20 January 2021
Do you experience redness, flushing, sensitivity and stinging on your face? If you do, rosacea might be a cause of these symptoms. Celebrities who suffer from this skin condition include Renee Zellweger, Prince William and Sam Smith.
Although rosacea is more common in fair skinned people with European ancestry; it is not uncommon in Asia. It is estimated that 1-22% of of populations suffer from this chronic skin condition. Rosacea is also more prevalent in females and patients aged 30 to 50 years of age.
One study on patients with rosacea in Singapore showed that this condition was more common in females and certain racial groups (Chinese and Caucasian). The average age of patients with rosacea in this study in Singapore was 43 years. These local findings are comparable to what we know about rosacea from other studies i.e. it tends to affect middle aged females.
What is rosacea and why should you see a doctor to get it treated? This guide will share the essentials about this red rash; that sometimes gets misdiagnosed as acne and eczema.
Rosacea is a chronic skin condition that causes redness, pustules, papules, flushing and warmth in the cheeks, nose, chin and forehead; although other parts of the face can be affected. These symptoms can be triggered by exposure to the sun, consumption of certain food and drinks (e.g. wine and spicy food), exercise and emotions like anger.
Patients who have rosacea tend to be fair skinned, female and in the 30-50 year age range. Nonetheless, this dermatological condition can also occur in males, different age groups and skin types.
Rosacea is a chronic inflammatory disease that affects mainly the center of the face. Most commonly, patients have a red rash or flush on their cheeks, noses, chin and forehead.
The cause of rosacea is still not known. Several factors such as genetics; immune dysregulation; dysfunction of blood vessels and nerves; and Demodex folliculorum mites have been implicated. It is likely that a combination of these factors result in rosacea.
Rosacea also damages the skin barrier, resulting in increased transepidermal water loss (TEWL). Excess TEWL causes skin dryness, peeling; hypersensitivity and stinging.
Although most commonly seen as a red/ pink rash; blushing or pimples in the center of the face; there are actually four different types or stages of rosacea:
1. Erythematotelangiectatic rosacea The most common type of rosacea. Redness, flushing and visible blood vessels (telangiectasias) are seen in erythematotelangiectatic rosacea. There may also be a burning or stinging sensation accompanying the flushing.
2. Papulopustular rosacea
Papules and pustules (i.e. pimples) and redness occur in papulopustular rosacea. Papulopustular rosacea can be misdiagnosed as acne vulgaris.
3. Phymatous rosacea
Skin thickens and becomes rough and bumpy in this phymatous rosacea. The surface of the affected area feels irregular. The nose, chin, forehead, eye and eyelids can be affected.
4. Ocular rosacea
Eyes and eyelids are affected in ocular rosacea. Redness, itching and stinging of the eyes may be experienced. The eyelids can become red and swollen. Infections, sensitivity to light and foreign body sensations can occur.
In Singapore, the most common type is also erythematotelangiectatic rosacea.
While the exact cause for rosacea is not known, several triggers have been found. Identifying the factors that trigger your flares and avoiding them is one of the tenets of rosacea treatment.
• Sun exposure: UV rays trigger inflammation and flares. Using sunscreen with protective ingredients can minimise irritation.
• Food: Chocolate, dairy, spicy food, vanilla, soy sauce, liver
• Drinks: Red wine and hot drinks
• High temperatures: Sauna, hot baths
• Emotions: Anger, stress
In Singapore, the top two triggers for rosacea were found to be sun exposure and diet.
The most common symptoms of rosacea are flushing, redness, pimples, pustules, visible blood vessels and sensitive skin in the center of the face. Flare-ups of these symptoms can occur due to a variety of factors mentioned above.
Doctors diagnose rosacea based on identifying the clinical features and subtype. Very rarely, a skin biopsy is needed. If you suspect that you have rosacea, it is prudent that you seek a doctor for proper diagnosis and treatment. The symptoms of rosacea can overlap with other dermatological conditions such as acne vulgaris, seborrheic dermatitis and eczema. If you are misdiagnosed, the inappropriate choice of skincare or medication may worsen your condition by damaging the skin barrier. This may perpetuate a vicious cycle or rosacea flares.
Treatment is centered on reducing symptoms and flares with a combination of lifestyle changes, skincare and medical therapies.
One of the key elements in self care is eliminating triggers that cause rosacea flares. Try to avoid food and drinks that trigger rosacea such as red wines (switch to white wine perhaps?) and spicy food. You can keep your room consistently cool with a fan or air conditioner. When exercising, keep your face cool by dabbing with a cold towel.
You can also consider trying probiotics. Although not completely understood, rosacea could also be caused by the increased numbers of Dermodex mites in the skin. Some studies show that probiotic supplements may improve rosacea by regulating the skin’s microbiome.
With rosacea, the skin can be irritable and hypersensitive. This does not mean that skincare should be abandoned. Instead, go lean with your steps and pick the right skincare ingredients and products. The right choice of skincare products can reduce flares, decrease inflammation and protect the skin.
Here’s what you should include in your skincare regimen:
• Sunscreen to reduce UV exposure which triggers rosacea flares.
• Moisturiser to reduce transepidermal water loss to reduce dryness, peeling and roughness. An effective moisturiser that also repairs the skin barrier is ceramides. Another safe and effective ingredient in moisturisers is hyaluronic acid.
• Non-foaming or soap free cleanser. Cleansing removes dirt and chemicals which irritate the skin. Non-foaming or soap free face cleansers do not damage the skin’s barrier.
Update: This blogpost, 5 Skincare Tips for Rosacea,will share more details about the ingredients to avoid if you have rosacea and sensitive skin in greater detail.
Treatments for rosacea consist of topical treatments, oral medications and laser and LED therapies in clinics.
Topical treatments reduce inflammation and erythema in rosacea. Some examples of these medications are metronidazole, azelaic acid, ivermectin (Soolantra) and brimonidine (Mirvaso). These medications can come in creams, gels or lotions. You can read more about Azelaic acid in this blogpost Azelaic Acid: A Multitasking Skincare Active to Know.
Oral medications, namely antibiotics, are prescribed if the symptoms and flares are not controlled by topical medications. Isotretinoin (roaccutane) may also be prescribed for severe or persistent papules and pustules. You can read more about Isotretinoin in this blogpost Is Isotretinoin (Roaccutane) Dangerous?
For persistent persistent redness and visible blood vessels (telangiectasias), lasers and LED light therapy are effective treatments.
Rosacea is a fairly common skin disorder in Singapore that affects mostly females, fair skinned patients and the 30-50 age group. The most common presentation and stage in Singapore is erythematotelangiectatic rosacea, where patients suffer from redness, flushing, stinging and visible blood vessels. Rosacea can also cause pimples (papules and pustules) and dry and sensitive skin; so it may also be misdiagnosed as acne vulgaris and eczema.
In Singapore, the most common triggers are sun exposure and food and drinks. Some lifestyle changes that can improve rosacea are sun protection and eliminating these food and drinks. Sunscreen and skincare products that protect the skin barrier are essential to reduce inflammation and flares.
Besides these lifestyle changes, medical treatment is usually necessary to control rosacea. Medical treatment comprises topical medications, oral medications and lasers and LED light therapy. If you think that you have rosacea, it is important to seek a doctor’s help early to be correctly diagnosed. Rosacea is a medical condition that requires topical medications at the very least; if left untreated, it can progress to cause fibrosis and lumpiness in the face.
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