Rosacea affects more than 40 million people worldwide1, and if left untreated, the disease may worsen over time.
The condition causes redness, both temporary and permanent, and often small, red, pus-filled bumps on the face.
Other symptoms of rosacea include itchy/sore/red eyes, dry appearance, itching, pain/stinging or burning, and a red, swollen nose.
Australian dermatologist and rosacea specialist Dr Belinda Welsh says common symptoms of rosacea can be easily overlooked, “which is why it’s important to raise awareness and provide those who may need medical advice with the support and treatment they need”.
The call for more awareness comes as 70 per cent of those in a survey who have suffered from rosacea say they wish more people understood the impact their skin condition has on their day-to-day life.2
Ongoing burden
The symptoms and impact of rosacea are more than skin deep. Global research released by Galderma in 2020 found half of those with rosacea who were surveyed reported that their disease had at least a moderate impact on their life and one in three felt their rosacea had a very large or extremely large impact on their life.3
Australian research launched during Rosacea Awareness Month in April found that 66 per cent of survey respondents who have experienced rosacea admit the condition had a negative impact on their mental health.2
The Galderma-led research surveyed 1086 Australians with skin conditions.
It revealed that those with rosacea were almost twice as likely to suffer from online bullying compared with the average of others with skin conditions (40 per cent versus 18 per cent).
Worrying about how their skin looks “all the time” was found to be a particular concern for younger generations, with 73 per cent of Gen Z respondents and 66 per cent of millennial respondents admitting the impact can be felt on a daily basis.
The study also revealed that skin condition sufferers feel most conscious in their day-to-day life when viewing their mirror reflection (34 per cent), in social settings (27 per cent) and while meeting new people (27 per cent).
This feeling of self-consciousness is accelerated online through social media platforms, with 48 per cent of surveyed Australians with skin conditions advising that social platforms make them more self-conscious about how their skin looks compared with others.
“We need to work to help break the taboo around skin conditions and ensure people feel confident to reach out and visit their GP or dermatologist,” Dr Welsh said.
Factors and triggers
Rosacea equally affects men and women, mainly in the 45-60 age group. It’s more common in light-skinned people and often goes undiagnosed among those with dark skin.
Dr Welsh says a number of factors may influence the likelihood of developing rosacea, including:
- Genetics. “It’s more common in people with northern European ancestry. It’s been described as ‘the curse of the Celts’. Some genetic variations have been found in people with rosacea, suggesting their immune system reacts more strongly to certain triggers.”
- Biologic factors. “Tiny mites called demodex that normally live in our hair follicles can be increased in some people with rosacea and are thought to play a part in triggering it. There’s also increasing evidence it may be associated with other inflammatory conditions – for example, inflammatory bowel disease and migraine.”
- Exposure to triggers.
Some common triggers of rosacea include:
- Heat and cold or a change in temperature.
- Too much UV radiation from the sun.
- Alcohol, as it aggravates flushing by a direct effect on the blood vessels and possibly the gut microbiome.
- Stress.
- Vigorous exercise.
- Spicy food. This modifies the body’s heat regulation and causes flushing.
“There are many different conditions causing facial rashes, so an accurate diagnosis is critical,” Dr Welsh said. “Many people get told they look like they’ve been sunburnt, because of the flushing and redness. Rosacea can also co-exist with many other common skin conditions, so it’s important to diagnose and treat all the contributing factors.”
Management
Rosacea can be successfully managed, so it’s important for those with symptoms to seek the medical support they need.
If left untreated, says Dr Welsh, rosacea will probably fluctuate in intensity over time and may gradually get worse.
“Rosacea doesn’t scar like acne can, but ongoing flushing can lead to the development of little capillaries on the skin that can be permanent,” she said. “Lasers are an excellent way of clearing these.
“Not everyone gets worse over time and not everyone gets the skin thickening (rhinophyma) which can happen to some people. Additionally, even if it’s gone untreated for a long time, it can always be managed.”
Disease symptoms and treatment regimens will vary depending on the type and severity of rosacea present and the individual factors that trigger the disease. Following appropriate diagnosis by a medical professional, different topical treatments can be prescribed, together with general skincare measures and the avoidance of known trigger factors (see above).
“Rosacea treatments aim to both relieve and prevent flare-ups, by targeting rosacea symptoms and inhibiting factors that exacerbate the disease,” Galderma Medical Director ANZ Khen Meng Kon said.
“Some agents work by constricting blood vessels, thereby reducing facial flushing. Other agents have anti-inflammatory and anti-parasitic properties, which reduce the inflammation, papules and pustules that may be associated with some types of rosacea, and the frequency of flare-ups.”
Patients with rosacea frequently have sensitive skin that is easily aggravated. For this reason, a gentle skincare regimen should always be adopted in conjunction with prescribed treatments, to reduce skin irritation and improve compliance with therapy, says Mr Kon.
“Skincare should include daily use of a gentle facial cleanser and moisturiser, such as [Galderma’s] Cetaphil Gentle Skin Cleanser and Cetaphil moisturising cream or lotion,” he said. “In addition, as sun exposure is known to be a trigger for rosacea flare-ups, a broad-spectrum sunscreen should be used routinely, such as Cetaphil UVA/UVB Defence SPF50+.”
Conversely, he adds that rosacea patients should avoid products containing ingredients that may irritate the skin further, “such as salicylic acid, AHA, BHA and topical retinols”.
Support
Mr Kon says pharmacists play an important role in rosacea patients receiving the optimal care they need.
“One of the issues with treatment of rosacea is treatment adherence, and pharmacists play an important role here by reinforcing the need for the daily application of topical treatments as well as recommending a simple and gentle skincare regimen for patients,” he said.
“Patients should see their local GP for ongoing advice on how best to manage their rosacea.”
Galderma is encouraging those experiencing symptoms of rosacea to visit a GP or dermatologist for a full diagnosis and plan.
For more information and resources on rosacea, visit faceuptorosacea.com.
References
- Shanler S, et al. J Am Acad Dermatol, 2008: AB9.
- Online survey commissioned by Mango Communications and conducted by Lonergan Research in accordance with the ISO 20252 standard.
- ‘Beyond the visible: Rosacea and psoriasis of the face’. Developed under the direction and sponsorship of Galderma International, with the survey conducted by Kantar Health and writing support provided by Abira Sittampalam, Havas Life Medicom.
This article was originally published in the May issue of Retail Pharmacy Assistants e-magazine.
