Rosacea

Rosacea is a chronic inflammatory condition affecting the central face - cheeks, nose, chin and forehead. It typically begins with flushing, progresses to persistent redness, and in some people goes on to visible vessels, bumps and pustules.

It affects fair-skinned adults most commonly, usually starting between 30 and 50, and it runs in families. It is often mistaken for acne or for a sensitive skin type, and the treatment for those is not the treatment for this.

Say this plainly: rosacea is managed, not cured

Rosacea is a long-term condition with flares and quiet periods. Treatment controls it. Stopping treatment generally means it returns. Any claim that a course of anything will cure rosacea should be treated with suspicion.

Within that reality, good management makes a large difference - to appearance, to comfort, and to how often flares occur.

The subtypes

These often overlap, but identifying the dominant pattern determines treatment:

• Erythematotelangiectatic - flushing, persistent redness, visible small vessels, stinging and sensitivity
• Papulopustular - red bumps and pustules on a background of redness; the type most often confused with acne, though it lacks blackheads
• Phymatous - thickening of the skin, most often the nose (rhinophyma). Uncommon, and far more common in men.
• Ocular - dry, gritty, irritated eyes and inflamed lids. Often missed. If you have rosacea and persistent eye symptoms, see an optometrist or ophthalmologist; untreated ocular rosacea can affect the cornea.

What causes it

The underlying cause is not fully established. Current understanding points to a combination of abnormal blood vessel reactivity, an over-active innate immune response in the skin, and a genetic predisposition. Demodex folliculorum - a mite that lives normally on human skin - is present in greater numbers in rosacea, and may contribute to inflammation in some people, but calling it "the cause" of rosacea overstates the evidence.

Triggers

Triggers do not cause rosacea, but they provoke flares, and identifying yours is genuinely useful. Common ones:

• Sun exposure and heat - the most frequently reported
• Alcohol, particularly red wine
• Spicy food and hot drinks
• Hot showers, saunas, exercise
• Cold wind
• Stress
• Some skincare - alcohol-based, fragranced or abrasive products
• Some medications, including topical steroids, which can worsen rosacea considerably

Keeping a short diary of flares for a few weeks tends to identify a person's triggers faster than any test.

Treatments used at Me Clinic

• Laser and light - Nd:YAG targets individual visible vessels; Laser Genesis and IPL reduce diffuse background redness. These are the most effective in-clinic options for the vascular component.
• LED therapy - to reduce inflammation
• Cosmeceutical skincare - gentle, barrier-supporting products; the wrong skincare routine is a common reason rosacea stays inflamed
• Daily broad-spectrum sun protection - mineral sunscreens are often better tolerated
• Mineral make-up - green-toned products neutralise redness; also a physical sun barrier
• Gentle peels where appropriate, used conservatively

Prescription treatment

Papulopustular rosacea generally responds best to prescription medication, topical or oral. Those are prescription-only medicines and cannot be named in advertising to the public; they require a doctor's consultation. See prescription medication.

What each part responds to

Feature	Responds best to
Visible individual vessels	Vascular laser
Diffuse background redness	IPL or Laser Genesis, in a course; maintenance needed
Bumps and pustules	Prescription medication
Flushing episodes	Trigger management; some prescription options
Skin thickening (rhinophyma)	Ablative laser or surgical reshaping
Eye symptoms	Referral to an optometrist or ophthalmologist

What results are realistic

Redness and visible vessels generally reduce substantially over a course of light-based treatment. Vessels can recur, and maintenance sessions are usual - often annually.

Bumps and pustules respond well to appropriate medical treatment, and relapse when it stops. Flushing is the hardest feature to control.

Individual results vary. Nobody should promise you an end to rosacea.

Risks

• Flare of the rosacea itself after treatment
• Redness, swelling and bruising after laser - purpura can last a week or more with some settings
• Blistering and crusting
• Changes in pigmentation, which can persist
• Scarring, uncommon but possible
• Infection
• Irritation from topical products
• Incomplete response and recurrence

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. A course is quoted after assessment; budget for maintenance as well as the initial course. Cosmetic treatment is not covered by Medicare, though medical management by a doctor may attract a rebate.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: capillaries and skin redness, facial veins and spider veins, acne, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.