Rosacea – Treatments for 4 Types of Facial Redness recommended by a Skin Expert

If you experience persistent redness on your face, you may be suffering from rosacea. It is a common inflammatory skin condition that impacts a large portion of the fair-skinned population. The skin condition is more prevalent in women between 30 and 50 years of age, but there can be manifestations of the condition across all age groups and in men.

Although it may be more common in people with fair skin, blue eyes and Celtic ascendance, rosacea is not uncommon in Asian populations. The itchy, stinging skin condition is often mistaken for eczema, leading to non-precise treatments that may exacerbate the condition.

Constant facial redness is the most common sign of rosacea and resembles a frequent flush or sunburn that does not go away. Such redness may be accompanied by a tingling heat or warmth that comes and goes.

Types of Rosacea

Rosacea can be classified into 4 clinical subtypes: erthematotelangiectatic, papulopustular, phymatous and ocular. Most subtypes have characteristics of flushing and telangiectasia, where small blood vessels are prominent and visible. Patients are often diagnosed with more than one rosacea subtype and experience increased sensitivity of the facial skin such as burning, stinging or itchy sensations.

Erythematotelangiectatic rosacea is characterised by redness and flushing in the centre of the face, with telangiectasia present in most patients. The skin may be very sensitive and swollen.Telangiectasias are visible small, broken or widened blood vessels. Erythematotelangiectatic rosacea is the most common subtype and has a tendency to flush or blush more easily than other people.

Papulopustular rosacea is marked by bumps and pimples that result from chronic inflammation. Redness is also visible in this subtype, while telangiectasias may not be as evident here. This subtype may have acne-like breakouts and oily skin, but it must be differentiated from acne as the treatment required differs.

Phymatous rosacea is uncommon in women and develops over years. Marked by thickened skin and irregular skin surface, it has a bumpy texture. This subtype is rare, as the patient often has symptoms of another rosacea subtype first. The skin may thicken on the nose, chin, forehead, cheeks and ears, and pores appear large.

Patients with ocular rosacea may feel a burning sting around the eyes and experience crusty discharge on the lashes or eyelids. For this subtype, rosacea is affecting mostly the eye. The eyes may be more sensitive to light. Eyelids can be swollen and styes can be frequent. Patients having this condition may also have a watery or bloodshot appearance and may not have their vision as well as before.

Causes of Rosacea

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said:  “There is an underlying genetic predisposition for patients with rosacea, individuals with a family history of rosacea are more likely to develop the condition. While studies on the cause of rosacea remain unclear, it is proposed that underlying features are inflammation and vascular reactivity, leading to erythema (redness) and presence of papules and pustules.”

Certain triggers can stimulate an immune response, such as alcohol consumption, spices, hormones, stress, UV radiation, microbes, extreme weathers, humidity and certain cosmetics.

In the pathogenesis of rosacea, it is proposed that a microbial organism called Demodex Folliculoru incites a flare by triggering an immune response in patients. In simpler terms, patients with the condition do not react well to certain triggers as they incite an exaggerated immune response. The immune system then releases an overproduction of factors, leading to inflammation and vascular dilation.

Treating Rosacea

Treatment begins with a proper diagnosis, including identifying the subtype. Most therapies focus on suppressing the symptoms and targeting inflammation.

Lifestyle interventions include using high-factor sunscreens, patient education, dietary changes and avoiding irritants and triggers. Photoprotection has always been an important step, but for patients with rosacea, it becomes even more crucial as photoprotection may prevent a flare triggered by sun exposure.

A gentle skin care regimen is recommended to maintain skin hydration and barrier function. These 2 factors are fundamental in improving the symptoms experienced by patients. In our dermatologist’s office, a Hyaluronic Acid serum and a ceramide-based Multi-CERAM moisturiser are often recommended to respectively hydrate and repair skin barrier function. Clinical practice has shown marked improvements in cases with a strong focus on hydration and repair of the skin barrier. This helps to suppress the exaggerated inflammatory response in patients, which contributes to the facial redness observed.

Topical treatment options to inhibit the inflammatory pathways that are involved in rosacea include azelaic acid, erythromycin and metronidazole. Depending on the severity of the condition and the patient’s skin sensitivity, the medium of the topicals may be lotion, cream, gel or foam.

Short-term oral antibacterials such as tetracyclines and macrolides may also be prescribed when topical therapies fail to control the disease. For persistent cases of facial redness, oral isotretinoin may also be required. Laser, light-based therapies and surgical interventions are also treatment options for certain patients.

In addition, as the psychosocial impact of the condition can greatly influence individuals, cover-up or colour-correcting powders can be recommended to mitigate the effect.

Conclusion

Rosacea is a medical condition that is often under-diagnosed and under-treated, even though the condition potentially has a great psychosocial impact on the affected individual. As the common initial symptoms are often mistaken for something else, such as sunburn, the condition may go undiagnosed for most patients.

A proper diagnosis along with precise treatments can significantly improve the patient’s quality of life. If symptoms of persistent facial redness appear, it is recommended to consult an accredited dermatologist for advice and proper management, to keep the condition at bay.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.