Visible on the outside and deeply hurts on the inside
11 December 2019| Last updated on 11 December 2019
When it comes to Rosacea, most dermatologists do agree upon the fact that their patients seem to have some version of the same complaint, being repeated over and over again:
“It was a hit-and-run for a while, but now it is obvious: my Rosacea is back with a vengeance. My face looks flushed again, and my skin is hot, dry, flaky, and itchy! I am annoyed with how much I have been scratching lately, and mostly I do not even notice until I am in the middle of a scratching frenzy or bleeding. I am feeling so depressed, frustrated, and helpless. It feels as if I am trying to run away from something really dreadful, and every time I think I have gained some safe distance, it gains back on me. There is no escape for me!"
With a probable global incidence of approximately 5% among adults, Rosacea represents a common skin complaint worldwide. It is a chronic, yet manageable, aliment that mostly affects the face, and is often distinguished by cyclic flare-ups and remissions. Although Rosacea may affect any race and develop at any age, it commonly affects fair-skinned Caucasian populations aged 30–60 years and presents with flushing or redness on the cheeks, nose, forehead and chin that may come and go.
Moreover, some people may experience the symptoms on their neck, arms or legs, as well as eye problems like redness, dryness and burning. By time, the redness tends to become more intense and persistent, and spider-like small veins become visible on the skin of the face.
Left untreated, bumps or pimples that may be pus-filled (known as pustules) often develop, the skin becomes dry and flaky. In advanced cases, the skin pores become larger, and the nose may become enlarged and unshapely because of skin thickening.
The exact cause of Rosacea is yet to be determined, but it can be due to a combination of genetic (it often runs in families) and environmental factors. Nevertheless, a variety of factors are notorious for their ability to trigger an overreaction of the blood vessels of the face, leading to skin flushing and inflammation.
Some of the common factors include:
- Alcohol consumption and smoking
- Hot drinks and spicy foods
- Excessive exposure to sunlight, weather extremes or strong wind
- Topical steroids application and a long list of facial creams, hair sprays or cosmetics
- Stress, anxiety, or embarrassment
Unfortunately, Rosacea can be emotionally troublesome as it impinges on appearance. This can affect how people feel about themselves and how they mingle socially with others, with many reporting feelings of shame, low self-esteem or frustration.
You can control the Symptoms!
Rosacea symptoms can be controllable. In addition to the lifestyle modifications you can adopt to reduce recurrent flare-ups, the good news is that significant advances in treatment have made it increasingly possible to achieve best possible outcomes, and in some cases, a clear skin!
The impact of Rosacea differs from one person to the other, and it can take time to figure out how to manage your condition effectively. Because proper diagnosis and subsequent timely treatment can considerably reduce the risk of Rosacea progression, the ideal way is to work with your dermatologist to develop a management plan.
While it is impractical to avoid all of the trigger factors, you can effectively minimize exposure as much as possible without hampering your quality of life (e.g. use a broad-spectrum sunscreen in case of exposure to the sun, put on a non-synthetic scarf to protect your face during wintertime, etc.). As regards controllable factors, keep a journal of the foods you eat and the cosmetics you put on your skin. This will help you figure out what induces a flare-up.
Medical treatment can include a combination of topical and oral medications. There is no `one size fits all`, and accordingly, your dermatologist will tailor your treatment regimen according to your individual health needs. These include:
- Topical medications: Help reduce skin inflammation and redness and are applied to the skin either once or twice daily. Metronidazole cream, Brimonidine gel, Ivermectin cream, and Azelaic Acid cream are examples of commonly-prescribed topical medications.
- Oral antibiotics: May be used during Rosacea flare-ups — when there is a fiery breakout or inflammation. They have been proven to keep Rosacea`s bacterial element under control and also possess an anti-inflammatory impact. Examples include tetracycline, doxycycline, and erythromycin.
- Laser, IPL or Radiofrequency treatment: Used selectively in some instances with advanced skin redness, they help to eliminate the visible blood vessels from the face.
Controlling skin flare-ups can feel like an ongoing battle. The most crucial thing in battling Rosacea is to visit your trusted dermatologist for proper assessment and management. It is equally important that your dermatologist rules out other skin diseases which can cause rash on face before starting treatment for Rosacea. Finding the most suitable therapy for your unique needs is the key.
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Authored by Dr. Bina Rabadia, MBBS, MD
Dubai London Clinic