Rosacea is a notoriously hard skin condition to treat and often returns even after successful treatment, but what is rosacea? What causes rosacea? And how can we treat it? Here is everything you need to know about rosacea, including; symptoms, causes, and treatment options.
What Is Rosacea?
Rosacea is a chronic inflammatory skin condition that is particularly hard to treat and often returns. It mostly affects the central face and is more common in women than in men .
There are four subtypes of rosacea:
- Erythematotelangiectatic – characterized by flushing and persistent central facial erythema, often with visible broken blood vessels or capillaries. (This is the most common form of rosacea).
- Papulopustular rosacea – characterized by papules and pustules that occur centrally on the face. (Similar in appearance to acne vulgaris).
- Phymatous rosacea – characterized by thickened skin with enlarged pores.
- Ocular rosacea – characterized by watery or bloodshot eyes that often feel like they are burning or stinging, or that there is a foreign object within the eye .
What Causes Rosacea?
The cause of rosacea is still relatively unknown, although the persistent redness that is characteristic of rosacea is due to repeated blood vessel dilation caused by environmental factors or other triggers.
Other factors that may contribute to the development of rosacea include the microbes that naturally occur on our skin and in our pores as part of our normal skin flora, including Demodex mites, as well as a damaged skin barrier .
The most common symptoms of rosacea can be separated into two categories; primary and secondary. In order to accurately diagnose rosacea, at least one primary and one secondary symptom should be present. These are:
- Flushing (a temporary reddening of the skin)
- Permanent skin redness
- Broken blood vessels/capillaries
- A burning or stinging sensation
- A dry appearance
- Facial swelling
- Located in the center of the face
- Red or bloodshot eyes
- Skin texture changes
The first symptom that is usually experienced before rosacea fully develops is facial flushing .
Treatment Options For Rosacea
Medications & Prescription Creams
The treatment options for rosacea largely depend on subtype, however, for all subtypes, sun protection, reducing skin irritability, and avoiding triggers for flushing (e.g. hot temperatures, spicy foods, etc.) are recommended .
Topical treatments that are available via prescription include metronidazole and azelaic acid which reduce facial redness by acting as anti-inflammatories. In addition, azelaic acid also has antibacterial and anti-keratinizing effects.
A medication called Ivermectin can also reduce the inflammation associated with rosacea and also targets the Demodex mites that are thought to be involved in the development of the pustules associated with papulopustular rosacea .
In the case of papulopustular rosacea, topical medications may be combined with oral medications, while Phymatous rosacea often includes the use of oral isotretinoin .
For full information on the medications that are available for the different types of rosacea, please see your doctor or dermatologist for a detailed discussion that is personalized to your individual skin needs.
There are a number of different vascular lasers available to treat rosacea and other facial redness.
Lasers work through a process known as ‘thermolysis’ which is where a substance is broken down by heat. In the case of vascular lasers, the thermolysis is selective in that it specifically targets the blood vessels in the dermis .
Lasers use a specific wavelength of light that is selectively absorbed by chromophores (light-absorbing molecules) within the skin. Vascular lasers are those that have a wavelength that is selectively absorbed by oxyhemoglobin – the substance that gives blood its bright red color.
The energy is transferred from the laser to the oxyhemoglobin in the form of heat which causes the small blood vessels to heat-up, destroying the blood vessel walls and coagulating the blood inside. The body then breaks down the old coagulated blood and it is absorbed into the bloodstream where it can eventually be excreted from the body as a waste product (this is similar to how a bruise heals).
The most common vascular lasers include:
- Pulsed-dye laser (PDL)
- Potassium titanyl phosphate (KTP) laser
- Nd:YAG laser
- Microsecond-pulsed Nd:YAG (e.g. Laser Genesis, Cutera)
- Intense Pulsed Light (IPL) – not a true laser and therefore less targeted than the others.
You can read more about how these lasers work for facial redness here: Vascular Lasers For Facial Redness.
At-Home Treatments For Rosacea
If your rosacea is mild and mainly facial redness and flushing, there are a number of treatments that you can buy from your local drugstore, cosmetics store, or even Amazon.
The treatments that are likely to be the most effective for rosacea are those that:
- Improve skin barrier function and increase skin hydration
- Reduce Inflammation
- Reduce blood vessel dilation
Examples of skincare ingredients that fall into one or more of these categories include:
- Vitamin C – improves skin barrier function, reduces inflammation and blood vessel dilation.
- Niacinamide – improves skin barrier function and reduces inflammation.
- Azelaic Acid – reduces inflammation.
- Cytokinins – reduce inflammation.
- Centella Asiatica – increases skin hydration and reduces inflammation.
- Snail Mucin – increases skin hydration and reduces inflammation.
- Ceramides – increase skin barrier function and reduce inflammation.
You can read more about how these skincare ingredients target redness here: 7 Of The Best Skincare Ingredients For Reducing Redness.
Recommended Products For Rosacea
- Avene Tolerance Extreme Cleansing Lotion
- Pyratine XR Creme
- Skinceuticals Correct Redness Neutralizer
- Replenix Power of Three Antioxidant Serum
- La Roche-Posay Cica Baume B5 Balm
- Eau Thermale Avene Skin Recovery Cream
- A’PIEU Madecassoside Cream
- Dermalex Rosacea Treatment
Other Skincare Tips For Rosacea
As mentioned earlier, it is important to use adequate sun protection in order to keep rosacea at bay. Some evidence suggests that some indoor lighting can contribute to the production of free radicals which can worsen rosacea. For this reason, sunscreens with iron oxide may offer extra protection.
A broad-spectrum sunscreen with an SPF of at least 30 should be worn daily, even if you spend the majority of your day indoors.
Avoiding skin irritation is also important which means choosing a gentle facial cleanser and moisturizer and avoiding too many active ingredients.
If you plan on using or are currently using, chemical exfoliants, opt for those with a larger molecular weight (molecule size) as these are less likely to irritate skin.
You can read more about the molecular weights of popular acids here: AHA vs BHA – Acids Explained.
- Rivero, A. & Whitfield, M. (2018). ‘An update on the treatment of rosacea’, Aust Prescr., 41(1), 20-24. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828925/
- Zhou, M., Xie, H., Cheng, L. & Li, J. (2016). ‘Clinical characteristics and epidermal barrier function of papulopustular rosacea: A comparison study with acne vulgaris’, Pak J Med Sci., 32(6), 1344-1348. Available at: http://www.pjms.com.pk/index.php/pjms/article/view/11236/4768
- Taieb, A., Khemis, A., Ruzicka, T. et al. (2016). ‘Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study’, J Eur Acad Dermatol Venereol., 30(5), 829 – 836. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26691278/
- Anderson, R. & Parrish, J. (1983). ‘Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation’. Science, 220(4596), 524-527. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6836297/