Rosacea: An Introduction

Rosacea and Rosacea Treatment: An Introduction — Help for Australians

An Introduction to Rosacea

Rosacea is a well-recognised, although frequently untreated, chronic skin condition presenting primarily as redness of the central facial skin, broken capillaries (telangiectasia), and (in more advanced cases) the formation of acne-like papules and pustules.

Previously thought to affect approximately 5% of the population, more recent studies establish prevalence at approximately 10%, although some specialists suggest the majority of more minor and moderate cases are never diagnosed, despite the benefits treatment would bring.

Rosacea affects more women than men, although in men the condition tends to be more severe.

Diagnosis is typically between 35 and 50 years of age, however the cardinal sign of rosacea — persistent flushing — can occur from as early as the teenage years, where early treatment is thought to reduce the likelihood of progressively worse disease in later years.

Rosacea is more common in fair-skinned individuals, those who blush easily, have sun-damaged skin and whom have relatives with the disease.

What is the Cause of Rosacea?

The precise cause of rosacea remains elusive. It now appears likely that a combination of factors interact to cause the disease, rather than any one single cause, and that the number of factors involved can vary from patient to patient.

Possible causes include microscopic skin mites, over-reactive facial capillaries prone to excessive and prolonged dilation, allergies and psychological factors.

Genetic predisposition is a strong marker for developing the disease.

How is Rosacea Diagnosed?

From 2002, the threshold at which rosacea should be diagnosed was lowered by an expert committee. Earlier and more sensitive diagnosis and treatment is thought to reduce the severity of the disease.

The symptom of "flushing" (sudden and then persistent skin redness) is now considered enough for a diagnosis of rosacea.

Patients with this very early form of rosacea frequently believe they have "sensitive skin" (a marketing term and not a medical condition) rather than rosacea and therefore do not seek treatment.

Permanent areas of skin redness on the central region of the face, broken capillaries and acne-like eruptions are additional symptoms, indicating more severe or advanced rosacea.

It is generally thought, although not scientifically established, that the more symptoms there are, and the more persistent those symptoms are, the more potentially severe the rosacea may become if left untreated.

Additional Skin Signs of Rosacea

Patients with rosacea tend to have subjectively "sensitive skin" characterized by episodes of burning and stinging. The relative dryness/oiliness of the skin bears no significance. Unfortunately, patients will often respond to their skin's sensitivity with products marketed as "natural" or "hypoallergenic" which nevertheless increase or have no impact on their skin's sensitivity and level of inflammation.

Thickened skin, particularly of the nose, is a symptom of more severe and longer-term untreated rosacea, particularly in men.

How is Rosacea Treated?

Modern rosacea treatment encompasses speciality anti-inflammatory skin care, with a particular emphasis on daily use of an appropriate rosacea sunscreen, and, as required, topically applied and/or oral antibiotics. Laser and light treatments treat more resistant or established symptoms of the disease, such as broken capillaries and thickened skin texture.

For further information on effective skin care see and for information on sunscreens see

Effective Treatments

For a list of ingredients in daily rosacea skin care, see

Topical antibiotics: metronidazole, clindamycin, erythromycin.

Sulfur products: sodium sulfacetamide.

Immunomodulators: tacrolimus, pimecrolimus.

Oral antibiotics: tetracycline, doxycycline, minocycline, macrolides (erythromycin, azithromycin, clarithromycin), metronidazole, ampicillin, trimethoprim/sulfamethoxazole.

Other oral treatments: aspirin, beta-blockers (e.g. propranolol), clonidine, selective serotonin reuptake inhibitors (antidepressant SSRIs), hormones (contraceptives), isotretinoin.

Laser and light rosacea treatments: Intense pulsed light (IPL), vascular lasers (pulsed-dye laser, KTP laser, Dornier 940nm laser), carbon dioxide resurfacing laser (usually not fractional).

Phymatous rosacea treatments: dermabrasion, microdermabrasion, hot-loop electrocoagulation.

Speciality clinical treatments: customised glycolic acid treatment, thymol iodides procedure.

Aggravating Factors

The list of triggers which can aggravate rosacea is long and can vary greatly between patients. Individual observation is key to determining which factors cause the skin to become more red and reactive. Fluctuations in ambient temperature and daylight (UV) exposure, even through glass in winter, are frequent environmental triggers. Alcohol, stress, inappropriate skin care and hot or spicy foods are other commonly aggravating factors. More obscure triggers include vanilla, tomatoes and soy sauce.

Even when treated with appropriate skin care, medications and/or procedures, patients may have to avoid aggravating factors to stabilise their skin.

Differential Diagnosis of Rosacea

Photosensitivity from medications, allergic contact dermatitis, lupus erythematosus, connective tissue diseases, carcinoma of the thyroid, VIPoma, mastocytosis, dermatomyositis.

Previous Rosacea Updates

16/8/13 — Ocular RosaceaOcular Rosacea Treatment.

16/8/13 — Acne Rosacea — Updates to Features, Diagnosis and Cause.

16/8/11 — Advances in Rosacea Treatment for 2011

16/5/10 — Updates to Rosacea Treatment and Rosacea Laser Treatment.

17/6/08 — Skinceuticals: Skinceuticals C F Phloretin.

30/3/08 — Updates to Rosacea Treatment and Rosacea Symptoms.

30/3/08 — Clinical Skin Care: Rosacea Sunscreens.

26/3/08 — Increased Expression of VEGF in Patients with Subtype One and Two Rosacea.

12/2/08 — Rhinophyma may increase the prevalence and obscure the detection of skin cancer.

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