Rosacea treatment in London
Rosacea is a highly prevalent skin condition and affects many people in the UK. Rosacea is a chronic skin condition which tends to undergo a unpredictable course. Low grade inflammation is responsible for the facial redness, flushing and the often visible blood vessels or thread veins. In untreated cases of rosacea, the patient may develop raised papules and pustules on the face. Rosacea. Rosacea undergoes flare-ups which can last a few weeks to many months followed by spontaneous resolution without any active treatment.
Rosacea commonly develops after the age of 30, and tends to affect people with lighter skin types. Although rosacea is seen more commonly in women, the more severe grades of rosacea tend to occur in men. In many cases, roascea can be heridatary with the condition running in families. Currently there is no definitive cure for rosacea but fortunately there are many excellent treatments with a proven track record. Our dermatologists are specially trained in the treatment of rosacea and achieve excellent outcomes to improve the quality of life of sufferers of rosacea.
RealSelf Top Doctors
RealSelf top doctor status is awarded to less than 10% of the RealSelf doctor community. This status is earned by achieving consistently high patient satisfaction (from RealSelf reviews), getting excellent feedback on expert answers to patient questions, and after investing significant time in Q&A and other doctor activity. RealSelf top doctors are rated among the very best surgeons in the United Kingdom and USA.
Our dermatology clinic at 106 Crawford Street was recently inspected and rated by the Care Quality Commission as good across all five domains of care.
Causes of Rosacea
Rosacea remains an incompletely understood condition and the precise causes are therefore unknown. There are however, a number of possible explanations for the appearance of facial redness:
Defects in blood vessels
The facial redness of rosacea may partly be down to an underlying defect in the superficial blood vessels. The blood vessel dysfunction is possibly linked with raised levels of a number of growth factors including vascular endothelial growth factor and certain prostaglandins and pro-inflammatory cytokines. VEGF is responsible for the profliferation of new blood vessels. VEGF also makes the tiny capillaries more leaky which leads to the plasma part of blood being released into surrounding tissues. This results in the formation of a localised inflammatory process which leads to the commonly observed signs of redness. The prostaglandins are responsible for increasing the diameter of the blood vessels and this also contributes to the redness observed.
In more chronic forms of rosacea, the facial flushing and chronic skin changes are often due to the presence of pro-inflmmatory cytokines. The dermodex mite parasite has also been found in more chronic forms of rosacea. The follicle sebaceous shafts are where the mites tend to reside. Research has shown raised levels of the dermodex mite in rosacea sufferers. With increased levels of mite, skin irritation then becomes an added problem.
Everyday common precipitating causes of rosacea
The exact causes of rosacea are unknown although there are known to be a number of triggers which can make rosacea appear. For any rosacea sufferer, it is important to steer clear of these triggers for optimal control.
- Food with a high spice content such as Indian food
- Heavy alcohol intake
- Hot cups of tea or coffee
- Hot showers, saunas or steam rooms
Clinical features of Rosacea
Rosacea has a number of characteristic clinical features and our dermatologists will accurately assess you to determine your particular sub-type of rosacea. The following clinical features are most commonly found in most forms of rosacea:
- Persistent facial flushing and redness – Patients with rosacea often have diffuse facial redness with associated flushing. In many cases, patients often report their faces feeling very warm when the flushing starts
- Inflammatory lesions (red papules and pustules) – small red lesions that are raised along with small pustule lesions. In papulo-pustular forms of rosacea, acne can be mistakenly misdiagnosed as the two conditions can look very similar. The key distinction lies in the stinging and burning sensation which most patients get with papulo-pustular rosacea.
- Facial thread veins (telangiectasias) – facial thread veins are often seen on the cheeks and nose. These blood vessels are also known as facial telangiectasia and often a feature of the blood vessel inflammation that occurs in rosacea.
- Facial warmth, burning, or stinging sensation – patients often find they experience a warming sensation on the face in the early phase of rosacea which progress to burning and stinging sensations when patients experience an exacerbation of rosacea.
- Facial Edema – swelling of the face is a very common feature of rosacea.
- Disfigurement of the nose – In advanced cases of rosacea and particularly in men, the skin of the nose may begin to thicken and can cause a severe cosmetic disfigurement. This is called rhinophyma and severe cases may even impair breathing.
- Red and watery eyes – ocular rosacea is a distinct subtype of rosacea which often presents as red, watery and irritable eyes. The eyelids can look inflamed mimicking the appearance of a blepharitis. In more advanced cases of ocular rosacea, localised bacterial infections of the eyelids can occur or even visual disturbance in severe cases.
Prevention of Rosacea
The most important aspect of the management of rosacea is learning how to prevent exacerbations of rosacea. Every individual will have certain triggers which may not the be the same in others. Treatment is always tailored to the individual and the specific type of rosacea. Patient education is important in order to understand the condition as much as possible along with the maintenance of good hygiene.
