Are you getting hot and flushed in the face after a drink, or experiencing unusual breakouts? You might put it down to being older, or hormonal changes, but it could be that you have rosacea
Rosacea is an inflammatory skin condition that usually develops after 30, but can be more severe in sufferers over 50, says The National Rosacea Society (NRS) in the US, because it is often not diagnosed. Up to one in ten of us has it. In many cases it is diagnosed as adult acne, the treatment for which exacerbates rosacea.
Who is susceptible?
It’s more common in women, but men tend to get more severe symptoms, possibly because they don’t seek treatment as quickly. Well-known male sufferers include Bill Clinton and Prince Charles. Princess Diana is said to have had it.
Rosacea can be hereditary, and particularly affects people with pale skin and those who blush easily. Triggers include alcohol, spicy food, temperature extremes, wind, exposure to sunshine, stress, hot baths and vigorous exercise.
Signs you have rosacea
There are four types of rosacea, which are distinguished by:
Facial flushing and persistent redness, leading to visible broken veins; sensitive, stinging, swollen or rough scaly skin (called erythematotelangiectatic rosacea). The red nose and face associated with rosacea has often been misinterpreted as excessive drinking.
Persistent redness with bumps or pimples, raised patches or acne-like breakouts (called papulopustular).
Thickening of the skin, usually around the nose, and bumpy skin texture (this rare form is called rhinophyma).
Watery, red, irritated eyes; or dry, itchy or sensitive to light: this is ocular rosacea, which can lead to sight problems.
Diagnosis: is your skin problem actually rosacea?
Gisele Mir, having Iranian parents, did not fit the conventional rosacea profile and was misdiagnosed in her 30s, first with acne, and then with pregnancy-related skin problems.
Eventually, in her early 40s, she was diagnosed correctly while her regular dermatologist was on holiday.
She was a solicitor, but her struggles with her skin led her to retrain as a cosmetic scientist. She developed her own range of products, Mir Skincare, for people with sensitive skin and rosacea, which has now been selling online for 13 years.
The first step if you think you might have rosacea is to see your doctor. But do some research before you go (either on NHS Choices or, Gisele’s suggestion, DermNet), as doctors don’t get much dermatology training and early cases may not be recognised.
Maggie Alderson (left) is a writer and bestselling novelist who was in her early 40s when she started to get red spots on her face. Maggie’s rosacea shows up as “red, sore, raised welts on my nose, cheeks and chin that come and go randomly”.
She says: “I figured out for myself it was rosacea, and had a formal diagnosis from a dermatologist recommended by a friend when I was visiting New York.”
Treatment and skincare for rosacea
Tetracycline antibiotics are sometimes prescribed to reduce inflammation and redness. Laser and intense pulsed light treatments can be used to remove visible veins and reduce facial redness.
Topical treatments are often used to calm the skin and treat bumps and pustules. “Be cautious with these,” advises Gisele. “Products with an alcohol base can cause irritation, and a cream base can cause clogging.”
Each case is caused by different triggers and will respond differently to treatments, so her advice is to “take selfies and keep an online journal, recording what you are using, and what your skin looks and feels like on it”.
One of High50’s editors, Jacqui, agrees. She was diagnosed with rosacea at 51and the first two prescribed treatments didn’t work. She had to be persistent to get repeat appointments with her NHS dermatologist and is now on a third treatment, after seeing a different consultant.
Having tried many ranges, Maggie has realised that “the less I do, the better”. Her skincare routine now comprises a MakeUp Eraser cloth to cleanse, using no products, followed by moisturising with organic coconut oil. If she gets a breakout, putting slices of cucumber on her face draws out the heat.
She uses Bare Minerals powder foundation, which covers rosacea blotches, and points out that beauty companies tend to only address the generalised flushing type of rosacea, with products to tone down redness.
It can be trial and error. Even quality, plant-based brands have inflamed Jacqui’s skin, and within the same brand some products can irritate but others not.
She now sticks to REN’s No 1 Purity Cleansing Balm, 3-in-1 Cleansing Water and Evercalm Day Cream. For the generalised redness she swears by Laura Mercier’s Crème Smooth foundation, for good coverage without being heavy, using Secret Camouflage concealer on severe patches.
Diet changes to help rosacea
The rosacea journal suggested by Gisele is also helpful in identifying food and drink triggers. Maggie believes that major changes in her diet have made her skin better than it’s been for years. “Coffee is an absolute disaster, so I’ve given it up,” she says. “White wine is almost as bad and these days I hardly drink.
“I now have only two cups of tea a day, whereas I used to have up to six. And I’ve cut right down on sugar.”
If it’s not treated, rosacea tends to become progressively more severe, says the NRS, so don’t ignore unexpected flushing or breakouts. Though rosacea is a chronic condition for which there is presently no cure, it can be controlled with the right combination of diet, skincare and medication.