Rosacea is an inflammatory skin disorder affecting 10% of the population, with a higher prevalence in females, fair skinned individuals and people over 30 years of age3,4,6,8,9. The exact cause of rosacea is yet to be elucidated, however a genetic link has been suggested4,8,10.
It predominantly affects the chin, nose, cheeks and the forehead, and typically moves through phases of exacerbation and remission3,10.
Scientifically rosacea is a complex condition, however research has substantiated that there are nervous, vascular and immune influences involved in its development4,8,10. These aspects are overstimulated within the area of concern and in combination with various trigger factors, lead to the development of the symptoms associated with the condition8,10.
There are many trigger factors involved in the exacerbation of rosacea symptoms including:
- Environment: heat, extreme cold, extreme temperature changes, UV radiation, hot steam
- Chemicals: pH changes
- Microorganisms
- Emotional stress
- Exercise and physical stress
- Diet: spicy food, alcohol, specific vegetables, hot drinks
- Medications
- Irritating cosmetics: high alcohol content, formaldehyde, menthol, camphor, sodium lauryl sulphate4,6,7,8,9,11
The Demodex mite has also been implicated in the exacerbation of rosacea, with increased numbers being found within affected skin, especially in cases where papules and pustules are present4,8,10. It has been suggested that defective skin immune function may allow for greater numbers of this mite within the sebaceous gland and the affected skin of Rosacea sufferers, and with greater numbers comes an exacerbation of inflammation4,8.
UV exposure has also been implicated in rosacea amid concerns associated with UV radiation alongside the heat produced by the sun which can trigger symptoms8,10. UV induced free radical damage has also been connected, and has the potential to cause damage to skin structures via inflammation which again exacerbates the symptoms 2,6,8,10. Antioxidant levels are decreased in rosacea due to higher levels of free radicals within the skin, hence the internal free radical defence system is compromised which can lead to skin damage due to oxidative stress2,6,10.
Due to the above processes changes to the skins structure can be noted in rosacea including:
- Damage and degradation of blood vessels, collagen and elastin
- Increased numbers of skin blood vessels
- Persistent dilation of blood vessels
- Dilated lymphatic vessels
- Poor skin barrier function
- Development of fibrotic tissues
- Occasional presence of solar elastosis4,8,9,10
Generally rosacea starts with symptoms of transient flushing and skin redness, however over time as the skin loses structure and strength the symptoms tend to persist for longer and become more prominent4,10. Constant triggering of symptoms can lead to worsening of the condition as a continuous cycle4,9,10.
Common symptoms associated with rosacea may include some or all of the following:
- Dilated capillaries
- Skin inflammation
- Transient or persistent skin redness and flushing
- Papules and pustules
- Skin hypersensitivity: burning, stinging, pain and itching
- Heightened sensitivity to UV exposure
- Skin dryness and dehydration
- Rhinophyma: overgrowth of glandular tissue, particularly on the nose, causing physical abnormality (not common)
- Eye symptoms: conjunctivitis, blepharitis, burning, stinging, light sensitivity, foreign object sensation, keratitis (rare)3,4,6,8,9
Rosacea has the potential to progress through stages of severity overtime if not managed due to its chronic nature4,7,9. There is no cure for rosacea, rather treatment is based on alleviation of the symptoms present5,7,9,11. When treating rosacea, it is essential to avoid all trigger factors as much as possible4,5,7,11.
The use of appropriate skincare for rosacea sufferers is essential1,7. Skincare for rosacea is based around reducing the symptoms of skin inflammation, redness, flushing, poor barrier function, dryness, dehydration and reactivity1,4.
Regular skin cleansing is essential to remove excess environmental debris, cosmetics and microorganisms which can exacerbate the condition1. It is recommended to use a well-tolerated, soap free facial cleanser that is customised to the skin type of the client1,7. The water temperature should be luke-warm and irritating exfoliants should be avoided where necessary1.
Moisturisers assist with supporting skin barrier function, and as this is depleted in rosacea, they assist with improving skin hydration and dryness, hence skin reactivity and symptoms of rosacea can decrease1,4,5,7,11.
