Rosacea is a distressing, commonly occurring skin condition that is due to a disorder of the pilosebaceous units of the skin and is characterised by a pink or red (flushed) appearing face which may be permanent or temporary. There are often also an increased number of telangiectasias or small red blood vessels present with papules or pustules. This generally affects the central face in a symmetrical distribution although the neck and upper chest can also be affected.
This condition affects up to 10 % of the population with women being more affected than men. It often occurs in adult patients usually in their 30’s to 40’s with a teenage history of acne.
Oftentimes, Rosacea is only recognised years later after the skin appearance and texture has been affected, and presents with:
- Flushing (with or without facial swelling and eye symptoms)
- Papules and pustules
- Rhinophyma (enlarged sebaceous glands leading to a large nose)
- Oily thick skin with enlarged pores
- History of acne
- Textural changes
- Post-inflammatory hyperpigmentation
- Skin sensitivity and irritability
The exact cause is unknown with experts thinking that is due to both inherited and environmental factors. Which commonly results in misdiagnosis and inappropriate treatment.
* It is useful to keep a journal as this may give an indication of what is triggering your Rosacea Everyone is different, but some common triggers are a cold wind that blows on your face or eating spicy foods. Others might include sunlight, stress, red wine, drugs, and exercise.
* For acne-like breakouts of Rosacea, your immune system seems to overreact to a bacteria called Bacillus oleronius.
* A type of bacteria called H. pylori normally lives in your gut. Some studies suggest this germ can raise the amount of a digestive hormone called gastrin, which might cause your skin to look flushed
* A common mite called demodex is linked to rosacea. They’re tiny insects. A type called Demodex folliculorum normally lives on your skin and usually isn’t harmful. Some people, though, have more of these bugs than usual. Too many mites could irritate your skin.
The fundamental treatment of Rosacea is control of the Pilosebaceous gland.
- Rosacea cannot be cured, only treated and controlled.
- For treatments to succeed well-defined goals must be set.
- Rosacea must be treated at the same time as other skin conditions such as Melasma or Erythema else those treatments may also fail.
- The biggest key to controlling rosacea is to avoid triggers – factors that cause the skin to flush.
- Treatment includes topical as well as oral medication as well as energy-based treatments and peels.
A. Treat sebaceous gland enlargement and hyperactivity to reduce sebum production, suppress inflammation, reduce breakouts, and prevent further textural damage.
B. Improve skin tolerance by restoring a strong Barrier function using ZO Skin Health Restoration Principles
C. Treat Rosacea induced PIH with HQ or non-HQ melanocyte stabilization methods
D. Calm the acne eruptions if present and reduce pore size by using standard ZO protocols as well as medications when required.
E. Improve skin texture and colour with Tretinoin as well as other procedures such as Chemical peel and Vascular laser treatments.
F. Antibiotics have only a limited role as bacterial infections are not really implicated in Rosacea and may result in antibiotic resistance.
Rapid treatment protocols include conditioning the skin for 6-12 weeks then treating with a Deep Chemical peel or a CO2 Laser then restarting Rosacea topical treatment combined with Isotretinoin.
Slower protocols involve the use of topical agents and oral Isotretinoin, using Deep chemical Peels and CO2 laser later only if needed.
Source: Dr Vernon Ching – Plastic Surgeon, Precision Aesthetics