Redness: When should you consult a dermatologist?

Redness being physiological, the symptoms generally limit themselves to a redder skin. On the contrary, rosacea being a disease, other signs are observed and complicate the daily life of those affected. Therefore, when these signs are observed, it is essential to consult a dermatologist so that they can make a diagnosis and prescribe an appropriate treatment.

Rosacea is a chronic skin disease affecting approximately 4 million people in France. This condition predominantly affects women and individuals with a light phototype (light skin, light eyes, light hair).

As previously mentioned, there are 4 forms of rosacea. There are specific signs for each type of rosacea:

• Vascular rosacea or couperose:

Rosacea is the most common form of rosacea. It is characterised by temporary redness (erythema) or permanent redness (erythrosis) associated with the development on the skin's surface of small, fine, red or purple blood vessels that become visible to the naked eye (telangiectasias). These rednesses are located in the centre of the face (forehead-eyes-nose-cheeks-chin).

This condition is accompanied by skin dryness and a significant sensitivity of the skin. This skin sensitivity is due to a high number of nerve endingsin the deeper part of the skin and the presence of a substance referred to as "substance P"which is found locally and in the blood, leading to local inflammation.

Besides redness, rosacea is accompanied by repeated sensations of hot flushes which occur under certain conditions (consumption of alcohol, spicy foods etc).

An extra-cutaneous sign manifests in 1 out of 3 people: ocular burning (a constant sensation of having a grain of sand in the eye).

• Ocular Rosacea:

In 30 to 50% of cases, individuals with rosacea develop an ocular condition.

Ocular rosacea can sometimes precede skin involvement. It presents itself in the form of conjunctivitis, eye irritation, eyelid inflammation (blepharitis), teary red eye (conjunctival hyperemia), a burning sensation, dryness with a feeling of a foreign body in the eyes and light sensitivity (photophobia).

This ocular condition would be due to the malfunction of the Meibomian glands. These are located along the eyelids and secrete an oily substance responsible for the lubrication of the eyes.

• The Papulopustular Form:

This form is characterised by redness accompanied by inflammatory lesions similar to acne lesions : the papules and pustules.

The papules are inflammatory red bumps without pus that are less than 5 mm. They can be round or oval in shape and are often painful. They are possibly caused by the invasion of the sebaceous gland by Demodex Folliculorum, a parasite typically found in the follicle.

Unlike papules, the pustules are characterised by the presence of pus. These are red bumps with a white head containing pus.

These lesions progress in flare-ups. In other words, the redness persists and the papules and pustules recede. However, during subsequent flare-ups, the number of papulopustular lesions increases and the flare-ups become increasingly frequent.

Please note : there is a very rare form of rosacea characterised by the presence of numerous painful pustules and nodules: this is fulminant rosacea. It generally appears in women aged 30-40, during pregnancy, following Crohn's disease or treatment with interferon alpha.

• The Hypertrophic Form:

The hypertrophic form is the rarest type of rosacea and generally affects men.

A tissue fibrosis of the dermis is observed. The sebaceous glands of the nose increase in size and the pores dilate. The nose is the part of the face most affected by these deformities known as rhinophyma.

The skin thickens, forming fleshy protrusions or swellings which are very unsightly.

Please note : fibrosis is the result of an inflammatory process triggered by tissue damage.

Although the signs and symptoms of rosacea can manifest in various ways, it typically begins with transient facial redness.

Regrettably, these redness episodes recur and become more intense and last longer each time. Visible blood vessels may eventually appear.

In the absence of treatment, bumps and spots often develop, spreading over time, and in the most severe cases - particularly in men - the nose can become swollen and enlarged due to excess tissue. In some individuals, the eyes are also affected: this is ocular rosacea.

The only way to manage this chronic medical condition is to consult a dermatologist at the first signs of its onset. They will be able to confirm the diagnosis and assess the stage of the disease. Consequently, they will prescribe a treatment that is tailored to your case.

The treatment varies depending on the stage of the disease:

• For minor forms, the dermatologist prescribes topical treatments based on ivermectin, azelaic acid or metronidazole. The brimonidine is a new vasoconstrictor treatment in gel form that helps to reduce redness in cases of moderate to severe erythema ;

• For severe forms (papulopustular), the dermatologist prescribes the doxycycline (an antibiotic) for a 3-month period in conjunction with a local treatment ;

  Please note : generally, the combination of oral antibiotics and topical treatment is most commonly prescribed due to its significant effectiveness. Following the initial 3 months, the topical treatment is continued in order to reduce the number of flare-ups.

• In the rare forms of fulminant rosacea, it is necessary to combine a corticosteroid therapy through general administration with isotretinoin ;

• For ocular forms, a consultation with an ophthalmologist is necessary. The doxycycline is the standard treatment but other local antibiotics can be used in corneal complications (fusidic acid, tetracycline etc).

Beyond medicinal treatments, there are physical treatments such as the laser (the KTP laser, pulsed dye lasers and the Nd Yag laser). The laser helps to reduce redness and visible telangiectasias associated with rosacea. It is particularly recommended in cases of thread veins. It appears that the laser may help to reduce the recurrence of the disease.