Beauty

Rosacea: everything you need to know, from early signs and symptoms to how to control flare-ups

Rosacea is a common and, often, stressful skin condition – but how much do you know about it? A consultant dermatologist explains all…

Some people associate rosacea with rosy cheeks, but it’s a long-term skin condition that goes much deeper beyond the surface. For some, symptoms can include swelling, dry skin, burning feelings and thickened skin. It’s also difficult to pinpoint what causes flare-ups, making it a difficult condition to live with.

Rosacea can begin at any time and at any age. For rosacea and skin positivity campaigner Lex Gillies, it was aged 18. “It was very mild but when I went to university, it started to become more noticeable and I was eventually diagnosed at 21,” says Gillies. “A combination of stress, poor diet, late nights, and too much alcohol left my skin purple, swollen, bumpy and sore”.

While triggers for flare-ups vary person-to-person, Gillies has realised stress is the biggest cause for her. “Something as small as running late for a meeting can result in a burning face that ruins my day,” she says. “A close second is direct sunlight and heat: my husband refers to me as ‘Vampire Wife’ as in the summer I scuttle from shadow to shadow, refusing to ever be in the sun!”

Unfortunately, rosacea is a skin condition that still isn’t taken seriously despite being common, particularly amongst women. This is something Gillies has been working hard to overturn – just last year, she got Instagram to change it policies on censoring skin conditions. Incredible.

So, to help everybody understand it better, we turned to Dr Anjali Mahto, consultant dermatologist at Skin55 and author of The Skincare Bible: Your No-Nonsense Guide to Great Skin, to help break down everything you need to know, from early signs to how to control it…

What is rosacea?

“Rosacea (from the Latin “rose-coloured”) is a common, inflammatory skin condition. It is unfortunately under-recognised, inappropriately treated or dismissed as a cosmetic concern rather than a recognised dermatological issue. It tends to affect women, usually with fair skin or of Celtic descent between the ages of 30-60 years of age.”

“Common features affecting facial skin include redness, flushing or blushing, sensitive skin, spots or pustules which look similar to acne and thread veins. Occasionally there can be a thickening of the tissue of the nose known as rhinopyhma. A number of people with rosacea may also suffer with eye symptoms such as dryness or grittiness.”

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Are there different types of rosacea?

“In the past, rosacea has been divided into subtypes on largely descriptive factors,” says Dr Mahto. These are:

  • erythematotelangiectactic: redness, flushing, and prominent blood vessels
  • papulopustular: acne-type with presence of spots or pustules
  • rhinopehyma: thickening of skin of nose
  • ocular: rosacea associated with the eyes

What are the main causes of rosacea?

“We do not understand the exact pathophysiology of rosacea but the process is due to underlying inflammation in the skin and hyper-reactivity of facial blood vessels due to a number of triggers. Personal genetics, factors involving the immune system and environment are all implicated. Common triggers include sun exposure, stress, alcohol, spicy foods, temperature changes, exercise and certain skincare ingredients such as fragrances, witch hazel, menthol, peppermint and eucalyptus oil.”

What are the early signs of rosacea? And what are the general symptoms?

“Redness, flushing, sensitive skin, acne-type spots and prominent blood vessels or thread veins can all be associated with rosacea. The key thing to recognise is that not everyone with rosacea will have every single one of the features mentioned above. Equally, not everyone who has a particular symptom or sign will be suffering to the same degree - there is a spectrum. When making a treatment plan, it is important that the treating dermatologist takes this into account and tailors a plan to the individual sitting in front of them. For example, facial redness is managed very differently to acne-type spots.”

How do you clear up rosacea?

“Rosacea is often managed badly as it seems to fall between the medical and cosmetic world. Managing rosacea is a tricky process as the condition is chronic (it can be controlled but not cured). Coming up with a treatment plan involves a combination of lifestyle factors including skincare, medical creams and prescription tablets, light and laser therapies, camouflage techniques (if the patient desires), as well as input from a clinical psychologist where possible. The end goal is to put the patient in control of their skin and not let their skin problems control them.”

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Dr Mahto’s tips for controlling rosacea:

  • “Wear a broad-spectrum sunscreen (ideally SPF 50) every day – over 80% of those who suffer with rosacea will find their facial redness is driven by UV light. Opt for a mineral sunscreen over a chemical one as this is less likely to cause sensitivity and irritation.
  • “Use skincare that is fragrance-free and minimalistic. Complex multi-step routines, acids, exfoliators, menthol and witch hazel can all be common triggers so are best avoided. I recommend the La Roche Posay Toleriane range or Avene Antirougeurs Clean Cleanser and skin recovery cream.
  • “Minimise known triggers where possible. Some people find that alcohol or spicy foods can be problematic – limit these.”
  • “See an appropriately trained medical professional. A consultant dermatologist will have extensive experience in managing the condition and those of us that do laser treatments will be able to put together the right plan in the right order to be able to advise you how to manage the condition both short and long term.”
  • “Green tinted primers can be worn under make-up to camouflage or neutralise redness – I like the Vichy and Smashbox ones.”
  • “I recommend nearly all of my rosacea patients receive input from a clinical psychologist if possible. Living with a visible skin condition can be extremely difficult, especially one that has a habit of flaring up at the most inconvenient of times or can be triggered by stress. Managing any long-term skin condition is a team effort with the patient, doctor, and ideally mental health input to realistically get a good outcome. As always, the impact that one’s skin can have on their self-esteem and body image should never be trivialised or ignored.”

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Main image: Lex Gillies

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