Fact Sheet 6

Rosacea

What is Rosacea?
Rosacea (pronounced roh-ZAY-sha) is a common rash, found on the central part of the face, usually of a middle-aged person. A tendency to flush easily is followed by persistent redness on the cheeks, chin, forehead and nose, and by crops of small inflamed red bumps and pus spots. It is a different condition to the more common Acne vulgaris and the two are often confused. Rosacea is much less well diagnosed than acne vulgaris, a frequent misconception being that the red face of Rosacea sufferers is mistaken for acne or due to a “healthy” outdoor complexion or worse. What is less frequently observed is the mental stress and anxiety that can accompany Rosacea. In recent surveys by the National Rosacea Society, more than 76 percent of rosacea patients said their condition had lowered their self-confidence and self-esteem, and 52 percent reported it had caused them to avoid public contact or cancel social engagements.

What are the symptoms?
The face becomes flushed and red and typically feels itchy and burning. Small white and yellow pimples may appear,
which sometimes become pustules. In some cases the rash becomes permanent, leaving the skin red. When the nose is affected, particularly in older men, the skin becomes thickened, swollen and purple, a condition called rhinophyma.
The skin of the face feels sensitive, and can burn or sting. Flushing (the face becomes bright red) adds to the
embarrassment caused by the rash. Be sure to consult your doctor if you have problems with your eyes.

Who's affected?
Up to one in ten people may have rosacea. Although it can appear for the first time at any age, it more commonly
appears between the ages of 30 and 55, with women more often affected than men. It can run in families.

What causes rosacea?
The cause of rosacea is not fully understood, but many think that the defect lies in the blood vessels in the skin of the
face, which dilate too easily. Rosacea is more common in women than in men, and in those with a fair skin who flush
easily. Many things seem to make rosacea worse, but probably do not cause it in the first place. They include alcohol,
too much exercise, both high and low temperatures, hot spicy foods, stress, and sunlight. Things that stir up one
person’s rosacea may well have no effect at all on the rosacea of someone else. The idea that rosacea is due to germs in the skin, or in the bowel, has not been proved. Rosacea is not catching.

What does rosacea look like?
Rosacea starts with a tendency to blush and flush easily. After a while, the central areas of the face become a deeper shade of red and end up staying this colour all the time. The area becomes studded with small red bumps (papules) and pus spots, which come and go in crops. Small dilated blood vessels (telangiectasia) appear, looking like thin red streaks. Scarring is seldom a problem.

Subtype 1                           Subtype 2 (erythematotelangiectatic     (papulopustular rosacea)                               rosacea)	Subtype 3                            Subtype 4 (phymatous rosacea)            (ocular rosacea)

The consensus committee and review panel of 17 medical experts worldwide identified four subtypes of rosacea,
defined as common patterns or groupings of signs and symptoms. These include:

• Subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent redness, and may also
  include visible blood vessels.
• Subtype 2 (papulopustular rosacea), characterized by persistent redness with transient bumps and pimples.
• Subtype 3 (phymatous rosacea), characterized by skin thickening, often resulting in an enlargement of the nose  
  from excess tissue.
• Subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen
  eyelids, recurrent styes and potential vision loss from corneal damage.

Many patients experience characteristics of more than one subtype at the same time, and those often may develop in
succession. While rosacea may or may not evolve from one subtype to another, each individual sign or symptom may
progress from mild to moderate to severe. Early diagnosis and treatment are therefore recommended.

Other problems with rosacea include the following:
• Rosacea can lead to embarrassment, anxiety, or depression, and a disrupted social life.
• The face may swell (lymphoedema), especially around the eyes.
• The nose may grow big, red and bulbous (rhinophyma) due to the overgrowth of the sebaceous glands. This is more
  common in men than women.
• Some people with rosacea have eye symptoms (red, itchy, sore eyes and eyelids; a gritty feeling; sensitivity to light).
A few patients with rosacea have more serious eye problems, such as rosacea keratitis, that can interfere with vision.

What is the treatment?
It isn't possible to prevent a first attack, but those affected can learn to avoid common triggers. These include hot food
and drink, alcohol, spicy foods, caffeine, temperature changes, exposure to the sun or wind and stress. When flare-ups occur they can be successfully treated with topical antibiotics. Other treatments may be necessary for more severe causes of rosacea, and surgery or laser treatment can be used to treat rhinophyma. No treatment can be guaranteed to switch rosacea off forever. However long-term treatments control symptoms and can clear the spots. Treatment works best if started when rosacea is at an early stage. Although it's difficult to predict how long rosacea will last, in time it does disappear.

Patients should check with their physicians to ensure their skin-care routine is compatible with their rosacea. A gentle
skin-care routine can also help control rosacea. Patients are advised to clean their face with a mild and non-abrasive
cleanser, then rinse with lukewarm water and blot the face dry with a thick cotton towel. Never pull, tug or use a rough washcloth.

Patients may apply non-irritating skin-care products as needed, and are advised to protect the skin from sun exposure
using a sunscreen with an SPF of 15 or higher.

Cosmetics may be used to conceal the effects of rosacea. Green makeup or green-tinted foundations can be used to
counter redness. This can be followed by a skin-tone foundation with natural yellow tones, avoiding those with pink or orange hues.

