Do you suffer from redness across your nose, cheeks, forehead and chin that comes and goes? Do skincare products —and sometimes even just water—sting your skin?

These two symptoms alone won’t necessarily lead to a diagnosis—they could be indicators that you might have an allergy to a certain ingredient, or just sensitive skin. But they might also suggest that you are suffering from rosacea.

What is rosacea?

Depending on who you speak to, the skin disease rosacea affects anywhere from one per cent to 22 per cent of the population, so if you’re a sufferer, you’re far from alone.

While it can affect people at any age, rosacea usually begins between 30 and 50 years of age. It tends to affect women more than men: in one UK study, around 80 per cent of cases were diagnosed after the age of 30 — women accounted for more than 60 per cent of cases.

EV Editorial Panel member Dr Anna Hemming is the Founder of Thames Skin Clinic and The Cosmetic Skin Doctor. She developed rosacea as an adult so has a particular interest in its care and management.

“We describe rosacea as a common relapsing skin condition mostly affecting fairer skin,” she says. “There is a genetic tendency, but there’s also a lifestyle link too. For example, I believe my rosacea developed due to my active outdoor lifestyle—rowing, racing, army expeditions, living in Fiji, travelling a lot—and having fair skin.”

Alongside the redness and stinging, rosacea patients may also have spots and enlarged oil glands. It can also occur in combination with acne.

Rosacea is a condition characterised by flare-ups, meaning you can go weeks or months without experiencing symptoms and then—bam—it’s like it never went away. Dr Hemming says that some people can point to triggers, such as alcohol, cold weather, exercise, chocolate, spicy foods and stress which exacerbate their symptoms, but that’s not the case for everyone.

What actually causes rosacea?

“The real cause is not comprehensively understood due to the condition's complexity,” says Dr Hemming, “but we do know it has a neuromuscular element.”

The neuromuscular system is how medics describe the body’s muscles and the nerves that relate to them, and recent research suggests that there might be an association between rosacea and other more systemic diseases, suggesting it could also be related to the immune system.

But it’s still a condition that needs a lot more research.

Another theory, based on recent interest in the skin’s microbiome—or the microbes that live on our skin—is that it’s caused by tiny mites, known as Demodex folliculorum. 

These mites are found in all skin types but they seem to be present in greater numbers on the skin of those who have rosacea—although the jury is still out on whether the mites cause rosacea, or the rosacea encourages the presence of the mites.

How can I treat my rosacea?

Brace yourself for the bad news… “Rosacea can’t be cured,” says Dr Hemming. “It’s a skin condition that is with you for life. However, what we can do is manage the symptoms and reduce the triggers. Skin can flare up unannounced and we just have to expect that from time to time. Likewise, skin can be well behaved for years without any help from us at all.”

Look on the internet and you’ll find all sorts of lists of dos and don’ts when it comes to skincare.
It’s generally agreed that as sun can make things worse, you should be using a high factor, broad spectrum sun protection—but then everybody should be doing that anyway. It also makes sense to steer clear of ingredients that have a potential to irritate skin such as menthol, camphor, fragrance and sodium lauryl sulfate.

But beyond that, there seems to be little consensus. Some people will say that you categorically shouldn’t use tretinoin—the prescription form of vitamin A—while others will argue that it can help.
In reality, the most sensible thing you can do is find a dermatologist who can put you on a skincare regime to help manage it.

They might want to use prescription ingredients, such as metronidazole—an antibiotic, azelaic acid or vitamin A—but they can also create a bespoke regime that will address your rosacea, as well as any other concerns you might have, such as fine lines and wrinkles.

“We know that by taking oil away from the skin and correcting the barrier function within skin we can protect it and minimise inflammation,” says Dr Hemming. “Clearing congestion helps reduce pimples and enlarged oil glands, and reduces inflammation too.”

She often recommends a product called Rozatrol from ZO Skin Health to her patients. “It’s a soothing redness relief cream which increases exfoliation sensitively, calming the skin with advanced amino acid complexes and antioxidants that work to reduce inflammation and damage caused by daily oxidative stress.”

Once you’ve sorted the skincare side of things, there are also in-clinic treatments that can help with the redness.

“Thread veins can be removed with ThermaVein [a treatment that uses heat delivered via a probe to seal the walls of the thread vein causing them to disappear permanently] and we can also treat redness with lasers, such as the Laser Genesis or the Excel V+ laser.”

These lasers are non-invasive and work by delivering heat to the lower levels of the skin where they shrink blood vessels, break down scar tissue and stimulate collagen production.