Medical Dermatology

Rosacea

Dr. Liew Hui Min

accredited consultant dermatologist

Rosacea is a chronic skin condition that primarily affects the face, causing redness, visible blood vessels, and pimple-like bumps. It commonly appears on the central areas of the face, including the cheeks, nose, forehead, and chin. Rosacea is thought to result from a combination of genetic factors, environmental triggers, and an abnormal immune response that causes inflammation in the skin. While there is no cure for rosacea, effective treatments can help manage symptoms and control flare-ups.

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Rosacea

Rosacea presents with a range of symptoms, from mild redness to more severe inflammation. The most common signs include:

Facial redness

Persistent flushing or redness, especially across the cheeks, nose, forehead, and chin, is a key characteristic of rosacea. This redness can intensify with triggers such as heat, stress, or alcohol consumption.
Visible blood vessels

Dilated blood vessels become more visible, causing the skin to appear flushed or blotchy. These vessels are more prominent in fair-skinned individuals.
Pimple-like bumps

Red, inflamed bumps and pustules resembling acne can form, often accompanied by swelling and irritation. Unlike acne, rosacea bumps do not contain pus.
Eye irritation

Ocular rosacea affects the eyes, causing dryness, redness, irritation, and a gritty feeling. It can lead to more severe eye conditions if left untreated.
Thickened skin

In some cases, especially in men, the skin can thicken, particularly around the nose (rhinophyma), leading to a bulbous appearance. This is a less common but more severe symptom of rosacea.

Causes and Risk Factors

Rosacea develops due to a combination of factors, including genetic predisposition, environmental triggers, and an abnormal immune response.

Genetics: A family history of rosacea increases the risk of developing the condition, indicating a hereditary predisposition. Genetic factors may influence how the body responds to triggers.

Immune system dysfunction: An overactive immune response may lead to inflammation in the skin and the dilation of blood vessels.

Environmental triggers: Common triggers include hot weather, spicy foods, alcohol, harsh skincare products and sun exposure. These can cause blood vessels to dilate, worsening rosacea symptoms.

Skin microorganisms: The Demodex mite, which naturally resides on the skin, has been linked to rosacea in some individuals. Overgrowth of these mites may contribute to inflammation.

Vascular changes: The dilation of blood vessels is central to the redness seen in rosacea. The body’s response to environmental stressors can lead to persistent vascular changes, contributing to the condition.

Types of Rosacea

Erythematotelangiectatic rosacea

This is the most common type, characterised by persistent redness, visible blood vessels, and a flushed appearance, particularly across the central face.

Papulopustular rosacea

Characterised by red, pimple-like bumps and pustules that may resemble acne. This type often results in a bumpy texture on the skin.

Phymatous rosacea

In more severe cases, rosacea can cause skin thickening, especially around the nose (rhinophyma), which can alter facial appearance and texture.

Ocular rosacea

Involves the eyes, causing dryness, irritation, redness, and a gritty feeling. Left untreated, ocular rosacea can lead to more severe eye complications.

Diagnostic Methods

Physical examination

The skin is closely examined for key signs of rosacea, such as persistent facial redness, visible blood vessels (telangiectasia), and pimple-like bumps (papules). The distribution and pattern of symptoms help distinguish rosacea from other skin conditions with similar features.
Medical history

A thorough history of symptom onset, duration, and known triggers is collected. Information about family history and any previous treatments provides valuable context for diagnosis and treatment planning.
Eye examination

If ocular rosacea is suspected, an eye examination is conducted to assess symptoms like dryness, irritation, burning, or redness, which are common in rosacea-related eye issues.
Laboratory tests

In certain cases, laboratory tests may be used to rule out other skin conditions that share symptoms with rosacea, such as acne, eczema, or other inflammatory skin disorders, ensuring an accurate diagnosis.

Treatment Options

Treatment for rosacea focuses on managing symptoms, reducing flare-ups, and improving quality of life. Various options are available depending on the severity of the condition.

Topical treatments

Ivermectin: A topical cream that works by reducing inflammation and helping to control the growth of microorganisms that contribute to rosacea flare-ups. It is particularly effective in reducing the number of pimples, pustules, and redness.

Brimonidine: A topical gel used to constrict the blood vessels in the skin, brimonidine is effective at reducing facial redness and visible blood vessels. By temporarily narrowing the dilated vessels, it provides relief from the persistent flush or redness that is characteristic of rosacea.

Oral antibiotics

Tetracycline antibiotics such as doxycycline are often prescribed for more severe cases of rosacea. These antibiotics help control inflammation and clear up bumps and pustules by reducing the presence of bacteria and modulating the immune response. They are typically used in a low dose over an extended period to manage rosacea symptoms effectively.

Isotretinoin

For persistent or severe rosacea, isotretinoin (oral retinoid) may be prescribed. It reduces the size and number of sebaceous glands, helping to control oil production and inflammation, which can significantly improve symptoms.

Pulsed dye laser (PDL)

This treatment targets visible blood vessels to reduce redness and enhance the skin’s appearance. By emitting short bursts of light, it effectively addresses the vascular issues associated with erythematotelangiectatic rosacea, helping to improve overall skin tone and reduce visible blood vessels.

Prevention and Management

While rosacea cannot be fully prevented, effective management involves identifying and avoiding triggers, such as hot weather, spicy foods, and stress. Regular moisturising helps maintain skin hydration, and sunscreen should be applied daily to protect against sun-induced flare-ups. Gentle skincare routines, including mild, fragrance-free products, are necessary to avoid irritation. Reducing stress through relaxation techniques can also help minimise flare-ups, and managing diet may reduce the severity of symptoms in some individuals.

Frequently Asked Questions

Can rosacea go away on its own?

Rosacea is a chronic condition, which means it does not typically resolve on its own. However, with proper treatment, its symptoms can be controlled, and periods of remission can occur. Without treatment, symptoms may worsen over time.

How does stress affect rosacea?

Stress can worsen rosacea by increasing inflammation and blood vessel dilation. Stress management techniques, such as relaxation exercises and regular sleep, can help reduce flare-ups and improve overall symptom control.

How long will it take to see results from treatment?

The time it takes to see improvements varies depending on the treatment and severity of rosacea. Topical treatments may take a few weeks to show noticeable results, while oral medications and laser treatments can take longer. Consistency with prescribed treatments and following a proper skincare routine can help improve outcomes over time.

Dr Liew Hui Min

Dually Accredited Dermatologist In Singapore and the UK

Dr. Liew Hui Min is an accredited consultant dermatologist from the Ministry of Health and the General Medical Council UK.

Her clinical interest includes:

Paediatric Dermatology,
Women’s Dermatology,
General Adult Dermatology.

Having trained in major London Hospitals, Dr Liew returned to Singapore in 2014 as a Consultant at KK Women’s and Children’s Hospital (KKH) where she specialised in paediatric, women, obstetric and vulva dermatology. Currently, Dr Liew practices at HM Liew Skin & Laser Clinic located at Gleneagles Hospital.

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