Rosacea is a very common skin complaint that mainly affects the face. The condition will present as the skin becoming red for short periods, this can also referred to as flushing. Other associated symptoms can include:

• Permanent redness
• A burning or stinging sensation
• Spots
• Small blood vessels that are visible in the skin

Rosacea is a condition that is prone to relapsing. This means you will experience episodes of severe symptoms that will be followed by periods where the condition is less severe. An episode of rosacea can be triggered by numerous factors, with different people having different triggers. The most common triggers are:

• Exposure to hot or cold temperatures
• Strong winds
• Alcohol, caffeine and hot drinks
• Spicy food and dairy products
• Sunlight exposure
• Stress
• Humidity
• The menopause

It isn’t fully understood what exactly causes rosacea. There are a number of possible factors that have been suggested. It is believed by some experts that rosacea is caused by a blood vessel abnormality. However, what causes this particular abnormality is still unknown.

More recent research has suggested that the external triggers of rosacea can lead to the activation of molecules in the skin known as peptides. Having excess levels of peptides in the skin can activate both the immune and neurovascular systems of the skin. This activation can cause the blood vessels to dilate, resulting in redness and inflammation.

Another possible cause is microscopic mites called demodex folliculorum. These mites usually reside harmlessly on human skin. Sufferers of rosacea present with higher numbers of these mites and research suggests rosacea can be caused by the skin’s reaction to the bacteria found in the mite’s faeces.

Alternatively, a current theory suggests that a bacteria found in the digestive system, helicobacter pylori bacteria, is the cause of rosacea. This theory argues that helicobacter pylori stimulates the production of a protein called bradykinin. This protein is known to cause blood vessels to expand and hence cause the effects of rosacea.

It is apparent that rosacea is more common in families. This could suggest a genetic cause of the condition. However, it is not clear which genes are involved or how the condition is passed on.

The main and most common symptom of rosacea is facial flushing. This is characterised by the skin turning red for short periods-usually only a few minutes. This flushing will mainly affect the face but in some instances, the neck and chest can be affected as well. Some sufferers experience an uncomfortable heat sensation that accompanies this skin reddening.

Some sufferers are affected by a persistent facial redness that resembles a patch of sunburn that does not subside. This form of rosacea is known as erythema and it usually affects the nose, cheeks and chin. In some cases, erythema can spread to the forehead, neck and chest.

Another visible symptom of rosacea can include permanently widened blood vessels. These vessels have dilated over time and will be visible on the skin. This is known as telangiectasia.

Someone with rosacea can develop papules and pustules. A papule is a round red bump that protrudes from the skin. A pustule is a pus-filled swelling. These will mainly appear on the face and can resemble the symptoms of acne. However, rosacea and acne are unrelated conditions. Unlike acne, rosacea does not potentially damage the skin or cause any scarring.

In more severe cases of rosacea the skin can thicken, causing the sufferer to experience a buildup of excess tissue. This tissue usually forms around the nose causing it to become enlarged and bulbous. This symptom will take years to develop and is not that common. This thickening of the skin is called rhinophyma and tends to affect more men than women.

Rosacea can, in some cases, affect the eyes as well. This is known as ocular rosacea and symptoms can include; dry, irritated or bloodshot eyes, inflammation of the eyelids and feeling as though there is something in your eyes. If ocular rosacea starts to cause any pain in the eye, blurred vision or a sensitivity to light then it is recommended to seek medical advice immediately.

Other more generic symptoms associated with rosacea include:

• Lymphoedema: A swelling of the face
• Rough, dry skin
• Sensitive skin can include; burning, stinging, itching and pain

Unfortunately, rosacea doesn’t have a cure. However, there are treatments available designed to keep the symptoms under control. The type of treatment will depend on the symptoms you are presenting with, it may just involve self-help techniques or these techniques combined with medicinal treatment.

If your rosacea has caused papules and pustules to develop then there are various different treatments that can be effective. The first line of treatment will usually be a topical gel or cream. The two topical treatments most often prescribed are Metronidazole (Rozex Gel), Ivermectin (Soolantra Cream) and Azelaic Acid (Finacea Gel). Treatments such as Finacea and Rozex are usually applied once or twice daily to the affected area. If Finacea and Rozex have proved ineffective then a 6 - 12 week course of oral antibiotics (Erythromycin or Efracea) may be necessary.

Treating facial redness in rosacea can prove more difficult to treat than papules and pustules. Brimonidine Tartrate (Mirvaso Gel) is a topical gel treatment that works by restricting the dilation of the blood vessels in the face. Research shows it can have an effect in as little as 30 minutes after application. Once applied the effects of Mirvaso Gel can last for up to twelve hours.

For information regarding self-help techniques for preventing and treating rosacea, see 'Prevention' below.

Treating thickened skin (rhinophyma) will require referral to a dermatologist or plastic surgeon. There are a number of surgical treatments available that can remove the excess tissue from the nose.

Treating ocular rosacea may require lubricating eye drops or oral antibiotics from your GP. If these prove ineffective then you will need to be referred to an ophthalmologist for further testing and treatment.

There are a number of self-help techniques that can help lessen the symptoms of rosacea. These involve:

• Avoiding known triggers: For example, if you know hot baths trigger your rosacea then try reducing the water’s temperature or have a cooler shower instead. If sunlight makes your symptoms worse then reduce exposure by covering the skin or by using a sensitive, high SPF sunscreen. Stress is a very common trigger of rosacea. By managing your stress levels you can help reduce the chance of an outbreak.
• Looking after your skin: Cleanse and moisturise your skin using non-irritant, hypoallergenic products designed for sensitive skin. It is recommended to avoid astringent toners and products that contain ingredients that can cause irritation to the skin. Known irritants include; fragrances, alcohol, menthol, lanolin, clove oil, witch hazel, eucalyptus oil, sodium lauryl sulphate and camphor. For men, switching to an electric razor has been shown to reduce skin irritation.
• Using camouflage make-up: If suffering with persistent red skin then using suitable make-up products will help to conceal these patches. Your GP or specialist can refer you to a skin camouflage service or directly prescribe skin camouflage products.
• Keeping your eye lids clean: If rosacea is known to affect you eyelids then ensure they are kept clean. This will help reduce any inflammation or irritation. If using eye make-up, it is recommended to select a product that is mild and washes off easily.