Don't be red-faced over rosacea

A 25-year-old woman, who came to see me recently, said her friends and family had been asking her the same question of late: "Why is your face so red?"

June, as we shall call her, was starting to find this upsetting.

She was getting self-conscious of the red, peeling skin on her face and declined to go out with her friends whenever her skin flared.

She had been experiencing sensitivity on her face for at least two years before she consulted me.

Her skin would itch and sting. Almost all the facial products she had bought off the counter - and she had tried a lot - were unsuitable. She also had painful pimples that would appear intermittently on her cheeks and forehead.

Most upsetting to her, though, was the red skin on her face. She found it increasingly embarrassing to be seen in public as her face was perpetually flushed.

She was perplexed as to what to do. She had to go for work interviews but using make-up to cover the blemishes would irritate her face and worsen the redness.

She had seen various doctors over the past two years. Most of them had told her she had eczema and prescribed steroid-based creams that did help, but not for long.

When she stopped applying them, the flushing returned with a vengeance. There was nothing wrong with the creams - it was the diagnosis that was incorrect.

Once, a doctor told her she had acne. The topical medication that was given to her made her redness and sensitivity worse.

This is the classic history of a person who is suffering from rosacea, which is often mistaken for other skin diseases. A rosacea patient may be misdiagnosed and wrongly treated for years.

When I think of rosacea, the ruddy cheeks of celebrities like actress Renee Zellweger and the late Princess Diana come to mind, as it is a common condition seen in light-skinned people.

People mistakenly think that rosacea is not seen in Asians, but Asians with lighter skin do and can have rosacea. This being so, it is often diagnosed as other diseases, such as eczema, which mimics its signs.

June has papulopustular rosacea, which is characterised by redness, swelling and acne-like breakouts.

If this form of rosacea is misdiagnosed and topical medication for acne is applied, it can worsen the redness and sensitivity.

In the sensitive and red form of rosea (erythema-telangiectatic rosacea), the skin on the cheeks, chin, nose and forehead will be flushed.

Prominent vessels may also be seen, especially around the nose and cheeks. The skin will also be sensitive and patients will often complain of stinging or itchiness.

A third form of rosacea (phymatous rosacea) typically appears after years of poorly controlled rosacea. This is when the skin turns coarse and appears to be thick. The nose, chin and ears may also be affected. Unfortunately, medications may not help anymore.

To smooth out the skin, one may have to turn to ablative laser treatment, dermabrasion and even surgery, all of which have their limitations.

Yet another type of rosacea affects the eyes. The eyes feel gritty and dry, and sometimes red too. Eye specialists should be consulted if this occurs.


Rosacea happens when there is inflammation deep inside the skin and the support for the fine vessels within the skin is thought to be defective. Sometimes, skin mites can also cause rosacea.

Alcohol, heat, UV light, spices, hormones and stress are some of the common triggers for rosacea. But there is no definitive cause that can be singled out.

When the blood vessels in the skin dilate, the reaction is seen as red flushing on the cheeks, nose and chin. This often appears on the whole face and neck.

Avoiding triggers can help prevent permanent dilation of the vessels. Controlling the inflammation over time may prevent the skin from turning coarse.

Treatment for rosacea involves the use of topical medications, oral medications and procedures.

The topical medications that are most often used to treat skin inflammation include metranidazole gel, azaleic acid cream and gentle cortisone lotion, which can be prescribed by a doctor.

To settle persistent facial redness of rosacea quickly and temporarily, patients can consider using brimonidine topical gel, which was approved by the US Food and Drug Administration in 2013 as a treatment for rosacea. It is extremely useful when a person wants to prevent flushing and redness for the day or for an important meeting or event.

Oral medications such as antibiotics and isotretinoin can prevent flare-ups.

Certain procedures can also be done to decrease the vessel size and settle the facial redness if medications are unable to control the activity of the rosacea adequately. If the skin is already coarse and thickened, procedures involving lasers and dermabrasion can help improve the appearance and smoothen the skin.

June was prescribed medicated creams and an oral medication. Her condition improved after six months. She also underwent a series of laser treatments to shrink the vessels on her face and is happy with the results.

A patient's confidence and quality of life should start to improve once treatment is under way.

If you have been struggling with red, sensitive skin, it is best to consult a dermatologist.

A proper diagnosis with the right treatment will make a significant difference to your quality of life.

•Dr Lynn Teo is a consultant dermatologist at The Dermatology Practice.

This article was first published on Dec 13, 2016.
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