How to manage rosacea: from common triggers to the best treatments

Between 2017 and 2020, incidences of rosacea in the US rose tenfold

When drama teacher Louise Sewell first spotted a small red bump on her cheek in summer 2020, she blamed a mosquito bite.

“The spot was itchy so I applied insect cream, assuming it would disappear. Instead, it grew to the size of a tomato. Then a patch appeared on the other cheek. And another between my eyebrows. I also noticed my nose wasn’t just red, but slightly widening.”

On a camping trip after the pandemic with other families, “I was out of the tent bright and early, of course make-up free. Hours later I caught myself in a mirror – I looked like a burns victim.”

The local pharmacist confirmed it was rosacea. Louise’s story isn’t uncommon; the National Library of Medicine reports that between 2017 and 2020, incidences of rosacea in the US rose tenfold. Some theories suggest the stress of the pandemic and face-mask wearing may have played a role.

Louise Sewell first developed symptoms of rosacea in summer 2020

So how do you know if you have rosacea, or whether it’s blushing from embarrassment, menopausal flushes or perhaps the effects of red wine? Let’s start with the basics.

What is rosacea?

“Rosacea is a long-term inflammatory skin condition affecting around one in 20 people in the UK,” explains Dr Dev Patel, who worked in the NHS for 13 years before specialising in dermatology as an aesthetics doctor.

He says there’s no “cure” as such, but it’s a condition “that can be managed”. Rosacea is not contagious.

“The exact cause remains unclear. But theories have included the involvement of the Demodex mite. Yes, everyone hates the idea of skin mites, but they live harmlessly on many people’s skin. This link was made only because mites were found in higher numbers in those with rosacea.

“Also, Helicobacter pylori, a bacteria long-known for its association with stomach ulcers, may also be associated with rosacea.”

Dr Patel adds that other hypotheses include patients with rosacea having a decreased “sensitivity threshold” (meaning minimal triggering can induce redness and other symptoms). “Or abnormal immune reactions in the skin causing inflammation and dysregulated communication between the nerves and blood vessels in the skin. Historically, long-term use of steroids could present like rosacea, but this is rarer now we understand more about overuse of steroids.”

What rosacea looks like – are symptoms obvious?

“It’s characterised by facial flushing, telangiectasia (the fine visible capillaries) and papules (acne-like spots),” says Dr Patel.

The nose, forehead, cheeks and chin are most commonly affected. In 50-70 per cent of cases, there may be sore, red or dry eyes, and/or a progressive thickening of nose skin.

“At my clinic, we see patients with rosacea daily, but many don’t realise they have it, while others suffer severely enough to cause genuine distress.”

According to Dr Patel, rosacea’s key feature is redness: “flushing which typically lasts longer than 10 minutes.” Less visible – yet equally annoying – symptoms include:

• Skin irritation
• A burning/tingling sensation
• Dryness
• Tearing
• Blurred vision
• Hypersensitivity

How should people know the flushing is rosacea – instead of menopausal, or from that final glass of red wine?

“Rosacea flushing generally lasts longer, but as well as closely examining the skin (by the naked eye or microscope) it’s crucial to understand the details of clients’ lives to pinpoint it, and then offer effective solutions.”

What are the triggers? 

Alcohol and spicy foods are the most frequently discussed triggers, although Louise was aware of this and found cutting them out made little difference.

“Wind or sun, hot baths/showers, stress, extreme temperatures, exercise and some skincare products, like chemical-based sun protection” can be triggering, says Dr Patel.

Louise turned to Justine Masters, a well-known facialist, for help. Masters agrees that use of the wrong products can lead to flare-ups.

Dr Patel says: “Frequently people mistake rosacea for acne, so they turn to the products of their teens to combat this, but they’re too harsh, further inflaming the skin. Your skin’s needs change over time, and continuing to use products you’re loyal to, or worse – investing in expensive anti-ageing regimes – can do more harm than good.”

He also says stress can be blamed, which Louise believes was true in her case. The drama teacher from west London had always enjoyed a clear complexion until lockdown.

