Rosacea Treatment

Rosacea is a highly prevalent skin condition and affects many people in the UK. Rosacea is a chronic skin condition which tends to undergo an unpredictable course. Low grade inflammation is responsible for the facial redness, flushing and the often visible blood vessels or facial thread veins. In untreated cases of rosacea, the patient may develop raised papules and pustules on the face. Rosacea undergoes flare-ups which can last a few weeks to many months followed by spontaneous resolution without any active treatment. Rosacea can in many cases mimic the appearance of active acne.

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, rosacea can be hereditary 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.

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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.

Inflammatory processes

In more chronic forms of rosacea, the facial flushing and chronic skin changes are often due to the presence of pro-inflammatory 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 mites, 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 several 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

Rosacea has several 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 oedema – 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 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 blepharitis. In more advanced cases of ocular rosacea, localised bacterial infections of the eyelids can occur or even visual disturbance in severe cases.

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 sunscreen of at least SPF 30 is highly recommended.
• Reduce intake of hot drinks such as tea and coffee.
• Avoid the use of heavy makeup and foundation that is water-repellent.
• Avoid the use of hot showers, saunas and steam rooms and other environments 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.

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

Topical antibiotics are used to reduce facial redness and is known to be effective in reducing the pustular component of rosacea. Recurrent symptoms are uncommon and is generally 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 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, topical retinoids can reduce redness, papules and/or pustules, although treatment can take months.

Oral Prescription Medications for rosacea treatment

Tetracycline antibiotics have been used for rosacea treatment for over 50 years and are generally safe. Tetracycline antibiotics are used to both treat and prevent rosacea. They exert useful anti-inflammatory effects, which help to reduce redness. Other antibiotics, such as 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.

Roaccutane is usually the last line of treatment for patients who have shown a lack of response to other commonly used treatments. Roaccutane taken at low doses has resulted in improvement of facial redness, papules and pustules with a lower risk profile. Roaccutane carries recognised adverse side effects and all patients are placed under the close supervision of a dermatologist. It is very important to use adequate contraception while on Roaccutane as the drug is not safe to use in pregnancy (risk of birth defects).

IPL treatment for rosacea treatment

Rosacea can be very effectively treated with IPL or intense pulsed light and is commonly used by dermatologists to achieve effective symptom control in relapses of the condition. IPL acts on the small superficial blood vessels located beneath the skin. The pulses of light emitted from the IPL handpiece impart thermal energy to the blood vessels causing them to reduce in size significantly. The appearance of the skin is visibly improved following treatment. Your dermatologist takes special precautions during treatment to prevent injury to other parts of the skin. It is common to experience mild discomfort during treatment and is often compared to a light flick of an elastic band against the skin. In some cases, you may prefer to have a topical anaesthetic applied before treatment. The final results are determined by the number of treatments and how severe the grade of rosacea is.

Our specialist dermatology clinic is a centre of excellence for the treatment of all types of rosacea and facial redness.

Laser treatment for Rosacea

Lasers in the treatment of rosacea can 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 a reduction in redness as well as both flushing symptoms and burning and stinging sensations. Many types of lasers and light devices have been increasingly used to treat rosacea. The laser can be used for both the two most common subtypes of rosacea – erythematous-telangiectatic (ETR) and papulopustular (PPR) forms. The long-pulsed Nd:YAG laser is an excellent laser treatment used by dermatologists at the 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 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.

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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 your 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 controlled and reduce the risk of potential exacerbations.

You will be booked in to see one of our expert dermatologists at Centre for Surgery on Crawford Street in Marylebone for your rosacea consultation.

Centre for Surgery is located at 106 Crawford Street in Marylebone. Crawford Street is just off Baker Street. We are easily accessible by all major bus routes that pass through Baker Street as well as Baker Street underground station.

From the tube station, we are just a 5 minute walk southwards down Baker Street followed by a right turn onto Crawford Street. The clinic is about 200 yards on the left.

There is ample local pay & display parking in the surrounding area and an NCP car park is located further west along Crawford Street. Our local residential parking zone is the City of Westminster.

Address: 106 Crawford Street, Marylebone, London, W1H 2HY

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