Introduction

Acne rosacea is a condition that causes the skin of the face to look red.¹ This affects people with light skin more than people with darker skin tones, and it is more common in people assigned female at birth.^2,3 It usually happens after the age of thirty.³

This article will explore rosacea in more detail and the ways that photodynamic therapy may be able to help improve symptoms.

What is rosacea?

Rosacea is caused by inflammation of the skin. Unfortunately there is no cure, so it is something that affects people for their whole lives.³

Rosacea usually affects your face, but can sometimes affect other parts of your body like your chest and neck.² The symptoms of Rosacea can be long lasting, or they may flare up for a short while before getting better but they usually return.¹ 

Symptoms of rosacea

Rosacea can cause many symptoms. These are listed below:^1,2,3 

• Skin redness, also known as flushing
• Broken blood vessels visible on the surface of the skin
• Yellow bumps on the skin full of a yellow, pus-like substance
• The skin becomes thicker, especially at the nose. This can cause the nose to look “bulbous”
• The skin may feel hot/a burning pain
• Patches of yellow and/or orange on the skin
• Burning, dry, watering or irritated eyes
• Skin swelling (sometimes called oedema)

Types of rosacea

There are four main kinds of rosacea. A person may have only one type, or a mix of two or more kinds or rosacea:^3,4

Ocular rosacea

This type of rosacea affects your eyes, making them feel irritated. The eyes can become bloodshot and they can water too much, causing tears to run down the face. You may get styes (otherwise known as hordeolum) which are painful red bumps on your eyelids caused by blocked glands.^{, 5} You may get other symptoms light light sensitivity and temporarily blurred vision, but if it is left untreated then it can cause problems with the clear front layer of the eye (the cornea).³

Erythematotelangiectatic

This kind of rosacea flares up and then can get better again in ways that are difficult to predict.  People with this kind of rosacea usually have broken blood vessels that can be seen on the skin and is also known as vascular rosacea.³

Phymatous

This kind of rosacea leads to the skin becoming swollen (also called oedematous) and therefore bumpy. This is normally noticeable on the nose, which can cause rhinophyma (bulbous nose).³

Papulopustular

People often think that they have acne when they have papulopustular rosacea. This kind can also make your skin swell, but it causes pus-filled spots on the skin too.³

Risk factors for rosacea

It is not known exactly what causes rosacea.¹ We do know that if your parent or sibling has Rosacea it makes it more likely that you will also have the condition.³

There is some evidence that suggests that Rosacea may be caused by a person’s immune system being too active.³ 

There are some things that can make it more likely that Rosacea will flare up. These are:²

• Stress and anxiety
• Drinking alcohol
• Exercising
• Eating food that is spicy
• Some beauty products
• Being in a hot environment
• Being in a cold environment
• Being in a windy environment
• Drugs that affect the blood vessels
• Hot drinks
• Ultraviolet light exposure (eg. from being in the sunlight)

Diagnosis of rosacea

If you think you have Rosacea, you should make an appointment with your doctor.² During your appointment, they will ask you about the symptoms that you have been having and any other health issues you may be experiencing. They will also look at your skin to see if it has a typical Rosacea appearance.³

Your doctor may refer you onwards to a doctor who specialises in skin problems, also known as a dermatologist.³

Treatments for rosacea

There are several ways to try to treat the problems caused by rosacea.²

Medicines

Your doctors may prescribe you medication to help with the symptoms or rosacea. These may include:³ 

• Topical medications (a cream or a gel that is put on the skin). These usually contain medication like metronidazole, azelaic acid or ivermectin to help to reduce the pimples that people with rosacea can experience. Brimonidine gel can also be used to help make skin less red
• Antibiotics such as doxycycline can be used to improve spots on the skin

Surgery

If a person has severe rhinophyma, their healthcare team may recommend surgery to make the affected skin look more like it used to.³ 

Effects of rosacea 

Rosacea can have a large impact on a person’s daily life. Some people have reported depression, embarrassment, anxiety, loss of sleep and even thoughts of ending their own life due to Rosacea.⁴ 

Photodynamic therapy

Photodynamic therapy is a treatment that is used to kill unhealthy cells with a combination of chemicals and light.⁶ This technique can be used for skin conditions like rosacea but it can also be done in the mouth, eyes and oesophagus (the tube that takes food from the mouth to the stomach) for other health problems including cancer, acne and warts.⁶ 

What happens when you have photodynamic therapy?

Photodynamic therapy has two stages.⁶

Stage 1

Stage 1, also known as the preparation stage, is when the special light-sensitive chemicals are applied to the relevant area of your body (in this case, the area of your skin that has been affected by rosacea). This may be given to you as a liquid for you to drink, a cream, or an injection.⁶

Then you can leave the clinic for a few hours or days while the chemical makes its way into the cells.⁶

Stage 2

Once the chemicals have had time to settle into the cells, you will have the light treatment part of the treatment which is stage 2. Your healthcare team will shine a special lamp or laser on the affected skin for between ten minutes to three quarters of an hour.⁶

Sometimes the area will be numbed to make you more comfortable while the light treatment is taking place, and on occasion patients are put to sleep for the procedure (though this is more common when the photodynamic therapy is required for a place inside the body).⁶

Sometimes photodynamic therapy is done using daylight. This means that, instead of having a laser or light shone at you, you instead spend about two hours outdoors to activate the chemicals.⁶

After photodynamic therapy

It can take between two to six weeks for the affected area to heal completely. After the surgery, your health team will cover the skin in a dressing to protect it as it starts to heal and this dressing should be in place for at least a day, though your doctor will tell you how long exactly to leave it on. You should keep the area dry and also avoid bumping, knocking or scratching that area if you possibly can.⁶

Once you take your dressing off, you can shower etc. as normal as long as you gently pat the skin dry rather than rubbing it.⁶

Effects of photodynamic therapy on rosacea

It may take several treatments to get the best results, with one study finding an improvement between fifty and seventy-four percent after three treatments.⁷ 

People who have had Photodynamic Therapy usually report that their symptoms improve and that the side effects are not bad enough to outweigh the good effects of the treatment.⁴ 

Other ways to manage rosacea

Some people use other methods to reduce the signs of Rosacea.³ Some of these options are described below.

Makeup

Using makeup with a green tint helps to neutralise the redness of a person’s face and therefore these are good at helping to reduce the visibility of rosacea.³

It is good to use products that are designed for sensitive skin. Another tip is to use cosmetics that do not have any fragrance, as perfumes can make the skin more irritated and therefore increase redness.³

Makeups made of mineral powders are also less likely to irritate the skin than some other products, so it is always worth checking the ingredients list on your cosmetics to see what they are made of and to see if other products may be less bothersome for your skin.

You can get anti-acne creams from your pharmacy that have an antibacterial component. These can sometimes help with rosacea, but always check with your doctor or pharmacist first.³

It is always a good idea to wear sun protection as ultraviolet light can cause rosacea to flare up or worsen.³ Try to use makeup that has sun protection built in, or wear it as well as your usual cosmetics.

Conclusion

Rosacea is a common issue that affects lots of people. It is not dangerous to a person’s health, though it can negatively affect their self esteem and everyday life.

As there are many things that we do not know about rosacea, more research is needed on the causes and treatments available to the public.⁴

We do not know exactly what causes it but there are several ways to treat rosacea, including photodynamic therapy. If you think that you have Rosacea, you should speak to your doctor to have this investigated.