April is Rosacea Awareness Month and to highlight the condition Dr Julia Sen looks at what causes it and what you can do to control it.
Remember when you were a teenager and the worst thing you had to worry about was getting a spot? Oh, if only life was so simple now. As “mature” adults we would expect to have removed skin break-outs from our list of concerns. So how demoralising to get to one’s 40s only to be gifted once again with those blessed eruptions … plus the added humiliation of turning puce after the first sip of Pinot Grigio. Not fair!
What is Rosacea?
This common inflammatory skin condition can begin any time, but is found most commonly after the age of 30. It causes flushing and/or redness of the cheeks, nose, forehead and chin. Over time, visibly dilated blood vessels may appear (telangiectasia).
Frustratingly, what causes rosacea is still not fully understood, although genetic and environmental factors are both thought to contribute. A family history is reported in up to 40% of cases and it is more prevalent in fairer skin types. Abnormal immune system regulation results in inflammatory changes within the skin. Possible triggers include the skin parasite Demodex and the bug associated with stomach ulcers, Helicobactor pylori. Women are more commonly afflicted but men are more likely to develop the more severe manifestations:
The eyes may have it: Eyelids are involved in up to 50% of cases and in about one fifth, occurs before the skin changes. Blepharitis is a condition I come across frequently in my ophthalmic practice and causes sore, red, itchy eyes. In severe cases, it can lead to inflammation and ulceration of the surface of the eye (keratitis). It can also lead to dry eye or chronic eyelid puffiness and make wearing cosmetics, such as mascara, very uncomfortable.
Knobbly noses: Lumpy, bulbous thickening of the nose – Rhinophyma – can be a highly disfiguring effect of rosacea, occurring mainly in men.
Shame faced: Because rosacea affects our most cosmetically sensitive area, it can cause significant psychological morbidity. According to an international study published in 2015, 77% of those questioned admitted that it affects them emotionally; 65% finding that it negatively impacts their work and 53% reporting adverse effects in their relationships. It’s a real blow to confidence when self-esteem may already be taking a beating from the many other changes occurring in middle life.
If rosacea is impacting your life, below is what I recommend:
1) Triggers: Try to identify anything which sets off the flushing. The most common stress factors include alcohol, spicy food, UV light and stress. Avoid what you can; mitigate what you can’t. Stress, for example isn’t avoidable but learning how to manage it is absolutely possible and will benefit every aspect of your life. Exercise, breathing techniques, yoga, meditation, spending time outdoors and listening to music are obvious ones but find what works for you.
2) Diet: Many inflammatory diseases are now thought to be influenced by our gut health, which is inextricably linked to what we put into our mouths. There is a higher incidence of bowel disorders in people with rosacea and in one study, treatment of SIBO (small intestinal bacterial overgrowth) which causes abdominal pain, bloating, and abnormal bowel habit, resulted in improvement in the patients’ rosacea. Feed and nurture your gut microbiome by avoiding processed foods and those with a high glycemic index (these are readily broken down to into sugar) like white bread and white pasta. Instead, eat plenty of fibre-rich vegetables (prebiotics), fermented foods (probiotics), such as kefir, sauerkraut, kimchi and kombucha, and healthy fats (extra virgin olive oil, nuts and seeds).
3) Supplements: Whilst they won’t help you cheat your way out of a poor diet, specific supplementation may be worth considering. Omega 3 has anti-inflammatory effects and may be beneficial in many autoimmune disorders (where the body attacks itself). The standard UK diet is depleted in this essential fatty acid, because the food industry has prioritised shelf-life over nutritional value, so consider taking it if you’re not eating oily fish (salmon, anchovies, sardines etc.) several times per week. Vegan Omega-3 capsules are also available.
4) Skincare: Use gentle products to help to restore the skin’s acid mantle.
Start with a gentle, non-astringent cleanser: iS Clinical Cream Cleanser Cream Cleanser 120ml – iS Clinical; Tropic Clear Skies Cleansing Powder Clear Skies Cleansing Powder | 60g | Tropic Skincare
Choose a serum specifically designed for rosacea: The Ordinary Azelaic Acid Suspension The Ordinary | Skincare – Boots; iS Clinical Pro-Heal Serum SHOP IS CLINICAL | Dr Julia Sen; Tropic Pure Lagoon Serum Pure Lagoon Blemish Prevention Serum | 30ml | Tropic Skincare
Use a lightweight moisturiser every day: iS Clinical Reparative Moisture Emulsion Reparative Moisture Emulsion 50g – iS Clinical; Tropic Fresh Waves Balancing Moisturiser FRESH WAVES balancing moisturiser – Tropic Skincare
SPF is an absolute must, to prevent UV induced flushing, in addition to the long-term adverse effects of UV light on fair skin: iS Clinical Eclipse SPF 50 Eclipse SPF 50 – iS Clinical; Tropic Sun Day Facial UV Defence Sun Day Facial UV Defence | Daily SPF Sunscreen | Tropic Skincare
5) Topicals: Brimonidine, Ivermectin and Metronidazole may be a helpful first therapeutic step. All need to be prescribed and overseen by a doctor.
6) Antibiotics: Such as the tetracycline family have anti-inflammatory effects when taken in low doses over several months. They are unsafe to use if pregnant or breast feeding and some make skin more susceptible to sunburn- another reason to slather on the factor 50.
7) Laser: Light energy of specific wavelengths can be used to target the various manifestations of rosacea, particularly redness and thread veins. This is not usually available within the NHS but can be accessed by consulting a dermatologist, such as Dr Saj Rajpur, Consultant Dermatologist at Midland Skin, Edgbaston, Birmingham.
So there is hope! For further information or to arrange an appointment with Dr Saj Rajpar, visit or contact 0121 285 4540.