Masters insists that “stress is the one trigger that most affects the skin”.

She adds: “When bodies are stressed, they slow down the production of HCI, the stomach acid needed to break down food and allow us to absorb nutrients.”

Masters has worked with women’s skin for years and runs holistic clinics across London. “Healthy skin needs the right nutrients, so my first approach to rosacea is first to understand the client’s life, identifying the stresses causing the flare-ups.”

Who is most at risk from developing rosacea?

“Age, ethnicity and gender all play a part, as does genetics, as there is a higher incidence of rosacea in those with a family history,” says Dr Patel.

“The condition most commonly affects women aged 30-50,” says Dr Patel, though he has treated men and young people too. No one is immune. “Fair skin types, those with that classic ‘Irish’ pale complexion, are more at risk.”

Age, ethnicity and gender all play a part in rosacea – iStockphoto

Masters believes hormone changes, such as the menopause, should be taken into consideration. “But also it’s at this similar age when life is busy and stressful, and past traumas may rear their head and become apparent on the skin. Gut health issues can catch up with you. So if you’ve taken long-term antibiotics or even antidepressants, your gut lining can be weaker and the skin is the first organism to show signs of the body’s stress.”

Of course, no one should stop taking doctor-prescribed medications like antibiotics, or antidepressants, if they’re working for you. But “improving gut health generally can only be beneficial,” says Masters.

How is rosacea treated?

“Traditionally, the NHS had just a handful of medicated creams or antibiotics at our disposal,” admits Dr Patel. Like Masters, he steers patients away from antibiotics because of “the significant disruption of gut flora and long-term consequences on the immune system”.

“Oral vitamin A and isotretinoin can be very effective for thickening of the skin, e.g. on the nose.”

Ultimately, Dr Patel says: “The two most important things for rosacea is to use a zinc-oxide based sunscreen every day and identify your personal triggers, e.g. windy weather, then tweak your lifestyle to avoid them.”

So passionate about skin health is Dr Patel that he has devised his own range, CellDerma, which anyone can buy online, though it’s cheaper at this clinic: Perfect Skin Solutions.

Louise Sewell’s holistic route to healing “has been a process of months”, but she’s delighted with her results.

Working with Masters to repair her gut health with tailored supplements, including magnesium to aid sleep, Louise has also taken measures to reduce stress long-term, slowing down her morning routine, and reducing coffee, sugar and ultra-processed foods in her diet.

She uses only water in the mornings to clean her face and then uses Masters’ bespoke products – most crucially SPF – each day and a calming, barrier-building moisturiser.

Louise Sewell after receving treatment for rosacea

“Having bespoke skincare sounds expensive, but you use so little that it’s better value than the premium brands I was buying before, which weren’t helping. Next time I go camping I’ll be happily make-up free.”

Are there any long-term effects of untreated rosacea?

“Uncontrolled rosacea will certainly accelerate signs of ageing,” says Masters. “But there are so many other implications involved, so if your gut health is a cause of rosacea, it could also lead to other health issues.”

Dr Patel emphasises the negative impact rosacea has on mental health. “Especially if it’s affecting your work. Feeling bad about your appearance can lead to depression and socially isolating yourself.

“As a doctor, I’m reluctant to make claims about the long-term effects of untreated rosacea, but there is evidence mental health issues can be linked to higher incidences of heart and gut health. If you’ve got rosacea, you may be more likely to have other inflammatory conditions which should be investigated. So it’s about more than just aesthetic reasons. Signs of inflammation need attention.”

Finally, don’t despair. “Most rosacea can be dramatically improved, if not entirely eradicated, with the right products and identifying – and reducing exposure to – your personal triggers,” assures Dr Patel. “Laser surgery can also help with thickening of the nose later,  if necessary.”

And, adds Masters, “if rosacea clears but leaves scarrings, options such as microneedling can help. There is no need to suffer in silence.”

As well as working for the NHS, Dr Dev Patel is the medical director of Perfect Skin Solutions and founder of CellDerma.

For more information about Masters’ work, see her website www.justinemasters.london or follow her on Instagram

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