ROSACEA is a common, often distressing, skin condition, characterised by persistent redness of the face. Recent data from an ongoing study of female nurses in the US, suggests that drinking four or more cups of caffeinated coffee a day may reduce your risk of developing rosacea. This raises questions about current guidelines, which highlight caffeinated drinks as a potential trigger for symptoms, albeit in those who already have the condition. It is suggested that caffeine may reduce the widening of blood vessels in the skin that cause the typical redness, as well as caffeine’s antioxidant properties decreasing skin inflammation.

Rosacea is sometimes also referred to as acne rosacea, yet the two conditions are separate. It is common, affecting 1 in 10 individuals, though to varying severity. Rosacea usually first develops after the age of 30, but has been seen in children. Although it affects women more than men, in men the condition tends to be worse.

As mentioned, the hallmark feature is facial redness. At the start this may be episodic blushing, but with time it becomes fixed. Sufferers may develop pus filled spots, similar to those seen in acne. Rosacea can affect the eyes and eyelids, with the feeling of something in the eyes, or dryness. Overgrowth of the oil producing glands in the nose results in a swollen, unsightly nose, known as rhinophyma, sometimes unkindly referred to as a “drinker’s nose”.

Rosacea is associated with significant psychological distress, anxiety and depression, and the effect skin conditions may have on the sufferer should not be underestimated nor belittled.

A definite cause for rosacea has not yet been found. In those with rosacea, blood vessels close to the skin surface widen more readily than in those without the condition. Rosacea may be a result of sun damage. The mite “demodex folliculorum” which is harmless and lives on the skin, is found in greater numbers in those with rosacea.

Although there is no cure for rosacea, thankfully multiple treatments exist. Those which can be commenced by your GP include brimonidine gel, which rapidly reduces the redness. Although bacteria are not a cause, long term antibiotics may help by reducing inflammation. Ivermectin cream can be applied to the face to kill the demodex mite. Beta-blockers and clonidine may help to lessen facial flushing.

If these do not produce satisfactory results, more specialist treatments are available through a dermatologist or plastic surgeon. These include laser therapy for damaged blood vessels in the skin, as well as to reduce the size of a rhinophyma. Isotretinoin, commonly known by its trade name “Roaccutane” is used to increase cell turn over and hence shed damaged skin.

The baseline for all those with rosacea is to look after your skin, and recognise your triggers. Practical advice includes using a high factor sunscreen daily, and avoiding perfumed skin products. There are multiple triggers, and keeping a symptom diary may help if you are struggling to work them out. However, if coffee does not cause your condition to flare, I see no reason why you shouldn’t enjoy your daily fix.

Ask Dr Zak

Question: I had a nasty bout of vomiting and diarrhoea last week and I noticed that there was some blood in the pan. Thankfully this has all cleared up now. Should I be worried about the blood? Patty, 70

Answer: When you suffer gastroenteritis, the lining of the bowel can become inflamed, and you may pass some blood as a result of this temporary damage. If it has stopped, then it is unlikely to be anything more concerning. However if you had persistent bleeding from your bottom after the diarrhoea had stopped, unexplained noticeable weight loss, persistent tummy pain, or you felt a lump in your abdomen, I would seek the advice of your GP urgently.

Question: What do you recommend for Seasonal Affective Disorder (SAD)? I seem to get it this time every year. Nicholas, 55

Answer: SAD is very common, and its management is the same as for any other mood disorder. Basic self-help measures would involve trying to get as much natural light during the daytime as possible, making sure that you exercise regularly and maintain a good diet. For moderate symptoms, counselling including cognitive behavioural therapy (CBT) may help. Antidepressants should be reserved for more severe cases. Although light therapy is very popular, and several devices can be purchased relatively cheaply, the National Institute for Clinical Excellence (NICE) has advised that it is not clear whether it is effective. You may be as well getting yourself outdoors as much as possible, weather permitting.

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Dr Uddin’s advice is provided in good faith and in accordance with currently accepted evidence. However, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of a GP, or other qualified health provider, regarding a medical condition.