ROSACEA GETTING UNDER THE SKIN OF
Rosacea is one of many skin conditions that is often reported in the community pharmacy. By Aaron Courtenay MPharm MPSNI
kin conditions form one of the most common topics discussed across the countertop; whether
rash, pimple, redness, or sore – patients frequently attend their community pharmacy in order to speak with the pharmacist, find out what is causing the annoyance, and hopefully gain some information as how best to deal with their particular ailment.
In many instances, problems with the skin are mild, self-limiting, and will rectify themselves within a short timeframe, with no cause for alarm. Patients often quote that “it is not so mush the pain or discomfort, but the look of it that’s annoying”. Too often patients find skin conditions embarrassing, even though a significant number of people in society have skin ailments.
It is the role of pharmacists to equip patients with the knowledge and information that they require in order to take positive action and ultimately treat or manage their condition – including treatment options, avoidance suggestions, and of course medicines.
What is Rosacea? Rosacea is a common skin condition, which mainly affects the face – however the cause is poorly understood. It is estimated that up to 1 in 10 people have the condition, and approximately 1 in 600 people in the UK are diagnosed with the condition each year. 
It most commonly affects people with fair skin, however can also occur in people from Asian or African genealogy. Rosacea occurs in both men and women, but tends to be
more common in women, with the majority of cases diagnosed in the 30 – 50 years age bracket.
Rosacea is characterised by episodes of flushing, where skin turns red for a short period of time. Other symptoms can develop as the conditions progresses, such as burning and stinging sensations, permanent redness, spots (papules and pustules), and small blood vessels in the skin becoming more visible (telangiectasia).
Symptoms of Rosacea Rosacea causes a range of symptoms, although not every person will experience every symptom – this can add to the difficulty in achieving a diagnosis of Rosacea. Many people will have periods of time when symptoms are mild or perhaps nonexistent, however following some trigger factor, the condition can flare up and symptoms can become much more troublesome. The main symptoms of Rosacea are:
Flushing – skin turns red for a short period of time, usually no more than a few minutes. It tends to affect the face although it can spread to the neck and chest. In some cases the redness can be accompanied by an unpleasant feeling of heat.
Persistent facial redness – known as erythema, is like a blush or a patch of sunburn that does not go away. This type of blotchy skin is often associated with drinking too much alcohol and as such many patients report this to be upsetting, as people suffering from Rosacea can be mistaken for heavy drinkers. The redness usually affects the cheeks, nose and chin, but can spread to the forehead, neck and chest.
Telangiectasia – These are visible blood vessels in the skin that have become permanently dilated over time.
Papules and pustules – If you have rosacea, you may develop round red bumps that rise from the skin (papules), or pus filled swellings (pustules). These are similar to those found in acne, however the two conditions are very different in etiology.
Thickened skin – in the most severe cases of rosacea, the skin can thicken and form excess tissue, usually around the nose. This causes the nose to become larger than usual and bulbous in appearance. This is known as rhinophyma. Rhinophyma is an uncommon, severe symptom of rosacea, takes several years to develop, and is much more common in men than women.
Eye problems – in addition to the problems associated with the skin, rosacea can also affect the person’s eyes. This is known as ocular rosacea and includes a feeling of dry eyes, irritated and bloodshot eyes, inflammation of the eyelids, and feeling like there is something in your eyes.
Other symptoms include having sensitive skin with burning, itching, stinging, dry and rough skin. Permanent damage to the face, such as scarring is uncommon in rosacea. 
Causes of Rosacea The exact cause of rosacea is somewhat unknown, although a number of possible factors have been suggested as contributory. It is very
possible that a combination of factors may be responsible for the condition, although as yet the evidence is not there to support this for certain.
Some believe that abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This would account for the symptoms of flushing, persistent redness and visible blood vessels, however it is not known what causes these abnormalities. Damage to the skin by sunlight may be responsible for degeneration of the elastic components of the skin and dilation of the blood vessels.
Recent research has shown that external triggers such as ultraviolet light, spicy food, alcohol, exercise, stress, red wine, heat and cold can lead to the activation of certain immunomodulatory peptides within the skin. Increases in these peptides may in-turn affect the immune or neurovascular system causing dilation of the blood vessels, redness, and inflammation. 
Microscopic mites called demodex folliculorum usually live on human skin, however higher numbers of mites have been found on people suffering from rosacea. Currently it is uncertain whether the mite is a cause or an effect of rosacea, although some researchers believe the symptoms of rosacea may be caused by the skins reaction to bacteria in the mites’ faeces. 
People suffering from rosacea often find certain triggers make their symptoms worse, however different people can have different triggers. Common triggers include: exposure >
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