A beginners guide to rosacea

Many of you have surely heard of rosacea. Rosacea is a common chronic inflammatory skin disorder that affects over 5% of the world’s population. It is commonly associated with redness and sensitivity, but rosacea is more complex than that. Did you know that there are four types? We have listed them below: 

  1. Erythematotelangiectatic rosacea (rosacea with flushes)  
    This is the most common one. The symptoms are periods of flushes in parts, usually the center, of the face. Over time, this chronic flushing can cause blood vessels beneath the skin surface to become enlarged, leading to permanent redness (erythema).   

  2. Papulopustular rosacea (rosacea with pimples) 
    This type involves a permanent reddening of the skin with sporadic pimples.  

  3. Phymatous rosacea (rosacea with enlarged nose)  
    This type is characterized by enlarged pores and redness leading to a swollen, enlarged nose.  

  4. Ocular rosacea (eye rosacea)  
    Ocular rosacea results in inflammation of the outer parts of the eye, with symptoms such as a dry sensation, reddening around the eyelashes, increased tear production, and styes.  

If you think you have rosacea you should always go to a dermatologist or doctor to be properly diagnosed.

Who does it affect?  

Rosacea affects mainly adults, both men and women, usually in in the ages of 45 to 60 years old. From a global perspective, the majority of the affected people live in northern Europe and are of Celtic origin.  

Rosacea not only affects people physically but also mentally. New research shows that its psychosocial impact can be very serious, leading to social anxiety and depression. Interestingly, men tend to experience worse psychological effects than women. 

Why do you get rosacea?  

The exact reason for rosacea remains unknown. Genetics appear to play a role, meaning that, for instance, if your mother has rosacea, you are more likely to get it too. Rosacea has also been thought to be linked with immune system disorders and increased nerve sensitivity. 

There are indications that rosacea sufferers have higher levels of Demodex mites (a type of parasite) living in their skin. We all have some number of mites in our skin. They thrive both in bed linen and skin. Demodex mites live in our hair follicles and sebaceous glands. According to one theory, their feces (poop) trigger an inflammatory response in our skin. 

There is also a medical link between rosacea and autoimmune diseases such as diabetes, coeliac disease (gluten intolerance), and rheumatism. 

Skincare habits may also be a cause of rosacea. A large study revealed that cleansing habits can influence the onset and development of rosacea. Over-cleansing appeared to be a big risk factor. We have written a summarized article on the study here.   

Psychological stress also appears to be a high contributing factor to rosacea. As a matter of fact, Dermatologists in Sweden reported an increased number of rosacea-cases during spring 2020, i.e. during the covid19-pandemic. It is believed that the reason behind this increased prevalence of rosacea is due to higher levels of psychological stress. 

How is rosacea treated?  

There is no cure for rosacea, but there are several treatments available. Today, the condition is often treated with antibiotics and topical medications that have anti-inflammatory properties. Many of them need to be prescribed by a doctor. The main treatments are:  

  • Treatments that reduce redness, for example brimonidine and oxymetazoline. These treatments reduce the blood supply to the skin, so keep the skin from reddening so much. Brimonidine is also used in eye drops to treat ocular rosacea.  
  • Anti-acne medications, for example azelaic acid and tretinoin. They are used to treat papulopustular rosacea. Exactly how these substances work is not fully understood, but it is believed that their anti-inflammatory properties help reduce the inflammation caused by rosacea.   
  • Antibiotics, for example metronidazole and tetracyclines. It is not known exactly why antibiotics affect rosacea, but one possible explanation is that the antibiotics kill bacterial growth in the skin potentially caused by mites’ feces. 
  • Ivermectin, an insecticide that kills Demodex mites, is one of the newer treatments for rosacea.

References 

Gillbro, J. (2019) Hudbibeln. Stockholm, Bookmark förlag. 

Steinhoff, M., Schauber, J. & Leyden, J.J. (2013) New insights into rosacea  Dermatology. [Online] 69 (6), S15–S26. Available from: doi:10.1016/j.jaad.2013.04.045. 

Li, G., Wang, B., Zhao, Z., Shi, W., et al. (2020) Excessive cleansing: an underestimating risk factor of rosacea in Chinese population. Archives of Dermatological Research. [Online] Available from: doi:10.1007/s00403-020-02095-w. 

Van Zuuren, E.J., Fedorowicz, Z., Carter, B., Van Der Linden, M.M., et al. (2015) Interventions for rosacea. Cochrane Database of Systematic Reviews. [Online] Available from: doi:10.1002/14651858.cd003262.pub5. 

Gillbro, J.M., Lundahl, M., Westman, M., Baral, R., et al. (2015) Structural activity relationship analysis (SAR) andin vitrotesting reveal the anti-ageing potential activity of acetyl aspartic acid. International Journal of Cosmetic Science. [Online] 3715–20. Available from: doi:10.1111/ics.12253.