcellulose, or carbomer are also sometimes used and are covered by insurance, but they are generally less effective for rosacea. Treatment with antibiotic tablets or capsules such as doxycycline, minocycline, or tetracycline can also provide improvement. If eye problems persist, a referral to an ophthalmologist is advisable. They may prescribe cyclosporine eye drops.
Treatment for rhinophyma:
Rhinophyma can be treated in various ways. Plastic surgery, electrosurgery, cryosurgery, and laser therapy are among the options.WHAT ARE THE OUTLOOK?Rosacea symptoms are very bothersome and cosmetically disruptive. They can therefore impact quality of life, including social and professional functioning. It's important to be open about this with your healthcare provider so that the best treatment can be chosen. Rosacea is easily treated, but with current treatments, there is no definitive cure. Symptoms can return after discontinuing therapy. Maintenance treatment with a cream or gel can delay a flare-up or worsening.WHAT CAN YOU STILL DO YOURSELF?Certain conditions, foods, irritants, and medications can aggravate rosacea symptoms (see below). This can vary from person to person. It can be helpful to keep a diary to identify factors that aggravate your rosacea symptoms, so you can avoid them as much as possible. Using camouflaging cosmetics that conceal redness can be very helpful for those who are embarrassed by their red face.
Rosacea triggersCircumstances:exertion, climatic conditions (cold, heat, humidity, UV, wind), fever, hot flashes, stress and emotions (anger, fear, shame).Food and drink:alcohol, eggplant, avocado, vinegar, chili (peppers) and curry, chocolate, citrus fruits, coffee, tea, soy, spinach, tomatoes, dairy products.Irritating factors:cleaning products containing alcohol, menthol, perfume, aftershave, peeling products, cleansing wipes, shaving foam, waterproof cosmetics, soap.Medicines:Capsaicin, corticosteroids, doxorubicin, dupilumab, infliximab, niacin, nifedipine, nitroglycerin, prostaglandin E, rifampicin, tacrolimus.
Skin care:
The facial skin of people with rosacea is fragile and sensitive. Therefore, the following measures and advice for skin care apply.
Sun protection
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Avoid exposure to sunlight on the face as much as possible. |
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Wear a sunscreen every day that protects against UVB and UVA rays with an SPF of 15 or higher. |
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Products containing titanium dioxide or zinc oxide cause the least irritation. |
Skin care
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Cleanse your face at least once a day with a mild/soap-free cleanser, and rinse thoroughly with lukewarm water. Don't use a rough washcloth; use a soft cotton pad or your hands instead. |
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Gently pat the skin dry with a soft towel or tissue. |
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Depending on personal preference, a good moisturizing, non-greasy cream can be used as a day cream. |
Avoid the following skin care products:
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Waterproof makeup. |
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Skin tonics, toners and so-called astringents (which may contain alcohol, menthol, peppermint, camphor, witch hazel, lavender or eucalyptus oil). |
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Cosmetics containing sodium lauryl sulfate, perfume, fruit acids or glycolic acid. |
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Exfoliative creams (so-called scrub creams), scrubs and cleansing brushes. |
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