How to prevent rosacea:
- Avoid spicy foods such as indian food
- Avoid alcohol or at least reduce consumption to as little as possible. White wine is known to be better than red wine.
- Learn effective stress coping strategies. Stress is a well known trigger of rosacea
- Avoid the use of aggressive skincare and hair products. Exfoliating skin care products should be avoided.
- Keep well protected from sunlight exposure. Using suncreeen of at least SPF 30 is highly recommended
- Reduce intake of hot drinks such as tea and coffee
- Avoid use of heavy make-up and foundation that is water-repellent.
- Avoid use of hot showers, saunas and steam rooms and other environment which could make your skin get hot
- Tell your dermatologist what medicines you are taking, both prescribed and over the counter. Many medicines can make rosacea worse
Treatment of Rosacea
Currently, there is no single treatment which will eliminate rosacea. Treatment is therefore targeted based on symptoms, severity and the specific type of rosacea. Combination treatment is usually the best treatment strategy.
Topical Prescription Medications for rosacea
Brimonidine gel available in either 0.33% or 0.5% strengths. Brimonidine is applied one daily resulting in an improvement in redness which can last up to 12 hours. Treatment must be applied daily as the redness will quickly reappear otherwise. Oxymetalozine have also provided improvements but are not yet routinely available.
Topical metronidazole is used to reduce facial redness and is known to be effective in reducing the pustular component of rosacea. Recurrent of symptoms is uncommon with metronidazole and is generall safe and effective with a small risk of side effects including irritation and dermatitis.
Azelaic acid has antioxidant, antimicrobial and anti inflammatory activities which help to reduce redness and skin thickening. It is applied once daily and is safe to use in pregnancy. Side effects are minor and include irritation, dryness and burning/stinging sensation.
Retinoids such as tretinoin are able to stimulate connective tissue remodelling which helps to repair any sun induced damage. They also have anti-inflammatory actions. In combination with other topicals, tretinoin is able to reduce redness, papules and/or pustules although treatment can take months.
Oral Prescription Medications
Tetracycline antibiotics have been for rosacea treatment for over 50 years and are generally safe to use. Doxycycline is used at a 50mg dose for both treatment and prevention of rosacea. Although Doxycycline is an antibiotic, it exerts useful anti-inflammatory effects which help to reduce redness. Other antibiotics such as erythromycin may also be used.
Although topical and oral antibiotic treatments are good for inflammatory aspects of rosacea, they are less effective on improving the diffuse redness and prominent facial blood vessels.
Isotretinoin also known as Roaccutane is usually the last line of treatment for patients who have shown a lack of response to other commonly used treatments. Isotretinoin taken at low doses have resulted in improvement of facial redness, papules and pustules with a lower risk profile. Isotretinoin carries recognised adverse side effects and all patients are placed under close supervision of a dermatologist. It is very important to use adequate contraception while on Isotretinoin as the drug is not safe to use in pregnancy (risk of birth defects).
Laser treatment for Rosacea
Lasers in the treatment of rosacea are able to reduce both erythema and telangiectasia. The objective is to reduce the density of the blood vessels in the superficial part of the skin which leads to reduction in redness as well as both both flushing symptoms and the burning and stinging sensations. Many types of lasers and light devices have been increasingly used in the treatment of rosacea. Laser can be used for both the two most common subtypes of rosacea – erythemato-telangiectatic (ETR) and papulo-pustular (PPR) forms. The long-pulsed Nd:YAG laser is an excellent laser treatment used by dermatologists at Centre for Surgery. With Nd:YAG treatment, the entire face is treated. There is no requirement for topical anaesthesia although an air cooling device is used to protect the skin and also to reduce discomfort during treatment. Treatment is repeated at 3-4 week intervals.
Patients treated with Nd:YAG laser can become asymptomatic however it cannot be considered a cure as the underlying disease processes are not fully addressed and the patient may get an exacerbation in future. However, in our experience it does lead to long periods of disease remission. Because of lower melanin absorption with Nd:YAG lasers, there is less concern for epidermal damage, and they may be more safely used to treat patients with darker skin. Compared to other lasers, the risk for post-inflammatory hyper-pigmentation is very low. Nd:YAG laser is a very successful treatment in rosacea patients, and the effect among ETR patients was greater than for PPR patients.
Rosacea treatment before and after
Top Rosacea specialists in London
Our specialist dermatologists are experts in the diagnosis, treatment and management of all types of rosacea. We always customise treatment to the individual based on your lifestyle, goals and severity of condition. No two skin types are the same and therefore every case of rosacea is different. Depending on the subtype of rosacea, some patients can get good results with a straightforward topical skincare routine coupled with laser treatments to maintain remission. Other patients will need oral medication early on to control symptoms. Our dermatologists have access to the full range of treatment options using gold standard treatment protocols to ensure your rosacea is kept under control and reduce the risk of potential exacerbations.