Have you ever looked at someone and thought, “Why are they blushing all the time?!” Chances are, they might be suffering from a chronic skin condition called rosacea

Rosacea is often characterised by red flare ups and remissions in the central face, and patients generally experience flushing or redness on the nose, chin, cheeks or forehead. While this flushing may come and go, studies show that over time it becomes more persistent with visible blood vessels. If left untreated, pimples and red inflammatory bumps may develop. Patients may sometimes confuse these bumps with acne. In severe cases, excess tissue growth may cause the nose to look swollen and bumpy. At this stage, as many as 50% of patients experience irritated and bloodshot eyes.

Who is more likely to get rosacea?

Although rosacea can develop at any age, it is more likely to occur after age 30. For reasons we don’t exactly know, rosacea happens more in women but tend to be more severe in men. This disorder also tends to affect individuals with fair skin more — especially those who tend to flush or blush easily. Today, the cause of rosacea remains unknown, but researchers have at least identified that the role of the immune system plays a significant role in the development of rosacea. It is believed that an increase in mast cells, located between the nervous system and vascular system, is identified in patients with this disorder. 

Demodex folliculorum, a microscopic mite, is also believed to be a contributor to rosacea. Demodex folliculorum is a normal inhabitant of human skin; however it is more prominent in the facial skin of rosacea patients. Recent studies also show the link between rosacea and serious systemic diseases like gastrointestinal disease and autoimmune diseases, suggesting that rosacea may actually be a result of systemic inflammation. 

What we are certain, however, is the impact rosacea has on patients. In surveys conducted by the National Rosacea Society, a staggering 90% of patients reported that this disorder lowered their self esteem and confidence, and 41% have avoided public contact or cancelled social engagements at one point. Nearly 88% of those with severe rosacea reported that their professional interactions have been severely affected due to the condition, and about 51% skipped work before.

Is there a cure for rosacea?

Unfortunately, there is no cure of rosacea, but because we are aware of the signs and symptoms of rosacea, we can at least effectively control it from progressing through medical therapy and lifestyle changes. If you suspect you have rosacea or know or someone who may have it, please see a qualified physician to get treatment before the disorder affects your daily life.

What to look out for

While rosacea can vary from one individual to another, it usually contains at least one or two of the following signs:

Persistent facial redness 

Also the most common sign of rosacea, persistent facial redness resembles a sunburn or blush that does not go away.

Skin thickening

Skin thickening is commonly seen on the nose. This characteristic is known as rhinophyma. It is not common, but if severe can lead to facial disfigurement and insufficient nasal airflow.

Flushing 

Many patients with rosacea experience facial redness with a feeling or heat or burning that comes and goes. This is usually an early feature of rosacea.

Bumps and pimples

Small red bumps and pimples that resemble acne often develop. They come with a burning or stinging sensation.

Visible blood vessels

Prominent and obvious small blood vessels are common in many patients with rosacea. These blood vessels usually appear on areas of the central face like the cheeks and nasal bridge.

Eye irritation

Some patients may experience ocular rosacea, where their eyes appear watery or bloodshot. Their eyelids may be red and crusty. 

Treatment options for rosacea in Singapore 

In Singapore, treatment for rosacea would differ across individuals depending on each unique case. Options include:

1. Topical medications like antimicrobials and alpha adrenergic agonists to temporary shrink blood vessels

2. Oral medications like antibiotics and oral retinoids to reduce inflammation and down regulate the local skin immunity

3. Vascular lasers
Vascular lasers are used to target and destroy haemoglobin in blood vessels. The laser of choice depends on the characteristics of your skin and blood vessels. But generally, longer wavelengths like the 940nm diode laser would be a better fit for larger vessels and patients with darker skin, and shorter wavelengths like the 585nm pulsed dye laser may be more suitable for smaller vessels closer to the skin’s surface. 

4. Radiofrequency
Insulated radiofrequency needles puncture and coagulate the blood vessels without hurting the skin. The damaged vessels are absorbed by the body. 

5. Intense Pulsed Light
IPL can target haemoglobin in the blood, provided they are used with vascular filters. As such, normal IPLs without vascular filters like in spas and beauty salons would not be safe or effective.

Conclusion

Rosacea is a difficult condition to live with, but with proper diagnosis and treatment, it can be effectively managed regardless of your skin colour. The key is to get treatment before it’s too late! 

References

  1. Buddenkotte, J., & Steinhoff, M. (2018). Recent advances in understanding and managing rosacea. F1000Research, 7, F1000 Faculty Rev-1885. https://doi.org/10.12688/f1000research.16537.1
  2. Two, A. M., Wu, W., Gallo, R. L., & Hata, T. R. (2015). Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. Journal of the American Academy of Dermatology, 72(5), 749–760. https://doi.org/10.1016/j.jaad.2014.08.028