Rosacea is an inflammatory skin disorder affecting 10% of the population, with a higher prevalence in females, fair skinned individuals and people over 30 years of age. The exact cause of rosacea is yet to be elucidated, however a genetic link has been suggested.
It predominantly affects the chin, nose, cheeks and the forehead, and typically moves through phases of exacerbation and remission.
Scientifically rosacea is a complex condition, however research has substantiated that there are nervous, vascular and immune influences involved in its development. These aspects are overstimulated within the area of concern and in combination with various trigger factors, lead to the development of the symptoms associated with the condition.
There are many trigger factors involved in the exacerbation of rosacea symptoms including:
- Environment: heat, extreme cold, extreme temperature changes, UV radiation, hot steam
- Chemicals: pH changes
- Microorganisms
- Emotional stress
- Exercise and physical stress
- Diet: spicy food, alcohol, specific vegetables, hot drinks
- Medications
- Irritating cosmetics: high alcohol content, formaldehyde, menthol, camphor, sodium lauryl sulphate.
UV exposure has also been implicated in rosacea amid concerns associated with UV radiation alongside the heat produced by the sun which can trigger symptoms. UV induced free radical damage has also been connected, and has the potential to cause damage to skin structures via inflammation which again exacerbates the symptoms . Antioxidant levels are decreased in rosacea due to higher levels of free radicals within the skin, hence the internal free radical defence system is compromised which can lead to skin damage due to oxidative stress.
Due to the above processes changes to the skins structure can be noted in rosacea including:
- Damage and degradation of blood vessels, collagen and elastin
- Increased numbers of skin blood vessels
- Persistent dilation of blood vessels
- Dilated lymphatic vessels
- Poor skin barrier function
- Development of fibrotic tissues
- Occasional presence of solar elastosis.
Generally rosacea starts with symptoms of transient flushing and skin redness, however over time as the skin loses structure and strength the symptoms tend to persist for longer and become more prominent. Constant triggering of symptoms can lead to worsening of the condition as a continuous cycle.
Common symptoms associated with rosacea may include some or all of the following:
- Dilated capillaries
- Skin inflammation
- Transient or persistent skin redness and flushing
- Papules and pustules
- Skin hypersensitivity: burning, stinging, pain and itching
- Heightened sensitivity to UV exposure
- Skin dryness and dehydration
- Rhinophyma: overgrowth of glandular tissue, particularly on the nose, causing physical abnormality (not common)
- Eye symptoms: conjunctivitis, blepharitis, burning, stinging, light sensitivity, foreign object sensation, keratitis (rare).
The use of appropriate skincare for rosacea sufferers is essential. Skincare for rosacea is based around reducing the symptoms of skin inflammation, redness, flushing, poor barrier function, dryness, dehydration and reactivity.
Regular skin cleansing is essential to remove excess environmental debris, cosmetics and microorganisms which can exacerbate the condition. It is recommended to use a well-tolerated, soap free facial cleanser that is customised to the skin type of the client. The water temperature should be luke-warm and irritating exfoliants should be avoided where necessary.
Moisturisers assist with supporting skin barrier function, and as this is depleted in rosacea, they assist with improving skin hydration and dryness, hence skin reactivity and symptoms of rosacea can decrease.
Sunscreens are essential for addressing UV exposure to reduce UV associated skin damage, triggering of symptoms and also to decrease free radical damage. Sunscreens containing zinc oxide and titanium dioxide tend to be better tolerated by rosacea clients.
Vitamin A/retinoids can assist with rebuilding the skin which will give it strength over time, hence lowers exacerbation periods. The use of camouflage makeup is also beneficial for rosacea to improve the self-esteem of the client.