What can you do?
Unfortunately there is no cure for rosacea, but it can usually be effectively controlled if you are aware of several
external influences that may aggravate the skin.
• Protect your skin from the sun by using a sun block on your face every day (at least SPF15) even on shady days.
• Do not rub or scrub your face as this can make rosacea worse.
• Consider the lifestyle factors that can stir up rosacea (listed above). Learn which worsen your rosacea and avoid
  them. A written record of your flare-ups may help here.
• Cosmetics can often cover up rosacea effectively. Certain skin care products - Avoid using wrinkle creams,          cleansers  containing alcohol, exfoliating/abrasive cleansers.
• If your eyes are giving problems, do not ignore these - consult your doctor.
• Temperature extremes - Heat is a major cause of flare ups, so avoid hot baths and showers, dress in cool,
  lightweight clothing (avoid woollens completely).
• Hot drinks - Tea and coffee particularly, but any hot drink bring on flushing.
• Spicy foods - Avoid Chillies, curries, pickles, mustard and horseradish.
• Alcohol - Even a few sips can affect some people.

Skin Care & Cosmetics
Consistent, gentle skin care and effective use of makeup can make a visible difference in managing rosacea and
improving the look of your skin. The key is to use products and techniques that minimize irritation. One good guide:
look for products that are noted as appropriate for sensitive skin or skin with rosacea — and avoid any products that
sting, burn or cause irritation. In a National Rosacea Society survey of 1,066 patients, 41 percent reported that
certain skin-care products aggravated their condition and 27 percent said certain cosmetics also caused rosacea flareups.

To avoid irritation, follow these tips when choosing skin-care and makeup products:
• Watch out for common rosacea irritants. In surveys conducted by the National Rosacea Society, many patients cited
the following ingredients as triggers for irritation: alcohol (66%), witch hazel (30%), fragrance (30%), menthol
(21%), peppermint (14%) and eucalyptus oil (13%). Most respondents said they avoided astringents, exfoliating
agents and other types of products that may be too harsh for sensitive skin.
• Choose fragrance-free skin-care and makeup products. According to the American Academy of Dermatology,
"Fragrances cause more allergic contact dermatitis than any other ingredient." Skin is a vast portal for allergens,
and the irritations allergies bring can weaken skin even more. Using fragrance-free and allergy-tested products
reduces your risk of skin irritation. Note that "allergy tested" shouldn't be confused with "hypoallergenic," a term
that is not clearly defined by the cosmetics industry.
• Test a product first. Before using a product on your face, try it on a patch of skin in a peripheral area, such as the
neck. If you have a reaction, avoid the product and note the ingredients. Rosacea irritants may vary from person to  person, so your individual skin's reaction should be your guide.
• Use minimal products. Rosacea patients should also consider reducing the number of items they use on their skin by
choosing products with multiple functions.
• Proper, consistent skin care is an important measure to calm skin with rosacea and help minimize redness and
irritation - Moisturiser, according to many dermatologists, moisturiser is a key for preventing the burning, stinging,  itching and irritation associated with rosacea. It's important to build a strong moisture barrier to help keep out  impurities and irritants that may aggravate sensitive skin. Some moisturizers contain sheer, green-tinted neutralizers  to help correct the appearance of redness, an additional benefit for skin with rosacea.
• A sunscreen of SPF 15 or higher should be used the year round. Daily sun protection is a must for any skin type, but  anyone with rosacea should be especially vigilant. Sun exposure was named a top trigger for rosacea flare-ups by 81 percent of patients in a National Rosacea Society survey, and is also linked to the visible blood vessels (telangiectasia) and severe redness often associated with rosacea.

Cleansing Tips
To minimize skin irritation, try this gentle, step-by-step cleansing routine developed by leading dermatologists for
people with rosacea.
1. Using your fingertips, wash skin with a cleanser suitable for your skin type. Avoid using an abrasive washcloth or
sponge, which may irritate.
2. Rinse away cleanser with lukewarm water. Hot or cold water may cause flushing or irritation. If your face is irritated by water at any temperature, try using a soothing cream cleanser you can simply tissue off.
3. Gently blot your face dry with a thick-pile cotton towel. Don't rub skin, as this may cause irritation.
4. Since stinging most often occurs on damp skin, wait 30 minutes for the face to dry completely before applying any
topical medication. Slowly reduce the drying time until you find the least amount of time your skin needs to avoid a
stinging sensation.
5. After applying topical medication, wait five to 10 minutes more before applying moisturizer, sunscreen or makeup.
6. If you have ocular rosacea, be sure to follow your doctor's directions for eyelid scrubbing and medication.

For Men: Shaving Tips for Skin with Rosacea
Shaving may pose a unique challenge for men with rosacea. Here's what you can do to help get a closer shave
without irritating skin.
• Shaving. Men with rosacea may prefer an electric razor to avoid the irritation of a dull razor blade.
• Lotion. Avoid any shaving creams or lotions that burn or sting your skin.
• Aftershave. Use a post-shave balm and/or moisturizer to help soothe the skin.

Disclaimer

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. All content within Pure and Gentle SkinCare is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. Pure and Gentle SkinCare is not responsible or liable for any diagnosis made by a user based on the content of Pure and Gentle SkinCare website or advisers.  Always consult your own GP if you're in any way concerned about your health as he or she will be able to advise in greater detail. 

Other helpful information sites

www.nhs.uk  - telephone 0845 4647 to speak to an adviser or nurse

www.britishskinfoundation.org.uk - helpful advise on many different types of skin problems

www.rosacea.org - a support and informastion website for people suffering with rosacea

www.bbc.co.uk/health - information website