Rosacea skin condition could leave you a mite red-faced

Red-faced over what you think is an acne or eczema outbreak? It could be more insidious than that.

An overpopulation of invisible, microscopic mites called Demodex living on our skin and even the follicles of our eyelashes is believed to cause a skin condition called rosacea.

According to Dr Yanni Xu, medical director at The Urban Clinic Medical Aesthetics, many people who begin to develop rosacea have no idea they have it at all.

Symptoms include frequent flushing (may appear as blushing or unspecified redness), persistent redness and broken capillaries (may look like a chronic sunburn or darker dull skin), bumps and pimples (may appear pus-filled and red), eye irritation (if the rosacea is near the eye) and a burning or stinging sensation.

As some of the resulting effects closely resemble common skin conditions such as acne and eczema, many sufferers either self-medicate with unsuitable over-the-counter products or are misdiagnosed and prescribed topical steroid creams meant for acne or eczema, which may end up compromising skin barrier function, making skin more sensitive and irritated.

With April being Rosacea Awareness Month, Dr Xu sheds light on the condition and how to treat it.

There is also an online resource run by an agency for rosacea patients called Red Face Rescue (https://www.facebook.com/redfacerescue/).

What is rosacea?

It is a chronic, recurring inflammation of the skin, which is more common in females and can run in families.

Typically, the first signs of rosacea will appear before the age of 30 as redness on the cheeks, chin, nose and forehead.

These symptoms may come and go without worsening for some time.

But if left untreated, the redness turns more obvious and eventually leads to persistent flushing with visible blood vessels, bumps appearing as a persistent red area, pimples, nodular cystic acne, oil gland dysfunction resulting in oily skin, impaired barrier function with dry/rough and sensitive skin, and watery or bloodshot eyes.

What can trigger a flare-up?

Flushing is the most common symptom of rosacea, and experts believe that chronic flushing eventually contributes to other rosacea symptoms.

Flushing can be triggered by exposure to extreme temperatures (cold and hot), exposure to sunlight, drinking alcohol, eating spicy food, stress, exercise, taking certain medication, and having hot flashes associated with menopause.

The psychological burden of rosacea is real - flare-ups can cause or contribute to low self-esteem.

How common is it among Asians?

Rosacea has been documented in Asian populations and researchers in Korea found that rosacea was not uncommon in their clinics and hospitals.

Demodex mites thrive in the skin of 20- to 30-year-olds because of the sebaceous glands and pilosebaceous glands' increased activity.

The humidity of the tropics, combined with our oilier skin, makes mites prevalent in the skin of our population.

How can it be treated?

As rosacea skin is sensitive, a gentle, hypoallergenic skincare regimen will help prevent its dry and rough irritation symptoms.

Cleanse your face twice a day using lukewarm water, only the fingertips, and non-soap gentle cleansers.

Avoid harsh topical products like exfoliating agents, toners and astringents, and manual exfoliation with scrubs, sponges or rough cloths.

Topical medications such as metronidazole and ivermectin are used in most cases of mild to moderate forms of rosacea as they are capable of controlling the symptoms to a satisfactory level.

Those with severe forms of rosacea do not respond to oral antibiotics or topical medications, so they are treated with low doses of oral isotretinoin daily until the rosacea is managed - this takes five to six months of therapy.

Treatments with light-based therapy (laser and pulsed light) have positive results in treating papulopustular rosacea, but it should still be correctly diagnosed and combined with skincare, topical and/or oral medications.