Skin Conditions

Rosacea

What’s the cure for Rosacea?

It would be wonderful if there was a cure for rosacea, unfortunately it’s not that simple.

Although there is no cure for rosacea, there are multiple ways you can help control and minimise the condition.

Below is information on how to spot if you have developed rosacea with information on how best manage rosacea from treatments to diet and skincare routines.

 

How do you know you have rosacea?

Acne rosacea is a hereditary inflammatory skin condition that causes dilation of the blood vessels just below the skin’s surface.

 

Checklist for spotting rosacea symptoms

-        Your nose and/or cheeks are often red

-        The spots are small and pussy and only on your cheeks and nose

-        You were over the age of 30 when you started to get the spots

-        Your facial skin feels bumpy

-        Your spots and redness get worse in the heat or the cold, in the sun, after drinking alcohol or eating spicy food or after you use certain skincare products

 

Symptoms of rosacea can be made worse or minimised by diet, lifestyle and skincare habits.

These habits include alcohol, spicy food, sun exposure, frequent travel to different temperature destinations, stress, perfumed and chemical-laden cosmetics and skincare products and regular vigorous exercise.

Rosacea particularly affects people with pale skin and those who blush easily.

Rosacea is most typical in women over the age of 50 and is often triggered or exacerbated by the menopause. Approximately one in ten people have rosacea.

However it can occur in younger women and also in men. Notably even though less men get rosacea than women, in men the symptoms are usually more severe.

There is no conclusive evidence that rosacea is triggered in women by hormonal disruptions, however the menopause is often a danger zone. Pregnancy can also trigger rosacea, especially if the pregnancy is when a woman is over 30.

It’s often a misconception that people who have rosacea also have oily skin and acne. Adult acne and acne rosacea are often confused but are in fact very different skin conditions and require very different treatments.

Unlike adult acne, rosacea is usually accompanied by dry not oily skin and people who develop rosacea have typically not previously had spotty skin, although they may have had sensitive skin and skin that is prone to easy flushing.

The easiest way to guess that you have rosacea is the relatively sudden appearance of frequently flushed skin and small rashes spots across the cheeks and nose around middle age, these are typical signs of the onset of rosacea.

 

What should you do if you think you have rosacea?

If you’re getting new or unexplained skin problems as described above, it’s important to get it diagnosed so that you use the right products and treatments as early as possible.

The longer rosacea is left untreated the worse it can get.

However many family GP’s are not very specialised or knowledgeable about skin conditions like rosacea and a wrong diagnosis and treatment can lead to further and more severe problems, especially if you are prescribed treatments for adult acne.

The most assured method for a correct diagnosis is to research the condition and symptoms as much as you can first, then see your GP, then insist on an appointment with a dermatologist for a consultant diagnosis. Or go directly to a private dermatologist.

 

Are there different types of Rosacea?

There are four types of rosacea, and your dermatologist should tell you which one you have;

Papulopustular rosacea

Persistent redness with bumps or pimples, raised patches or acne-like breakouts with small puss filled spots.

Erythematotelangiectatic rosacea

Facial flushing and persistent redness on the nose cheeks and middle forehead, leading to visible broken veins; sensitive, stinging, swollen or rough scaly skin.

Rhinophyma rosacea

This is a rarer form of rosacea and its symptoms are thickening of the skin, usually around the nose, and bumpy skin texture

Ocular rosacea

Watery, red, irritated eyes; or dry, itchy or sensitive to light, this type of rosacea can lead to sight problems.

 

What treatment options are there for rosacea?

Rosacea is a very complex skin condition so treatments vary widely and what may suit once person may not suit another, so a degree of trial and error to find what works best for you is usually necessary.

Many people with rosacea will either initially or eventually opt to move away from treating their skin with antibiotics or medicated treatments due to the chronic and permanent nature of the condition.

Most people decide they can’t use medications forever and so alternative or more managerial solutions that at the very least help cut down on their reliance on medications and at best remove the need for them altogether.

But what you chose to use to manage your rosacea is a very personal choice, depending on the severity of symptoms, how much it effects your life, what your lifestyle habits are and what your feelings are towards use of medicated or non-medicated treatments.

