A fifth of rosacea sufferers have reported a severely impaired health-related quality of life because of their skin condition.
This really is quite a lot of people who are dramatically impacted by rosacea, considering that it is a common skin condition. And, for most people with rosacea, it doesn’t need to be this way as there are many things that can be done in the management of rosacea- I’ll get the ins and outs of this in just a minute after I’ve given a brief overview of the different types of rosacea (after all, if you understand what type of rosacea you have, you can better understand what treatment(s) you require and why).
Rosacea is a skin condition that’s classified into four subtypes that may overlap. It is not contagious, and it is not life threatening.
It is generally noticed on the cheeks, chin nose and forehead. In some cases, it can affect the eyes.
This is the most common type and is characterised by redness (erythema), spider or broken veins (also known as telangiectasia) and flushing. The sensations of stinging and burning is not unusual in the areas of this type of rosacea.
Redness is a persistent and, often, permanent aspect of rosacea. Flare-ups of redness can be triggered by stress, the sun, some food and alcohol.
Telangiectasia is very small, blood vessels which can be seen on the surface of the skin.
Flushing is similar in appearance to skin redness but is often accompanied by the feeling of warmth; flushing is generally short-lived, whereas redness is more of a permanent feature of the condition.
This subtype presents with skin redness and with pustules and papules (spots and bumps) in the area. Similarly to type 1, type 2 rosacea can be accompanied by stinging and burning sensations.
This type of rosacea presents with a thickening of the skin. Different areas of the face have specific terms to describe this thickening; Rhinophyma is on the nose (this has previously been referred to as drinkers’ nose), Gnathophyma is on the chin and Metophyma is on the forehead.
Ocular Rosacea affects the eyes rather than the skin. Those with type 4 rosacea may have eyes that are red and irritated looking; blurred vision; inflammation and cysts on the eyelids; and they may notice that their eyes are always watering or feel dry.
Anecdotally, this condition seems to run in some families but, at the moment the cause of rosacea is unknown. This also means that there is no cure for rosacea. However, for people with rosacea there are multiple ways of managing rosacea symptoms.
At our skin clinic we offer rosacea treatment for type 1 rosacea and type 2 rosacea, so I’ll be focusing on this; if you have ocular rosacea you will need to seek out the advice of an ophthalmologist (an eye doctor). Those with type 3 rosacea can also have their symptoms treated; there are oral prescription medications that are used to improve the symptoms as well as some lasers which remove the excess tissue.
For ease, I’ll break down the type of treatment for rosacea by the rosacea symptom they treat.
Thread veins can be treated by shutting down the little blood vessel and preventing it from filling up with blood; this results in your body naturally reabsorbing and removing the vessel.
At Skin to Love, we offer two skin treatments which do this. The first treatment is called Veinwave which uses a technique called thermocoagulation. Veinwave involves using a tiny, fine insulated needle which is carefully applied to the targeted vessel, heating it and in turn, destroying it. The surrounding tissue is not affected by the treatment.
Our second option is laser treatment for thread veins. The particular laser technology is called ‘pulsed dye laser’ and the brand we use at our skin clinic is Regenlite. This laser treatment is set to target haemoglobin; once the laser energy is omitted, the blood in the targeted area (in this case the small blood vessel) safely absorbs it and in turn the blood vessel is destroyed and naturally removed, much like in the Veinwave treatment.
It is worth mentioning that with any type of non-surgical vascular treatment, some blood vessels can refill and surface again and new blood vessels will still have the ability to present themselves in the future so, in some instances, occasional maintenance treatments may be required to keep on top of these symptoms.
When it comes to the skin redness that rosacea can cause, it is really quite important to have a good skincare routine that you do daily. Treatments can be highly effective but without daily treatment at home, it is like going to the dentist but not brushing your teeth at home every day. A skincare professional should be able to offer you advice on your specific needs and daily routine, but some general advice would be not to scrub your skin when cleansing it, as this can make redness worse and, as we know UV rays can trigger flare-ups in rosacea symptoms, make sure that you use a daily sunscreen of 30SPF or higher.
