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Rosacea: causes, symptoms, who to see

Rosacea, formerly called couperose, is an inflammatory condition that shows up as redness on the skin of the face (erythema), inflammatory pustules, papules, or small visible blood vessels under the skin. It should not be confused with other dermatological conditions, such as acne or psoriasis. In fact, because its symptoms are similar to acne, rosacea is sometimes called "acne rosacea" or "adult acne".

What are the symptoms of rosacea?

Rosacea mainly affects women between 40 and 50 years old. Rosacea also develops through 4 phases:
   • A phase preceding the symptoms of rosacea (phase 1);
   • A vascular phase;
   • The inflammatory phase;
   • A late phase in some patients;
The various symptoms of rosacea (from phase 1 to phase 4) therefore include:
   • The appearance of erythema on the skin of the face (nose and cheeks). Erythema is characterised by redness of the skin;
   • Flushing (hot flushes) causing a sensation of heat and redness;
   • Skin lesions around the mouth, eyelids or chin;
   • Facial oedema (swelling);
   • Tingling or burning sensations;
   • Papules (spots) or pustules (containing pus) that can look like acne lesions;
   • In some patients, hyperplasia of the tissue of the cheeks and nose (rhinophyma). The skin is red, thicker around the nose and bulbous;
   • Telangiectasia (visible blood vessels under the skin);
   • In cases of ocular rosacea: eyelid inflammation, itching (pruritus), conjunctivitis, various localised inflammations, swelling of the eye;
In all cases, it is recommended to consult a dermatologist if you have skin lesions. Dermatological conditions can often be confused with one another or misdiagnosed, which slows down proper treatment and recovery. Online consultation offers the benefit of a fast diagnosis with an online dermatologist. As general practitioners are not skin disease specialists, turning to a dermatologist is more sensible. The diagnosis of rosacea is mainly based on the presence of:
   • Red patches or erythema;
   • Abnormally visible sebaceous glands;
   • Flushing;
   • Papules or pustules;
   • Small blood vessels visible under the skin of the face.

What causes rosacea?

Genetic predispositions are often behind rosacea, although it is a multifactorial condition. There are also many environmental and external triggering factors that can bring on flare-ups of rosacea. Even so, the exact mechanisms and causes of rosacea are still not clearly understood. Some doctors believe it is an auto-inflammatory condition. It is possible to relieve and treat the symptoms, but the condition is, however, incurable: it can come back. Rosacea can be triggered by many factors:
   • Micro-organisms or bacteria;
   • Spicy food, alcohol, coffee, hot drinks;
   • Exposure to heat, cold, sun, wind or changes in temperature.
Among the mechanisms likely to play a role in the onset of rosacea, we can mention:
   • An overly strong immune response, causing erythema and vasodilation;
   • Angiogenesis: the formation of new blood vessels from an existing branch. Angiogenesis is behind telangiectasia;
   • Proliferation of the sebaceous glands, responsible for erythematous lesions;
More recently, it has been accepted for several years that an exacerbated immune system response plays an important part in the onset and symptoms of rosacea. As such, these various factors can encourage it:
   • UV rays;
   • Certain microbes, in the digestive tract, H. pylori or Demodex, a mite likely responsible for the papulopustular lesions of the skin;
   • Free oxygen radicals;
   • Neuropeptides: AMPs, antimicrobial peptides, are hormones that play a major role in the manifestation of rosacea.
Lastly, a vascular abnormality of the face may be responsible for the flushing and erythema.

Prevention and treatments for rosacea

The first line of treatment for rosacea is prevention; it is indeed possible to identify the factors that trigger rosacea, or the factors that worsen symptoms, in order to avoid them as much as possible. Various pharmacological and medicinal treatments then exist:
   • Topical or oral antibiotics for inflammatory rosacea (metronidazole, benzoyl peroxide, minocycline…);
   • Creams based on ivermectin and azelaic acid;
   • Other creams based on oxymetazoline, or a gel based on oxymetazoline;
   • Electrocoagulation and laser treatments;
Finally, in cases of rhinophyma, medication alone is unlikely to guarantee a cure. Surgical treatments may therefore sometimes be necessary:
   • Laser sessions;
   • Dermabrasion, a technique that involves rubbing the surface of the skin with an abrasive metal instrument to remove the top layer;
   • Another surgical procedure aimed at removing excess tissue;
When it comes to prevention, lifestyle habits play an important part in the onset of rosacea. These few habits can sometimes be enough to avoid rosacea flare-ups:
nbsp;  • Use a sunscreen with a minimum SPF of 30 when exposed to the sun. Indeed, the production of free radicals caused by sun exposure can cause chronic skin inflammation;
   • Take care of your skin daily, summer and winter alike, to avoid redness. It is recommended to use micellar water for gentle facial cleansing, or lightweight moisturising creams;
   • Do peels or scrubs, to remove irritating factors from the skin;
   • Avoid using cosmetics, especially foundations that are too oily;
   • Consult a dermatologist or beautician to learn medical make-up techniques, also known as "camouflage". This make-up hides lesions and redness by using make-up of an opposite colour;

Consult a dermatologist for your skin problems

Rosacea is often caused by external and environmental factors:
   • Sun exposure;
   • Emotional stress;
   • Hot or cold climate;
   • Spicy food;
   • Hot drinks;
   • Coffee;
   • Cosmetics;
It is therefore worth identifying these triggering factors and avoiding them as far as possible. Consulting an online dermatologist is often necessary to diagnose rosacea, which can sometimes resemble acne. Treatment mainly relies on the use of antibiotics and facial creams. Surgical treatments concern patients with severe symptoms. For more information or an online diagnosis, feel free to visit the Feeli platform! Multiple small blood vessels may also be visible under the skin: this is telangiectasia. Treatment also relies on avoiding triggering factors as far as possible, and, depending on severity, the use of topical and/or oral antibiotics. A brimonidine-based gel can also help reduce redness, in addition to an ivermectin-based cream. Surgical treatments include: laser sessions, dermabrasion, excision of excess tissue, electrocoagulation, or even cosmetic surgery. For more information, a fast diagnosis or a suitable treatment, ask an online dermatologist for their opinion with Feeli; and above all, take care of your health!