What is the cause of rosacea?
The cause of rosacea is unknown. There are several theories regarding the origin of overactive facial blood vessels and inflammation, including genetic, environmental, vascular, inflammatory factors.

Hair follicle mites (Demodex folliculorum) may be involved in at least some cases, as these are found in greater numbers within rosacea papules.

An increased incidence of rosacea has been reported in those who carry the stomach bacterium, Helicobacter pylori, but most dermatologists do not believe it to be the cause of rosacea.

Rosacea may be aggravated by facial creams or oils, and especially by topical steroids.

Clinical features
Rosacea used to be called ‘acne rosacea’ but it is quite different from acne. There are red spots (papules) and sometimes pustules in both conditions, but in rosacea they are dome-shaped rather than pointed and there are no blackheads, whiteheads, deep cysts, or lumps. Rosacea may also result in reddened skin, scaling and swelling of affected areas.

Characteristics of rosacea include:

• Red papules and sometimes pustules on the nose, forehead, cheeks and chin. Rarely it involves the trunk and upper limbs.

• Frequent blushing or flushing

• A red face due to persistent redness and/or prominent blood vessels – telangiectasia

• Dry and flaky facial skin

• Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)

• Sensitive skin: burning and stinging, especially with make-up, sunscreens and other facial creams

• Red, sore or gritty eyelid margins including papules and styes (blepharitis and/or conjunctivitis) – ocular rosacea

• Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening – rhinophyma

• Firm swelling of other facial areas including the eyelids – blepharophyma

Treatment
General measures

• Where possible, reduce factors causing facial flushing.

• Avoid oil-based facial creams. Use water-based make-up.

• Never apply a topical steroid to the rosacea.

• Protect yourself from the sun. Use light oil-free facial sunscreens.

• Keep your face cool: minimize your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.

Oral antibiotics

Tetracycline antibiotics including doxycycline and minocycline reduce inflammation. They reduce the redness, papules, pustules and eye symptoms of rosacea. The antibiotics are usually prescribed for 6 to 12 weeks, the duration and dose depending on the severity of the rosacea. Further courses are often needed from time to time as the antibiotics don't cure the disorder.

Sometimes other oral antibiotics such as cotrimoxasole or metronidazole are prescribed for resistant cases.

Topical treatment
Metronidazole cream or gel can be used intermittently or long term on its own for mild cases and in combination with oral antibiotics for more severe cases.

Azelaic acid cream or lotion is also effective, applied twice daily to affected areas.








 

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