At our Hertfordshire clinic, we offer a few very effective skin care treatments to help improve skin redness and further boost your at-home efforts.
Regenlite, as mentioned above, is a pulsed dye laser which is also used for background redness (not just the broken veins). Multiple studies show significant improvements in skin redness following the pulsed dye laser for rosacea, which is used for erythema in the same way you use it for specific broken vessels; the laser targets blood vessels below the surface of the skin, in the desired area(s), and is absorbed by the haemoglobin. In turn, the blood vessels which so often dilate in rosacea skin and cause the red, flushed appearance are destroyed.
Byonik is another skin treatment that you can consider for rosacea symptoms. Not only does it improve skin health and hydration, which is super important especially when our skin is compromised by conditions such as rosacea or acne, it also helps to reduce background redness.
One important element of the Byonik treatment is low level light therapy. Low level light therapy (also known as cold laser therapy) improves skin inflammation and promotes skin healing (in fact, red light therapy is used for those with eczema and psoriasis) which helps to reduce the background redness in your skin.
Flushing can be really uncomfortable and often catches you off guard which, if you experience this symptom, you can probably testify that it can be quite embarrassing. Because of the often-unpredictable nature of rosacea flushing, it can be difficult to treat because it might not be during an appropriate or practical time where you can nip off and apply your skincare product to help calm it down.
There is a treatment that can help rosacea flushing, however; Botulinum toxin (aka Botox) can be used to help flushing (even severe flushing) and persistent background redness. This might surprise you because many of us associate Botox with treating wrinkles which are formed due to muscle movement, such as forehead lines.
However, botulinum toxin was initially, and still is, used for medical conditions including chronic migraines, excessive underarm sweating, improving some types of scars, severe muscle spasms and some are even using Botox to alleviate symptoms of depression (the latter is based on ‘facial feedback hypothesis’ which suggests facial expressions can influence mood. But that’s a blog for another time).
When it comes to rosacea flushing and persistent redness, Botox can be used superficially, in the skin (intradermal), not into the muscle like it is in cosmetic Botox treatments. The treatment helps to block compounds triggered by immune cells, called mast cells which, interestingly, have been found to be higher in those of us with rosacea. These compounds trigger inflammation in the skin and the dilation of the blood vessels (vasodilation) in that area, resulting in skin redness and flushing. Botox used intradermally can significantly reduce the severity of persistent flushing and stubborn background redness.
The Mandelic acid skin peel is the ideal chemical peel for rosacea type 1 and 2 as it is gentle on this sensitive type of skin, not triggering further redness. It has an inti-inflammatory effect which is ideal for those with subtype 2 rosacea who have pustules and papules. This skin treatment also has a vasoconstrictive effect, meaning blood vessels contract and work better resulting in them being less visible.
As you can see, there are a number of clinic-based treatments that are able to help you manage the symptoms of rosacea. These treatments can be, and often are, used in combination with one another; especially if you have more than one symptom of rosacea that you would like to help improve. If you have questions about these treatments or would like advice specific for you and your rosacea symptoms, please contact our team, we’d love to help.
1 Bewley A, Fowler J, Schöfer H, Kerrouche N, Rives V. (2016) Erythema of rosacea impairs health–related quality of life: Results of a meta–analysis. Dermatology and Therapy. 6(2):237–47.
Disclaimer: This blog is not to be used for diagnostic or instructional purposes. We are all unique which means that our skin, treatment results, recovery and suitability for any type of treatment will vary. Always seek the advice of a professional should you have any health or cosmetic concerns or to discuss treatments specifically for you.
Disclaimer: This blog is not to be used for diagnostic purposes. We are all unique which means that our results, recovery and suitability for any type of treatment will vary. Always seek the advice of a professional should you have any health or cosmetic concerns or to discuss treatments specifically for you.
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