Health
Freedom from rosacea: the latest advice and treatments that could change your life
Rosacea is a chronic skin condition that can seriously impact self-esteem and wellbeing. While it can’t be cured, the latest management techniques and treatments can help you get your life back.
By Sabrina Rogers-Anderson
Whenever a friend wants to take a selfie or a family photo op crops up, Jodie Humphries tries to find a way out of it or hides her face behind her beloved pooch Wally.
“I was diagnosed with demodex rosacea in 2021 and the flares make me so self-conscious,” she says. “The first doctor I saw prescribed an ivermectin cream that cleared it up so well. So, when it flared again a year later, I saw another doctor and asked for the same thing, but she gave me antibiotics and metronidazole gel to use topically.
“That treatment plan also cleared it up initially, but the flares are happening more often now, so I've been looking for over-the-counter products. I've tried a few brands of skincare that claim to help with rosacea, but I'm still flaring. I need to go back to my doctor and see what she says. It’s ironic that I'm having these issues with my face as an adult because as a teenager I had the most perfectly clear and clean skin.”
Jodie’s story is common for people with rosacea. With poorly understood causes and triggers that vary from one person to the next, getting this skin condition under control can be a long game of trial and error.
But understanding rosacea and the latest treatment options can help patients get their lives back. Here's everything you need to know.
What is rosacea?
Rosacea is a chronic inflammatory skin condition characterised by facial flushing, redness, rash and acne-like bumps.
It’s estimated to affect 5% of people globally. While it’s more common in women, middle-aged and older adults and people with fair skin, anyone can get rosacea. In fact, the condition may be underdiagnosed in people with darker skin because the redness is less apparent.
There are 4 types of rosacea with different symptoms:
- Erythematotelangiectatic rosacea: Frequent blushing, temporary or persistent redness in the central area of the face, and visible blood vessels on the nose, cheeks or chin.
- Papulopustular rosacea: Acne-like bumps (papules and pustules) on the face.
- Swollen rosacea: Thickened skin that looks like orange peel on the nose, cheeks, forehead and chin. In severe cases, swollen rosacea can lead to an enlarged or deformed nose with dilated pores known as rhinophyma.
- Ocular rosacea: Red, sore or gritty eyelids or eyes that can lead to inflammation and permanent vision damage if left untreated.
What causes rosacea?
The exact causes of rosacea are unknown. “All we know is that it’s a chronic immune reaction and genetics play a big role in it,” explains University of Queensland Associate Professor Dr Yousuf Mohammed. “If you have a thin stratum corneum, which is the upper barrier layer of the skin, that makes it far worse.”
Environmental factors, including UV light and a reaction to the demodex mite that lives on human skin, may also play a role.
What are common triggers of a rosacea flare-up?
Triggers vary from one person to another, so keeping a diary may help you identify the foods, skin care products, medications and activities that make your rosacea worse.
Common rosacea triggers include:
- Sunlight
- Hot or cold weather
- Hot baths and saunas
- Strenuous exercise
- Hot foods and beverages
- Spicy foods
- Alcohol
- Stress, anger or embarrassment
- Some skin care products (especially those containing alcohol and soap)
- Some medicines (including oral and topical corticosteroids and blood pressure medications)
“Anything that increases blood flow to the skin can be a potential trigger,” notes Dr Mohammed.
Using an SPF30+ sunscreen and products designed for sensitive skin can go a long way towards keeping symptoms at bay. Avoiding temperature extremes and hot or spicy foods and drinks may also help.
How is rosacea diagnosed?
Your doctor will look for signs of rosacea on your face and ask you questions about your medical history.
They may also want to do a blood test or biopsy to rule out any other skin or medical conditions.
How is rosacea treated?
“As with almost all non-cancerous dermatological issues that aren’t life-threatening, the approach for treatment is quite conservative,” says Dr Mohammed.
Treatment options include:
- Topical treatments: “We start with creams and gels,” says Dr Mohammed. “Metronidazole antibiotic cream is one of the most commonly used.” Other topical treatments include azelaic acid gel and ivermectin cream.
- Oral medications: “For severe, persistent spots, oral medications like antibiotics or steroids may be required,” Dr Mohammed explains. “Steroids are generally avoided because they reduce the thickness of the skin and people with rosacea already tend to have reduced skin thickness, but if the inflammation associated with rosacea is severe, it can cause disfiguration and steroids may have to be used.”
Isotretinoin - a potent vitamin A derivative - may also be prescribed to treat severe cases where antibiotics haven’t worked.
- Laser or intense pulsed light therapy: “Pulsed dye laser is commonly used to heal or seal up the superficial blood vessels that can be seen,” says Dr Mohammed.
- Surgery: “When you have inflammation that's been around for a long time, the body starts to create more keratin and the skin thickens,” explains Dr Mohammed. “You end up with a bump on your nose of excess tissue, which is known as rhinophyma.
“The excess tissue can be removed through surgery [excision using a scalpel] or electrosurgery, which uses a weak electrical current. Radiofrequency therapy and cryotherapy [cold therapy] can also be effective.” - Botox: More recently, botulinum toxin (Botox) has been used to effectively reduce redness and other symptoms associated with rosacea.
A holistic program may also be effective
As scientists gain a better understanding of the gut-skin axis – or the role gut health may play in some inflammatory skin diseases – a growing number of people with rosacea are focusing on improving their gut microbiome in an effort to keep flare-ups at bay.
With rosacea having been found to be associated with gastrointestinal disorders including celiac disease, Crohn’s disease, ulcerative colitis and irritable bowel syndrome, boosting gut health has the potential to kill two birds with one stone.
This strategy worked wonders for Kaia Mus, who thought she’d tried every treatment under the sun for her rosacea, but nothing worked and her quality of life was suffering. It wasn’t until she joined Zing Wellbeing’s holistic health program – which focuses on a wholefood diet rich in fibre, probiotics, polyphenols, and healthy fats – that she started to see improvements in her skin.
“I went into 2024 with a goal and a dream to become a better me, firstly for me and for my children,” she says. “My mental health has been transformed, my skin has changed and my body has gotten stronger.”
Freedom from flare-ups
By following the latest management advice and focusing on improving your wellbeing from the inside out, you may finally gain control over your rosacea and get your self-esteem back.
This article contains general information only. It is not intended as medical or health care advice and should not be used to diagnose or treat any symptoms. Always consult with your professional health care provider.
Feature image: iStock/mixetto
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