Rosacea Treatment

Rosacea is a chronic skin rash that mainly affects the central part of the face. The target age groups include patients between the ages of 30 and 60 years old.

Rosacea can be triggered by genetic, environmental, vascular, and inflammatory agents. Chronic exposure to ultraviolet (UV) radiation can also contribute to skin damage.

Rosacea commonly appears in the form of red spots (papules) and, in rare cases, as pustules. These spots have a dome-shaped form. Patients diagnosed with rosacea experience frequent facial blushing or flushing. Sun exposure, hot and spicy food or drinks can cause increased amounts of redness. Individuals with sensitive skin may experience burning and stinging sensations in response to makeup products, facial creams, and sunscreens. Ocular rosacea may also be diagnosed when the eye area is affected; it is characterised by red, sore, and gritty eyelid margins with papules and styes.

General Measures

General management of rosacea includes avoiding oil-based facial creams; water-based skincare and makeup products are recommended instead. Sun exposure should be minimised, and light oil-free facial sunscreens are advised. To decrease the flushing effect, it is recommended to reduce consumption of hot and spicy foods and alcohol, and to avoid hot showers and baths. Some individuals apply ice around the mouth area or between the gum and cheek to reduce facial redness for short periods of time.

Topical Steroids

Topical steroids are not recommended for treating rosacea. Although short-term improvements have been observed, long-term use causes rosacea outbreaks to become more severe due to increased production of nitric oxide.

Oral Antibiotics

Various oral antibiotics are prescribed as course treatments for rosacea. Tetracycline antibiotics, such as doxycycline and minocycline, are frequently used. They help to reduce redness, pustules, papules, and eye symptoms. These antibiotics are typically prescribed for a course of 6 to 12 weeks, with duration and dosage determined individually based on the severity of the condition. Further prescriptions are required periodically, as antibiotics do not cure the disorder.

The anti-inflammatory effects of these antibiotics are currently under investigation; however, promising results have been reported. These antibiotics tend to inhibit the functions of matrix metalloproteinases (MMP), which in turn decrease inflammation and cathelicidins.

Long-term antibiotic use carries the disadvantage of promoting bacterial resistance. Low doses that do not carry antimicrobial effects are therefore preferred for treating various skin conditions, including rosacea.

Topical Treatments

Topical treatments are also employed in the management of rosacea. Metronidazole cream or gel is prescribed for mild inflammatory rosacea and may be combined with oral antibiotics in more severe cases. Azelaic acid cream or lotion is an effective remedy for mild inflammatory rosacea and is applied twice daily.

Medications to Reduce Flushing

Certain medications such as carvedilol and clonidine help to reduce vascular dilation, which in turn reduces flushing. These medications are generally well-tolerated. Potential side effects may include dry eyes, low blood pressure, low heart rate, and blurred vision.

Oral non-steroidal anti-inflammatory agents such as diclofenac help to reduce discomfort and redness of affected skin. Serious adverse effects are uncommon; however, rare occurrences of renal toxicity, hypersensitivity reactions, and peptic ulceration have been reported.

Vascular Laser and Intense Pulsed Light Treatment

Vascular laser or intense pulsed light (IPL) treatment can effectively reduce persistent telangiectasia (cutaneous blood vessels). Light pulses are targeted at the red pigment known as haemoglobin in the blood. The pigment is heated and destroyed without affecting the surrounding tissues and skin.