Sunscreens are essential for addressing UV exposure to reduce UV associated skin damage, triggering of symptoms and also to decrease free radical damage1,4,5,7,11. Sunscreens containing zinc oxide and titanium dioxide tend to be better tolerated by rosacea clients1,7.
Due to the situation of oxidative stress caused by free radicals, antioxidants assist with supporting the internal antioxidant systems to reduce free radical damage4,6. Antioxidants are often used in combination with anti-inflammatory botanical ingredients such as Ginko biloba, green tea, Aloe vera, allantoin and licorice1.
Vitamin A/retinoids can assist with rebuilding the skin which will give it strength over time, hence lowers exacerbation periods7,11. The use of camouflage makeup is also beneficial for rosacea to improve the self-esteem of the client1,5.
It is important to note that if cosmetic interventions are no longer successful, medical treatment may be required5.
1Draelos, Z. (2017). Cosmeceuticals for rosacea. Clinics in Dermatology, 35(2), 213-217. Doi: 10.1016/j.clindermatol.2016.10.017
2Erdogan, H. K., Bulur, I., Kocaturk, E., Saracoglu, Z. N., Alatas, O., & Bilgin, M. (2018). Advanced oxidation protein products and serum total oxidant/antioxidant status levels in rosacea. Advances in Dermatology and Allergology, 35(3), 304-308. doi:10.5114/ada.2018.76228
3Gallo, R. L., Granstein, R. D., Kang, S., Mannis, M., Steinhoff, M., Tan, J., & Thiboutot, D. (2017). Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology, 78(1), 148-155. doi: 10.1016/j.jaad.2017.08.037
4Holmes, A. D., & Steinhoff, M. (2017). Integrative concepts of rosacea pathophysiology, clinical presentation and new therapeutics. Experimental Dermatology, 26(8), 659-667. doi: 10.1111/exd.13143
5Moustafa, F. A., Sandoval, L. F., & Feldman, S. R. (2014). Rosacea: new and emerging treatments. Drugs, 74(13), 1457-1465. doi: 10.1007/s40265-014-0281-x
6Oztas, M. O., Balk, M., Ogus, E., Bozkurt, M., Ogus, I. H., & Ozer, N. (2003). The role of free oxygen radicals in the aetiopathogenesis of rosacea. Clinical and Experimental Dermatology, 28(2), 188-192.
7Schaller, M., Schofer, H., Homey, B., Hofmann, M., Gieler, U., Lehmann, P., Luger, T. A., Ruzicka, T., & Steinhoff, M. (2016). Rosacea management: update on general measures and topical treatment options. Journal of the German Society of Dermatology, Supp 6, 17-27. doi: 10.1111/ddg.13143
8Steinhoff, M., Buddenkotte, J., Aubert, J., Sulk, M., Novak, P., Schwab, V. D., Mess, C., Cevikbas, F., Rivier, J., Carlavan, I., Deret, S., Rosignoli, C., Metze, D., Luger, T. A., & Voegel, J. J. (2011). Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. Journal of Investigative Dermatology Symposium Proceedings, 15(1), 2-11. doi: 10.1038/jidsymp.2011.7
9Steinhoff, M., Schauber, J., & Leyden, J. J. (2013). New insights into rosacea pathophysiology: a review of recent findings. Journal of the American Academy of Dermatology, 69(6 Supp 1), S15-26. doi: 10.1016/j.jaad.2013.04.045
10Two, A. M., Wu, W., Gallo, R. L., & Hata, T. R. (2015). Part I: introduction, categorization, histology, pathogenesis, and risk factors. Journal of the American Academy of Dermatology, 72(5), 749-758. doi: 10.1016/j.jaad.2014.08.028
11Two, A. M., Wu, W., Gallo, R. L., & Hata, T. R. (2015). Part II: topical and systemic therapies in the treatment of rosacea. Journal of the American Academy of Dermatology, 72(5), 761-770. doi: 10.1016/j.jaad.2014.08.027