Rosacea

What is Rosacea?

Rosacea is one of the commonest skin problems presenting to Facial Artistry. It mainly affects fair-haired people of Anglo-Celtic descent. Indeed Irsh Dermatologists sometimes call rosacea ‘the curse of the Celt’!. It usually manifest in middle age and beyond. However, when a careful history is taken, rosacea patients usually have a history of easy blushing in their younger years.

At the turn of the 20th century it was proposed that rosacea be classified into four clinical groups. This grouping remains useful and allows for targeted therapy. Facial redness is arguably one of the most common clinical manifestations of rosacea (erythematotelangiectatic form). Over time, dilated capillaries develop, particularly around the nose, on the cheeks and on the chin. Other manifestations include inflammation changes, manifesting as ’pimple-like’ lesions often mistaken to be acne (papulopustular form) eye irritation (blepharitis) and a potentially disfiguring condition called rhinophyma. Rhinophyma is a rosacea condition predominantly affecting men, where the nose becomes discoloured, craggy and pitted.

With the most common form of rosacea, facial redness is the typical complaint. This is made worse by certain triggers, such as spicy food, alcohol, hot drinks, sun exposure, and menopausal hot flushes.

The pathology of Rosacea

Biopsy of skin affected by rosacea shows a large number of dilated blood vessels in the upper dermis, set in the midst of damaged upper dermal connective tissue, which no longer appears to have any supportive function to the blood vessels anymore. These dilated blood vessels accounts for the background diffuse redness and dilated capillaries seen in rosacea.

There has been an explosion of knowledge of the pathology behind rosacea, and this understanding allows us to understand how anti-rosacea treatments work. In a nutshell, rosacea is the result of abnormal skin reactivity to the skin’s own antimicrobial peptides (AMP), which is part of the defence system of the skin. One such peptide, cathelicidin LL-37 is thought to play a particularly prominent role. Special receptors in the skin (TLR2 receptors) can activate LL-37 production. Rosacea patients have more of these receptors and therefore more activated LL-37. Cathelicidins promote infiltration of the dermis by neutrophils (a type of white blood cell) and dilation of blood vessels. A resultant complex interplay of chemical mediators causes the clinical manifestions of redness and inflammation.

Treatment for Rosacea

  1. Avoidance of trigger. Spicy food, alcohol and hot drinks may cause flare up of rosacea and it is important to avoid these triggers if possible.
  2. Sun protection should be used diligently but rosacea patients with sensitive skin may not be able to tolerate some topical sunscreen. Facial Artistry has a range of skin care products containing high SPF factor, which are specially formulated for sensitive skin.
  3. The tetracycline family of antibiotics has anti-inflammatory properties properties. Dr Leung can prescribe these medications if required. Several topical preparations such as azelaic acid may also be of help.
  4. Laser and Intense pulse light forms the backbone of rosacea treatment. Limelight (IPL) is an excellent treatment for the redness in rosacea, particularly when combined with Laser Genesis.Dilated capillaries can be easily treated with our CuteraXeo Nd:YAG laser. Excellent clearance could often be achieved in 2-3 sessions.
  5. In 2014 a novel topical agent became available in Australia. It is a potent vasoconstrictor which causes the blood vessels to shrink. It usually starts working from around 30 minutes and the effect lasts up to 12 hours. It is a precription only medication and Dr Leung is able to prescribe this if indicated.

It is important to bear in mind that rosacea cannot be cured. These treatments can give excellent control and can be repeated as required.

Case study

Site Images / Pre Limelight IPL Treatment (medium)

This lady has diffuse facial redness and dilated capillaries.

 

Site Images / Post Limelight IPL Treatment (medium)

 

She had an excellent response to a series of Limelight, Nd:YAG vascular laser and Laser Genesis, with her complexion returning to normal.

For further information on rosacea please visit this authorative dermatology website.

To request an appointment with Dr Bernard Leung please email us or call us on 02 6255 8988.