While a subtle, rosy glow to the cheeks lights up a face and reflects good health and inner radiance, the persistent ruddiness experienced by more than 3-million Canadians with chronic rosacea is not the glow they’re looking for. Typically affecting fair-skinned individuals over the age of 30, and found in women more often than men, this chronic inflammatory dermatitis is often under-diagnosed, causes significant discomfort, and is commonly mistakenly associated with alcoholism.
People who suffer from rosacea are impacted both physically and emotionally; nearly 75% of people who have rosacea report that it has a negative impact on their self-esteem and on their careers. The good news is that while there is no cure, there are new developments in treatment for this chronic
Do you think you may have rosacea, or do you have questions or concerns about your previously-diagnosed rosacea? An app-based virtual care consult is a convenient way to receive a diagnosis, get answers and even obtain a treatment plan without leaving your home or office. Click here to check your eligibility for Medisys On-Demand or to learn more about telemedicine and virtual healthcare.
WHAT ARE THE SIGNS AND SYMPTOMS OF ROSACEA?
The first signs of rosacea often appear in adulthood, typically between the ages of 30 and 50. At first, the symptoms may be intermittent, with periodic redness and a burning sensation in the face. Over time, the redness becomes more permanent and dryness of the skin typically follows.
There are four subtypes of rosacea, the severity of which may be variable:
- Erythemato-telangiectatic rosacea (often called “couperose”), which is characterized by permanent redness and dilated blood vessels
- Papulo-pustular rosacea (or acne rosacea), characterized by lesions similar to acne
- Phymatous rosacea, a rare form of rosacea characterized by thickening of the skin
- Ocular rosacea, which involves the eyelids and/or conjunctiva, typically causing burning and itchy eyes and often accompanied by rosacea of the skin.
WHAT CAUSES ROSACEA?
The origins and causes of rosacea are only partially understood — rosacea is a complex disease and active subject of scientific research — but we know that it is caused in part by a genetic predisposition. This can lead to a defective skin barrier and a complex inflammatory cascade involving several naturallyoccurring skin micro-organisms.
Rosacea is not caused by alcoholism — a common and unfair misconception. Alcohol is, however, one of many triggers that can prompt or aggravate rosacea flare-ups in some patients (other triggers include sunlight, heat and environmental stress).
Dermatology concerns are one of the top three issues treated on the Medisys On-Demand virtual healthcare platform.
IS THERE A CURE?
There is no cure for rosacea; however, fortunately there are several effective measures for both rosacea prevention and treatment. If you have rosacea, dermatologists recommend gentle skin care with an emphasis on year-round sun protection and avoidance of possible triggers such as stress, exposure to extreme temperatures (hot or cold), spicy foods, coffee, alcoholic beverages and very hot drinks. The impact of these
lifestyle factors on rosacea vary from person to person.
Many topical cosmetic products are available over the counter that aid in rosacea management. Mild, fragrance free and alcohol-free skin products are recommended for rosacea sufferers and products with abrasive or skin-irritating ingredients should be avoided. For redness concealment, choose a green-tinted foundation for the affected areas and layer a skin tone matching product on top. Hypoallergenic make-up is recommended.
“It is important to keep the skin well moisturized, especially during the winter,” says Dr. Amina Bougrine, a leading dermatologist based out of the Medisys preventive health clinic in Montreal. Since sun exposure can worsen the symptoms of rosacea, it is recommended that rosacea sufferers use a broad spectrum sunscreen with an SPF of 30 or more on a daily basis. “For those suffering from rosacea, it’s important to stay cool when it’s hot outside. In extreme weather conditions, I recommend keeping the face covered and protecting the skin with a good moisturizer,” continues Dr. Bougrine. Stress management and a healthy, balanced diet also play a role in preventing rosacea flare-ups.
There are several effective medical treatments for rosacea as well, including:
- Topical treatments (ivermectin, metronidazole, azelaic acid and brimonidine)
- Oral treatments (antibiotics of the tetracycline family, isotretinoin)
- Laser therapies.
The once-a-day topical treatment Brimonidine (Onreltea) is a potent vasoconstrictor and temporarily reverses the redness caused by dilated blood vessels. The conventional topical therapies, metronidazole and azelaic acid, do reduce redness to a degree, although their main role is reducing acne-like skin lesions. Oral tetracyclines have been another cornerstone of treatment primarily used to treat the acne-like lesions. They are antibiotics, but are thought to work via an anti-inflammatory mechanism.
To avoid disruption of the gut flora or contribution to global antibiotic resistance, they can be given at sub-antimicrobial doses (for example, Doxycyline is used at the sub-antimicrobial dose of 40 mg instead of the usual antibiotic dose of 100 mg). While the new Bimonidine is expected to be an important weapon in the arsenal against rosacea, energy-based treatments such as vascular laser and Intense Pulsed Light (IPL) are the most powerful methods for common forms of rosacea. This method treats the telangiectasia (tiny spider veins), that the conventional methods cannot, and also reduces background redness. Repeated treatments are required for optimal improvement.
Consult a dermatologist, your Medisys healthcare provider or your Medisys On-Demand virtual care team for proper diagnosis and treatment of any skin condition, including rosacea.
• Asai Y, et al. Canadian Clinical Practice Guidelines for Rosacea. Journal of Cutaneous Medicine and Surgery. 2016;20(5):432-45.
• Canadian Dermatology Association. (2016). Rosacea: Living with Rosacea, http://www.dermatology.ca/skin-hair-nails/skin/rosacea/#!/skin-hair-nails/skin/rosacea/living-with-rosacea/. Accessed October 16, 2016.