Causes of rosacea are not well known. Rosacea is often considered a hereditary condition. It is also said that rosacea is likely to occur in people who blush a lot. Occurrence of rosacea can be associated with environmental, chemical, food or emotional triggers. Common triggers include exposure to extreme heat and cold weather, hot beverages and spicy foods, and alcohol consumption. As a large number of hair follicle mites (Demodex folliculorum) are found in rosacea papules, they are also a possible cause of rosacea. The stomach bacterium helicobacter pylori is also reported to be associated with rosacea, though most dermatologists disagree with this theory. Rosacea may worsen with the use of facial creams, oils and topical steroids.

• Redness on the face, particularly the cheeks, nose, chin and forehead.
• Small red lines beneath the skin due to the thickening of blood vessels (telangiectasia).
• Skin becomes thicker, particularly over the nose.
• Hard raised lesions (papules) and pus filled acne pimples (pustules) develop on the reddened facial skin.
• Inflammation in the eyes causing a burning or stinging feeling.
• Irritation in the eyes, watery eyes, sensitivity to light and sometimes blurred vision.
• In advanced cases, the nose becomes larger and swollen with thickened skin causing a rhinophyma.

Rosacea-subtypes:

There are 4 sub-types of rosacea.

1. Erythematotelangiectatic rosacea marked by flushing and redness.
2. Papulopustular rosacea with papules and pustules and burning and stinging sensation.
3. Phymatous rosacea characterised by thickening skin and enlargement as in rhinophyma.
4. Ocular rosacea marked by ocular changes like conjunctivitis, telangiectasis of the conjunctiva and inflammation of the eyelids.

There are four acknowledged stages of rosacea.

1. First stage is called pre-rosacea characterised by facial blushing which may begin in early childhood, though the condition of rosacea sets in after the thirties. Frequency of flushing may increase and experience of burning and stinging when using antiacne products or cosmetics may be common.
2. In the second stage which is vascular, redness (facial erythema) and thickening of the blood vessels and their visibility on the skin as small red lines (telangiectasis) develop.
3. In the third stage facial erythema and telangiectasis increase with the formation of papules and pustules. In this stage changes in the eye (ocular changes) like inflammation of the eyelids and watering of the eyes begin to occur.
4. In the fourth stage, the skin and eye inflammation increase to a great extent. In very rare and severe cases ocular inflammation can lead to loss of vision whilst fibroplasia and sebaceous hyperplasia of the skin lead to rhinophyma.

It can lead to frustration due to the unattractive appearance and the discomfort experienced. It can mar the personal, social and professional life of the individual. In extreme cases the psychological effects of such a condition can be very serious and can cause the patients to become reclusive. Rosacea is primarily a facial occurrence and develops gradually. In its initial stages, patients often mistake the facial flushing, papules and pustules for adult acne, sun burn or normal signs of ageing.

There is no cure for rosacea. But there are various rosacea treatments to control rosacea effectively. Your Palm Clinic doctor will determine a treatment plan for you depending on the extent of damage to the skin.  IPL and laser treatments are most useful for the facial redness and flushing.

The first line of treatment for the pustules associated with rosacea is often topical or oral antibiotics generally prescribed by the family doctor. Metronidazole (Rosex) is generally given as a topical antibiotic. Oral medications include tetracycline antibiotics like tetracycline, doxycycline and minocycline. The antibiotic rosacea gel or rosacea cream should be applied on the entire face instead of on the lesion spots alone.

The eyelids should be cleaned everyday with a diluted baby shampoo or a rosacea cleanser for the eyelids. Warm compresses should be applied on the eyelids a few times a day.

For treatment of rosacea in the advanced stages like rhinophyma, laser or radiofrequency surgery is the ideal method to remove the excess tissue on the nose.

• Improves appearance.
• Boosts self confidence and self-esteem.
• No downtime with most rosacea treatments including IPL.
• Long-lasting results.
• Few or no side-effects.