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A Beginner's Guide to Rosacea
Many of you have probably heard of rosacea. Rosacea is a common, chronic and inflammatory skin disease that affects over 5% of the world's population. It's usually associated with redness and sensitivity, but rosacea is more complex than that. Did you know there are four types? We have listed them below.

1. Erythematotelangiectatic rosacea (rosacea with redness)

This is the most common variant of rosacea. The symptoms are periods of redness in parts, usually the center, of the face. Over time, this chronic redness can cause the blood vessels beneath the skin's surface to enlarge, leading to permanent redness (erythema).

2. Papulopustular rosacea (rosacea with pimples)

This type involves a permanent reddening of the skin with sporadic pimples.


3. Phymatous rosacea (rosacea with enlarged nose)

This type is characterized by enlarged pores and redness leading to a swollen, enlarged nose.

4. Ocular rosacea (eye rosacea)

Ocular rosacea results in inflammation of the outer parts of the eye, with symptoms such as a dry feeling, redness around the eyelashes, increased tear production and hives.

If you think you have rosacea, you should always see a dermatologist or doctor for a proper diagnosis.

Who does it affect?

Rosacea affects both men and women and most commonly occurs after the age of 30. From a global perspective, you can see that it is significantly more common to suffer from rosacea if you come from the northern parts of Europe.

Rosacea not only affects people physically but also mentally. New research shows that its psychosocial impact can be very serious and lead to social anxiety and depression. Interestingly, men tend to experience worse psychological effects than women.

Why do you get rosacea?

The exact cause of rosacea is still unknown. Genetics seem to play a role, for example meaning that if your mother has rosacea, you are more likely to get it too. Rosacea has also been thought to be linked to immune system disorders and increased nerve sensitivity.

There are indications that rosacea patients have higher levels of Demodex mites (a type of parasite) living in the skin. We all have a number of mites in our skin and mites thrive, as many know, in both bedding and skin. Demodex mites can also live in our hair follicles and sebaceous glands. According to one theory, their feces trigger an inflammatory response in our skin.

There is also a medical connection between rosacea and autoimmune diseases such as diabetes, celiac disease (gluten intolerance) and rheumatism.

Skin care habits can also be a cause of rosacea. A large study showed that cleaning habits can influence the onset and progression of rosacea. Overcleansing appeared to be a major risk factor and we have written a summary article on this very interesting study here .

Psychological stress also appears to be a high contributing factor to rosacea. In fact, dermatologists in Sweden reported an increased number of rosacea cases in the spring of 2020, that is, during the covid19 pandemic. It is believed that the reason behind this increased incidence of rosacea is due to higher levels of psychological stress.

How to treat rosacea?

There is no cure for rosacea, but there are several treatments available. Today, the condition is often treated with antibiotics and topical medications that have anti-inflammatory properties. Many of those who suffer from more severe rosacea need to be prescribed treatment by a doctor. The main treatments are:

Treatments that reduce redness , such as brimonidine and oxymetazoline. These treatments reduce the blood supply to the skin, so the skin does not redden as much. Brimonidine is also used in eye drops to treat ocular rosacea.

Medicines against acne , for example azelaic acid and tretinoin. They are used to treat papulopustular rosacea. Exactly how these substances work is not fully understood, but it is believed that their anti-inflammatory properties help reduce the inflammation caused by rosacea.

Antibiotics such as metronidazole and tetracyclines. It is not known exactly why antibiotics affect rosacea, but one possible explanation is that antibiotics kill bacterial growth in the skin that could potentially be caused by mite feces.

Ivermectin , an insecticide that kills Demodex mites, is one of the newer treatments for rosacea. 

Rosacea

Factors that can negatively affect rosacea

What triggers a rosacea outbreak is individual, but for those of you who have rosacea, it can be good to know what can make the problems worse. The following factors can have a negative impact.

Sun & heat

But also cold and windy weather

Alcohol, hot drinks and strongly spiced food
Stress and nervousness
Hormonal changes

Like pregnancy, PMS, menstruation and menopause

Creams and ointments

Contains substances that can irritate the skin such as perfume, dyes or preservatives as well as certain sunscreens and cosmetics

Tips and advice

If you have rosacea, you should avoid excessive sunbathing because it often worsens the disease. One should also be careful when washing the face and choose a gentle cleansing product for sensitive skin. Feel free to choose a moisturizer that is not too greasy and that is soothing, strengthening and that supports the skin's microbiome. All the moisturizers we developed are suitable for rosacea-prone skin, but it is important that you seek advice from a doctor if you have more serious problems.

References

Gillbro, J. (2019) The Skin Bible . Stockholm, Bookmark publisher.

Steinhoff, M., Schauber, J. & Leyden, JJ (2013) New insights into rosacea Dermatology. [Online] 69 (6), S15–S26. Available from: doi:10.1016/j.jaad.2013.04.045.

Li, G., Wang, B., Zhao, Z., Shi, W., et al. (2020) Excessive cleansing: an underestimating risk factor of rosacea in Chinese population. Archives of Dermatological Research. [Online] Available from: doi:10.1007/s00403-020-02095-w.

Van Zuuren, EJ, Fedorowicz, Z., Carter, B., Van Der Linden, MM, et al. (2015) Interventions for rosacea. Cochrane Database of Systematic Reviews. [Online] Available from: doi:10.1002/14651858.cd003262.pub5.

Gillbro, JM, Lundahl, M., Westman, M., Baral, R., et al. (2015) Structural activity relationship analysis (SAR) and in vitro testing reveal the anti-aging potential activity of acetyl aspartic acid. International Journal of Cosmetic Science. [Online] 3715–20. Available from: doi:10.1111/ics.12253.

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