Rosacea

Rosacea is a chronic inflammatory skin condition that primarily affects the central face: the cheeks, nose, chin and forehead. It affects roughly one in ten adults in the UK to some degree, most commonly those with lighter Fitzpatrick phototypes (I, II and III), and is more often noticed in women although men can develop more severe forms of the condition. The clinical presentation varies and includes persistent facial redness (erythema), visible blood vessels (telangiectasia), flushing episodes triggered by heat, alcohol, spicy food, exercise or emotion, and inflammatory papules and pustules that can resemble acne but lack the comedones (blackheads and whiteheads). In some patients, particularly men, long-standing rosacea can progress to phymatous changes, most famously thickening of the nasal skin (rhinophyma). The precise cause is not fully understood, but the condition involves a combination of factors: dysregulation of the innate immune system (with an overactive antimicrobial peptide response), vascular hypersensitivity, a disturbed skin microbiome (with Demodex mites thought to play a contributing role in some patients), and impaired epidermal barrier function. Triggers vary between patients and often include ultraviolet exposure, temperature extremes, alcohol (especially red wine), spicy food, caffeine, emotional stress, and certain skincare ingredients such as alcohol-based toners, fragrance and physical exfoliants. Rosacea is a medical condition, not a cosmetic one, and first-line treatment is typically prescribed through a GP or dermatologist: topical metronidazole, ivermectin or azelaic acid for papulopustular rosacea, and oral doxycycline for more severe inflammatory flares. Once the medical side is controlled, aesthetic treatments address the vascular and textural consequences. IPL targets the haemoglobin in dilated blood vessels, reducing persistent redness and visible telangiectasia over a course of sessions. LED light therapy, particularly red and near-infrared wavelengths, has anti-inflammatory properties and can be used as a gentle maintenance treatment. Carefully chosen chemical peels (typically low-strength mandelic acid or azelaic acid peels) can reduce inflammation without provoking a flare, but must be used cautiously as the rosacea-prone skin barrier is easily irritated. Patients with rosacea should avoid retinoids, glycolic acid, strong exfoliants, hot water, steam treatments and fragrance-heavy products. A considered consultation also screens for the ocular form of rosacea, which can affect the eyes and cause irritation, grittiness and in some cases visual disturbance. Ocular rosacea needs an ophthalmology review rather than aesthetic treatment.