A Deep Dive into Rosacea with Dr. Mark Kirchhof

Ottawa, ON

Can you tell us from a dermatological standpoint what exactly rosacea is?

So, rosacea manifests in quite a few different ways, and it’s caused by a variety of different factors. We know that it manifests in the skin with flushing, with redness, with dilated blood vessels. You can get facial swelling, you can get pustules, pus-filled bumps, you can get pimples or bumps, red bumps on the face or elsewhere.

You can get ocular involvement or eye involvement as well. And then you can get these phymatous changes, which are like enlargements of the skin, so it really can manifest in a variety of different ways, involving different parts of the body.

And do we know what the underlying causes of rosacea can be?

We don’t have a clear etiology or pathophysiology of why people get rosacea. We do know that it is more common in certain types of people, so there is a genetic component to it. And we know that there is an immune system response that’s active, so there’s inflammation of the skin that’s taking place.

Our skin is a barrier between the outside world and the inside world. People with rosacea have a skin barrier that’s not as functional as it should be. So I would say rosacea is multifactorial with lots of different presentations.

Are certain people more prone to rosacea than others?

We do know that it appears to be more common in people who are white or Caucasian and people who are of Northern European descent. I will put a big asterisk on that to say that we certainly see rosacea in patients of skin of colour or who have darker skin tones, and I think we are probably underdiagnosing it in that population, so I suspect this might be a bias in terms of what we see.

Initially, it was thought that there was a gender difference, but more recent analysis has indicated that it’s probably equally likely in men and women. The time of onset, in terms of when it happens or when it starts in people’s lives, is a bit variable, but generally, the 30s to 40s is when we see most of the people start to have manifestations of this disease.

So, for people of colour, what should they be looking for in their skin in terms of potential rosacea, when the flushing and redness may not be as evident?

So, the first thing would be symptoms. Rosacea is often associated with burning, sometimes itching of the skin, often triggered by certain things. Food is a common trigger for some people, sun exposure is another one, and exercise or heat can be another trigger. So, looking for those symptoms associated with some sort of known trigger for rosacea would be one of the first things I would ask people to look for.

The second one would be the other manifestations. As I mentioned, you can have eye involvement, you can get these red bumps or papules, pustules on the face – those are more overt signs. And so you might miss the redness, but you might experience the symptoms, and you might see some of the more advanced manifestations of the disease, but certainly some of the fine redness or the flushing may be missed early on (in people of colour).

Can we talk a bit more about general food and lifestyle triggers for rosacea?

So we know that a lot of individuals have identified food triggers, and there’s a wide variety of things that I have heard: spicy foods, very hot food, certain spices, chocolate, etc. The belief is that these cause some sort of neurological stimulus, and that’s what causes the flushing and redness to come out. So, food is certainly a big trigger.

That’s not the only one, though. Sun exposure is one of the other big ones; it might be the heat, but also the actual radiation that comes from the sun. So, heat and sun exposure or radiation from the sun are both triggers for this condition.

Exercise is another thing that we have seen, as it’s causing a lot of blood circulation, vasodilation, or increasing the size of the blood vessels, and that can make flushing and redness much worse if you’re predisposed to it.

Can you give us some information about skincare for folks with rosacea?

So, in terms of skincare for rosacea, we know that the impaired skin barrier is one of the hallmarks of the condition, and so we do recommend that patients use a good moisturizer on a regular basis. This will help maintain the skin barrier and allow for healing to take place. It also calms some inflammation, as moisturized skin is less likely to be inflamed, so that’s the easiest thing that people can do.

The second thing is to avoid things that irritate the skin and cause more redness. So there are some products that contain alcohol, for instance, and alcohol is an irritant to the skin, so avoiding products that contain alcohol is an important consideration.

Then there are a variety of over-the-counter remedies that claim to improve rosacea and have a variety of botanical ingredients. The data and evidence on these are overall weak, but some patients certainly do find benefit from them. You can ask your pharmacist to go over the different products that are available.

Some of them also contain pigmented ingredients, so the redness can fade a bit when you use these products, and that’s also helpful for some patients.

Beyond that, I mentioned sunscreen is important because we know that the sun is a trigger, and so using sunscreen on a regular basis is another recommendation that we make.

Beyond the over-the-counter options, what does treatment from a dermatologist look like?

We have a variety of treatments available for rosacea, and it really depends on the type of rosacea and the severity, so we will tailor therapy appropriately.

In a general sense, we have topical medications, where some of them are geared more towards limiting the redness, and some of them are geared towards treating the flushing. Often, we will use oral medications to target the inflammatory processes.

And then we have lasers or other physical treatments that can be used to destroy some of the blood vessels, causing the flushing.

For ocular rosacea, we might use warm compresses as an initial therapy, along with lubricating or anti-inflammatory eye drops. And then oral antibiotics can sometimes be given as well for the eye involvement.

For the facial swelling, we sometimes use oral steroids to reduce the inflammation and swelling.

So it’s not a simple answer. It’s not one-size-fits-all. Treatments are really tailored to the patient and their manifestations of rosacea.

Is there anything further on rosacea that you think is important for folks to know from an educational standpoint?

I think rosacea is extraordinarily common. And if you are suffering from it, seek out medical attention. We do have treatments.

Certainly, it can be debilitating. It’s not just cosmetic. A lot of people assume that it’s just a cosmetic disease, but in fact, it can have other implications as well. We know that inflammation in the body, even in the skin, can have a long-term impact.