Causes of Rosacea
The exact cause of rosacea is unknown, although a number of potential factors have been suggested.
It is possible a combination of these factors may be responsible for the condition, although there isn’t enough evidence to say this for certain.
Some of the main factors that have been suggested are outlined below.
Blood vessel abnormalities
Helicobacter pylori bacteria
Triggers of Rosacea
Although they are not thought to be direct causes of the condition, many people with rosacea find certain triggers make their symptoms worse.
Different people can have different triggers, but triggers that have been commonly reported include:
- Exposure to sunlight
- Hot or cold weather
- Strong winds
- Strenuous exercise
- Hot baths
- Spicy foods
- Hot drinks
- Caffeine (found in tea, coffee and cola)
- The menopause
- Dairy products
- Other medical conditions
- Certain medicines, such as amiodarone, corticosteroids and high doses of vitamins B6 and B12
There is no currently no known cure for rosacea, but there are treatments available to help keep the symptoms under control.
Long-term treatment will usually be necessary, althoughthere may be periods where your symptoms improve and you can stop treatment temporarily.
For most people, treatment will involve a combination of self-help measures and medication. The specific treatments that are recommended will depend on your symptoms.
For mild rosacea, topical medications are usually tried first. The two medications most often recommended are metronidazole or azelaic acid creams and gels.
There is some evidence azelaic acid may be more effective than metronidazole in treating rosacea, although it is also more likely to cause side effects such as skin irritation, a burning or stinging sensation, itchiness, or dry skin.
You will usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms.
If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduce inflammation of the skin.
Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for four to six weeks, but longer courses may be necessary if the spots are persistent.
Common side effects of these medications include:
- Feeling and being sick
- Bloating and indigestion
- Abdominal (tummy) pain
- Loss of appetite
Some of the medications used can also make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds.
As with the topical treatments mentioned above, these medications usually need to be taken once or twice a day and you may not notice a significant improvement in your symptoms for several weeks.
Isotretinoin is a medicine often used to treat severe acne, but at lower doses it’s also occasionally used to treat rosacea.
Treating facial redness
Treating facial redness and flushing caused by rosacea is generally more difficult than treating papules and pustules caused by the condition.
But as well as the self-help measures mentioned above, there are some medications that can help.
Brimonidine tartrate (available on prescription)
Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of a gel that is applied to the face once a day.
The medication works by restricting the dilation (widening) of the blood vessels in your face. Research has shown it can start to have an effect about 30 minutes after it is first used and this can last for around 12 hours.
Common side effects of brimonidine tartrate include itchiness and a burning sensation where the gel is applied. Less common side effects can include a dry mouth, headaches, pins and needles, and dry skin.
Alternatively, there are a number of oral medications that may help improve redness caused by rosacea.
- Clonidine – a medication that relaxes the blood vessels
- Beta-blockers – medications that decrease the activity of the heart
- Anxiety medications – medications sometimes used to help calm the person and reduce blushing
It’s not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist.
Laser and intense pulsed light (IPL) treatment
Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing.
The advice below about skincare techniques may also help control your rosacea symptoms.(speak to your practitioner)
- Gently clean your skin every morning and evening using a gentle, non-abrasive cleanser. Use soap-free cleansers with non-alkaline or neutral pH. Avoid scented soaps and alcohol-based skin cleansers.
- Rinse your face with lukewarm water and allow skin to dry thoroughly before you apply medication or make-up.
- Look for products suitable for sensitive skin. These are usually described as mild, hypoallergenic, fragrance-free and non-comedogenic (will not block pores).
- Use a moisturiser to soothe skin if it feels sore.
- Avoid oil-based or waterproof cosmetics requiring solvents for removal. Use water-based make-up and skin products instead.
- Avoid astringents, toners and other facial or hair products that contain ingredients that might irritate your skin, such as fragrances, alcohol, menthol, witch hazel, eucalyptus oil, camphor, clove oil, peppermint, sodium lauryl sulphate and lanolin.
- You may want to avoid using anything on your skin that you aren’t sure of. You can then gradually reintroduce products once your symptoms have been treated and cleared to see if you can use them again without any problems.
- Men may find that using an electric razor, rather than a blade, helps reduce skin irritation.
- Some people find regular gentle facial massage reduces swelling (lymphoedema).
- Do not use steroid cream unless you are specifically instructed to by your GP, as it may make your symptoms worse.
It may be possible to disguise patches of persistent red skin using specially designed “camouflage” make-up.
The charity Changing Faces offers a skin camouflage service, available nationally and free of charge, to help with the use of these creams.
Your practitioner can refer you to the skin camouflage service and prescribe skin camouflage make-up.