What is Rosacea?
Rosacea is a chronic skin condition that affects those areas of the face that normally blush – forehead, nose, cheeks and chin. Blood vessels in these areas become engorged by triggering factors causing redness and warmth. Small blood vessels also become visible in these areas as they enlarge – these are called telangiectasia. An added feature of Rosacea is acne-like eruptions that occur and the condition can be mistaken for acne. Unlike acne it affects adults, both male and female and is more frequent in women.
Anything that promotes flushing should be avoided e.g. hot beverages, spicy foods, direct sun light and hot temperatures. Extreme cold temperatures should also be avoided as these can cause a reflex vasodilatation (enlargement) of the blood vessels. Alcohol is a trigger factor as well as some medications e.g. potent steroid creams and some anti-hypertensives (medications for elevated blood pressure).
Avoid stress, cigarette smoking and stimulants such as coffee. Avoid creams and moisturizes that might irritate the skin. Avoid face creams that are alcohol based.
Complications of Rosacea
Untreated, the erythema (redness) becomes more intense as does the eruptions (pimples). Untreated Rosacea of the nose leads to a condition called Rhinophyma – a bulbous, enlarged red nose.
The eye can also be involved in Rosacea with conjunctivitis – gritty, itchy eyes and if left untreated may progress to Keratitis which can impair vision.
There is no cure for Rosacea, as yet. A number of treatment options are available.
Topical creams such as metronidazole, azaleic acid have been tried and may be more effective if used in conjunction with a low dose oral antibiotic – a tetracycline.
Intense Pulsed Light (IPL) is another recognised treatment for Rosacea – again it does not offer a cure. This technique depends on the conversion of light energy to heat energy, thereby coagulating blood in the abnormal blood vessels, damaging them. It requires a number of treatments – 3 to 5 – and patients obtain relief from flushing and redness. This treatment is relatively safe and although patients undergo same discomfort, there is minimal down time from the treatment.
A further modification of IPL treatment is called Photodynamic Therapy or PDT. This involves preparing the affected area with a topical cream containing 5-Aminolevulinec Acid (5-ALA). ALA is a natural product found in the body. This cream is left on the affected skin with plastic occlusion (cling wrap) for 1hr to allow it to be absorbed and metabolised by the target tissue (abnormal blood vessels). The metabolic process converts the 5-ALA to a very light sensitive by product called Protoporphyrin IX. The area is then exposed to IPL treatment. The disadvantage with this modification is that the patient must avoid ultraviolet light for 24hrs (must stay indoors with blinds and shutters closed), however, the outcome is more superior to IPL alone and often less treatments are required.