#AskID: Rosacea with Prof Niki Ralph



We asked Prof Niki Ralph:
Rosacea is a common, chronic inflammatory skin condition affecting the face which may be recurrent or persistent. It occurs in approximately 1 in 10 Irish adults. It is known as the “curse of the Celts” as it is found most commonly in fair skinned, blue eyed individuals. It most commonly affects adults in their 30’s/40’s, however, can affect those in their teens/20’s. It is characterized by redness of the cheeks, nose, chin and forehead with/without inflammatory lesions - whiteheads/pustules and red spots/papules. It may also be associated with dry/gritty eyes, facial flushing and sensitivity of the facial skin.

The cause of Rosacea is unknown but is thought to be due to a number of hereditary and environmental factors. There is no specific reason why it would occur in your teens and then again now, bar the most common triggers which are UV exposure, hot and spicy food or drink, rapid change in environmental temperature (such as a hot room, shower, exercise), and topical steroids. Stress also triggers all skin conditions and as the last 7 months of the pandemic have been particularly stressful for people, with many experiencing flares of of pre-existing conditions such as acne, rosacea and eczema.

Not everyone reports the same triggers for their Rosacea, however it is very important that anyone suffering with Rosacea should protect their skin from UV exposure.

The following skincare routine is recommended for those who suffer with Rosacea:

Wash the face with oil-free products daily. Apply prescription topical therapies each morning or evening to clean, dry skin. This must be followed by daily use of a Zinc physical/mineral based SPF each morning (can put in such as ELTA MD clear/tinted) , then make up may be applied last. Ensure all make up is removed each evening. Avoid using harsh products which contain alcohol, glycolic acid, salicyclic acid, benzoyl peroxide which may be more suitable for Acne prone skin and may actually flare Rosacea. Caution with use of retinoids on Rosacea prone skin as it may flare the skin. It may be introduced slowly once the skin is more settled.

People often report feeling self-conscious, particularly when it comes to social situations, due to the redness of the skin and flushing associated with Rosacea. Men in particular do not have the luxury of being able to conceal their redness with make-up. Therefore IPL (Intense Pulse Light) is one of the most effective, non-surgical and simple treatments used to treat redness and broken veins. Our M22 Lumenis has minimal downtime therefore is a lunch-time procedure. For those who have inflammatory Rosacea with “spots” they may also use topical therapies such as antibiotics, anti-parasitics for milder rosacea and maintenance therapy, however for more extensive rosacea oral antibiotics called tetracyclines are used, which have an anti-inflammatory effect on the skin.