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Traitement contre la rosacée.

Can we treat rosacea?

Nearly 415 million people worldwide are affected by rosacea. Intense redness, heat flushes, visible blood vessels... solutions exist to alleviate these symptoms. But is it possible to treat this skin disorder?

Summary
Published February 27, 2023, updated on March 29, 2024, by Pauline, Head of Scientific Communication — 6 min read
Rosacea

The various aspects of rosacea.

Rosacea is primarily characterized by the presence of a widespread and diffuse redness on the face. This typically concentrates around the nose, cheeks, chin, and forehead, due to the high vascularization of these areas. The small blood vessels in the face tend to dilate and thus become visible.

Rosacea also comes with many invisible symptoms, such as hot flashes, significant skin sensitivity, burning sensations, and tingling around the affected areas. Although this skin condition can appear as early as childhood, it often reaches its peak between 30 and 50 years of age. People with fair skin and women are the most likely to develop this disorder. The characteristic symptom of rosacea is the presence

The causes of this dermatological disorder are still poorly identified. However, several ongoing studies have shown that certain factors could be responsible for rosacea flare-ups. These include hereditary predisposition, parasitic colonization, heat, sunlight, stress, or a certain diet.

This skin disease tends to progress over time and operates in cycles. Its symptoms can notably disappear for a few weeks before suddenly returning more intensely. Indeed, the face can also be affected by significant swelling, deformities, or papules. In the most severe cases, rosacea reaches the eyes and causes their inflammation. Four subtypes of rosacea have been identified:

  • Vascular rosacea or couperose.

    This is the most common form of rosacea. It primarily induces hot flashes, temporary or permanent redness known as erythema, heightened skin sensitivity, and the dilation of vessels beneath the skin, becoming visible.

  • Papulopustular rosacea.

    It is sometimes mistaken for acne due to the presence of red bumps, or even pustules, in addition to redness. Papulopustular rosacea is also accompanied by feelings of tightness and sensations of burning and discomfort.

  • Hypertrophic Rosacea.

    This rare form is characterized by a thickening of the skin and a dilation of the skin pores on the nose, referred to as "rhinophyma". It is a major complication of rosacea, due to the aesthetic damage it causes. The skin thickening is sometimes associated with papulo-pustules and can extend to the rest of the face.

  • The Ocular Rosacea.

    Rosacea sometimes affects the eyes. In such cases, patients exhibit redness in the eyelids, conjunctivitis, and dry eyes. Often, they also suffer from a persistent sensation of having sand in their eyes.

It is important to consult a dermatologist as soon as the first signs appear. Mild rosacea can quickly lead to complications, particularly affecting the eyes.

Rosacea: List of Various Available Treatments.

While rosacea never completely heals, various treatments exist to improve the skin's appearance by reducing redness and pustules. The progression of symptoms can also be slowed down with appropriate treatments. However, it should be noted that results only begin to become visible after several weeks.

The treatment of rosacea varies depending on the severity of symptoms and the stage of the disorder. The results can be satisfactory; however, symptoms tend to reappear if the treatment is discontinued. It is generally necessary to follow a continuous treatment in order to maintain the therapeutic benefits.

Topical treatments.

The topical application of creams or gels is generally used for cases of vascular or papulopustular rosacea. These creams contain active ingredients that often have vasoconstrictive properties, such as brimonidine, anti-inflammatory properties, like azelaic acid or ivermectin, and antiparasitic properties, like metronidazole.

These creams serve as preventive and curative treatments. They are applied daily, both during rosacea flare-ups and in the weeks following, in order to minimize the risk of recurrence.

Oral treatments.

When rosacea is widespread or affects the eyes, the use of antibiotics such as cycline is often necessary, in addition to topical creams. Used for its anti-inflammatory properties, this antibiotic reduces papules and pustules, but not redness or telangiectasias, which correspond to dilated small blood vessels.

These antibiotics work by inhibiting the synthesis of proteins necessary for bacterial growth. This effectively prevents their proliferation. As this treatment is photosensitizing, it is necessary to avoid exposure to UV radiation and to protect oneself by using a sunscreen.

Cyclines also have anti-inflammatory properties and regulate the secretions of the Meibomian glands, the dysfunction of which is the cause of ocular rosacea. In case of contraindication to cyclines, macrolides, antibiotics that inhibit the multiplication of bacteria, are generally prescribed.

Surgical treatments.

Surgical treatments may be necessary when rosacea reaches an advanced stage (hypertrophic rosacea). The procedure involves treating the thickening and deformities to best reshape the nasal appearance. For this, processes of dermabrasion, which involves the removal of dead skin cells, or skin grafting are used.

Laser treatments and pulsed light therapies also help to reduce redness and the visibility of blood vessels by decreasing their dilation. These solutions are typically used to treat cases of rosacea. Side effects are often mild: after the session, the treated areas may be slightly red and swollen.

Sources

  • Thèse de Kelly ZAROUKIAN. Étude des aspects cliniques cellulaires et moléculaires de la rosacée, des traitements dermo-cosmétiques associés ainsi que de l’impact sur la qualité de vie des patients (2017).

  • STEINHOFF M. & al. Recent advances in understanding and managing rosacea. F1000 Research (2018).

  • TAN J. & al. Rosacea: New Concepts in Classification and Treatment. American Journal of Clinical Dermatology (2021).

  • ALI F. & al. Rosacea. British Journal of Hospital Medicine.(2021).

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