Management for rosacea

Although previously known as ‘acne rosacea’, rosacea is different from acne and is not associated with the presence of comedones. It is a chronic inflammatory skin condition associated with recurrent episodes of facial flushing, persistent erythema, telangiectasia, papules and pustules. The eyes may also be affected (ocular rosacea) and (rarely) rhinophyma (an enlarged nose) which occurs almost exclusively in men. Some people find the facial redness deeply embarrassing and distressing and this can lead to anxiety and depression.

The cause of rosacea is unknown. High levels of facial skin-dwelling Demodex folliculorum mites are thought to play a role in some patients. A number of factors can trigger or worsen rosacea (e.g. hot or cold environments, spicy foods, hot drinks, alcohol, photosensitivity/sun exposure, stress and some drugs (e.g. calcium channel blockers, topical corticosteroids)).

There is no permanent cure for rosacea. However, treatments can ease symptoms and the aim should be complete skin clearance, where possible.

Self-management measures include avoiding trigger factors as far as possible. A diary may be useful to identify triggers, if not known.

A number of OTC products can be helpful. Dry, sensitive skin can be a problem for rosacea patients. This can make shaving painful for some men. Gentle, soap-free wash products (syndets) and oil-free moisturisers can be helpful.

Green-tinted moisturisers can help to camouflage erythema. In addition, people may self-refer to the charity Changing Faces (changingfaces.org.uk) which provides education on the application of cosmetic camouflage creams and powders.

Effective sun-protection measures including use of high-factor sunscreens and avoidance of sunbeds can be helpful.

A private PGD for brimonidine gel (Mirvaso) may be in place in some pharmacies. Brimonidine is an alpha2-adrenoceptor agonist that reduces flushing by causing superficial vasoconstriction when applied topically. It acts within 30 minutes and reaches peak effect in three to six hours, after which the erythema returns. It can make broken veins and papules look more prominent once the background redness is reduced. Topical brimonidine should be used once daily, as needed.

The first-line treatment for mild-moderate papulopustular rosacea is ivermectin 10mg/g cream. This is thought to act by reducing the numbers of Demodex folliculorum on the skin. Second-line treatments are metronidazole gel or azelaic acid gel.