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Byline: Dr Elena Douse

SPOTS at the age of 14 are expected - but spotty skin at the age of 40... ? If you're suffering from midlife break-outs, you could be suffering from the skin condition rosacea.

Rosacea is surprisingly common, affecting approximately 5% of the general population from the age of 30 onwards.

Patients initially notice flushing and persistent redness of the skin of the face. Tiny thread veins become visible on the surface of the skin around the nose and cheeks.

Pus-filled spots (pustules) and small red lumps (papules) develop on the skin over the nose, forehead and cheeks.

The exact cause of rosacea is still unknown, but many factors can affect the severity of the condition.

Patients find that they have periods where their symptoms are particularly troublesome and other periods where their symptoms are much improved.

Rosacea is typically made worse by alcohol, spicy foods and sunlight and I see many patients presenting with worsening of the condition over the summer months.

Other factors, which may exacerbate symptoms, include wind exposure, hot drinks, hot baths, stress, exercise and caffeine.

Avoiding these precipitating factors and protecting your face from the sun using a daily sunscreen containing at least SPF 15, helps prevent troublesome flare-ups.

Many patients have never heard of rosacea and suffer in silence, incorrectly believing that they have a form of middle age acne.

However, unlike acne, rosacea sufferers do not develop blackheads, a feature which distinguishes the two conditions. As with acne, the spotty, flushed appearance of the skin can understandably affect patients' confidence and may cause problems with low self-esteem.

Although there is no cure for rosacea, fortunately there are a number of treatments available, which can help alleviate the symptoms and improve the cosmetic appearance of the skin.

Initially, doctors will try topical antibiotic gels which can be applied to the affected areas of skin on the face.

These gels contain the antibiotic, metronidazole, and help treat the inflamed papules and pustules of rosacea.

The gels are generally continued for a few months and improvement should be expected after the first three to four weeks.

Oral antibiotics such as tetracycline or erythromycin are also used to help clear the skin.

Antibiotic courses are generally given for six to 12 weeks but recurrent courses are often needed to keep symptoms at bay.

The tiny visible superficial thread veins seen in rosacea, will not resolve with antibiotic treatment, and can only really be effectively treated with laser therapy.

In severe, persistent cases of rosacea, overgrowth of the sebaceous (sebum-producing) glands, particularly on the nose can occur.

This can lead to an enlarged, bulbous, disfigured shape to the nose known as rhinophyma - typically seen in elderly men.

Early preventative treatment of rosacea can help slow the development of this complication but, once present, surgical reconstruction with lasers and dermabrasion is the only effective way of improving the cosmetic appearance of the nose.

In addition to rhinophyma, rosacea may also cause sore, red, inflamed eyes, particularly affecting the eyelid rims.

This is known as blepharitis and is an indication for oral antibiotic treatment.

So don't suffer in silence! If you recognise the symptoms of rosacea and think you may be suffering from the condition, make an appointment with your GP where you can be properly assessed and appropriately treated.


Send your questions to Dr Elena Douse c/o South Wales Echo, Six Park St Cardiff CF10 1XR
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Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Publication:South Wales Echo (Cardiff, Wales)
Date:Aug 27, 2009
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