Here are some guidelines as to what is available and what may help.

 

Oral medications on prescription for rosacea

Tetracycline antibiotics are sometimes prescribed to reduce inflammation and redness of rosacea.

Also the drug isotretinoin, also known as Roaccutane (which acts on skin secretions) is sometimes used for the most severe cases.

 

Medicated topical treatments on prescription for rosacea

Cream and lotions are often used to calm the skin and treat bumps and pustules. However be cautious when trying these products as those with an alcohol base can cause irritation, and a cream base can cause clogging.

For inflammatory papules, topical treatments such as metronidazole (brand names Metrogel or Rozex) or azelaic acid (Finacea) can help. It's thought they have an anti-microbial, anti-inflammatory or antioxidant effect.

Another new treatment, brimonidine, wwas originally developed for the eye condition glaucoma.

Applied as a gel (brand name Mirvaso), it acts on receptors in blood vessels in the skin, restricting their dilation. It is generally advise not to be used very day but only for flare ups, though care must be taken in patients with heart disease and other vascular problems as trace amounts of the drug will be absorbed into the system, which could cause a catastrophic drop in blood pressure in some.

Mirvaso is now available on the NHS on prescription.

 

Laser and intense pulsed light treatments for rosacea

These can be used to remove visible veins and reduce facial redness. They shrink dilated blood vessels but are not a cure and can cause abnormal pigmentation, blistering and even scarring.

 

Diet tips for minimising rosacea

Diet is a very individual and complex part of a physical make up so there is no specific diet of food that helps or hampers rosacea.

However there are some g accepted evidence-based guides about diet and rosacea which are definitely worth taking note of.

Most evidence suggests that alcohol, spicy food, coffee and a high intake of sugar and saturated fat can all exacerbate rosacea.

Foods high in omega 3 and 6 oils such as most fish and seeds and food rich in antioxidants such as green and red vegetables and various antioxidant rich teas are generally accepted as helping to calm down rosacea.

There is mixed opinion as to whether dairy products help or hinder rosacea.

 

Milk may be troublesome. While all types of milk are linked with increased acne, some studies have suggested that skimmed is the worst.

Why? Nobody is sure, but it is likely to be because milk contains hormones which can cause an imbalance in human hormones.

The key culprit may be insulin-like growth factor-1, or IGF-1, a natural hormone which seems to increase skin cell growth in the lining of the pores, which then become blocked.

It’s thought that processing milk by removing fat may remove the hormone oestrogen which is stored in fat and protects against the male hormones that cause acne.

 

Non-prescription rosacea skincare

Most people find that aside from any medicated treatments, careful and regular skincare is the most effective way to minimise the symptoms of rosacea.

Moisturising

Rosacea is typically a dry skin condition and so regular moisturising is essential.

The surface of rosacea prone skin is often more fragile and open to the elements than normal skin due to the broken blood vessels and inflammation.

This is why rosacea is often accompanied by small pussy spots as bacteria gets easily into the open inflamed pores and causes localised infections.

Good skin care is essential for all types of rosacea. Moisturisers with as few chemicals and preservatives in as possible can help repair the skin's normal barrier function and can reduce dryness and discomfort. Ideally the moisturisers should also contain a strong antioxidant to help bring down inflammation

 

Night skin care

Try and use only light skin serums with anti-inflammatory and anti-microbial properties at night as it’s essential for rosacea prone skin to breath as it gets easily clogged. Heavy might moisturisers for dry skin can make the condition worse. You can apply more moisturising creams around the eye areas if required for anti-ageing benefits but leave the cheeks, nose and chin with only light reparative skin care products on during the night.

 

SPF’s

People with rosacea should wear a daily mineral based SPF every day of at least factor 20 if in non-sunny conditions and factor 25-30 if the sun is out. Direct sunlight is the most common trigger for rosacea flare ups.

 

Smart anti-bacterial treatments

New smart antibacterial agents help build good skin bacteria (flora) while killing off bad skin bacteria that leads to acne.

There is mounting evidence to suggest that products that promote the growth of good skin flora help strengthen the skin barrier and stop bad bacteria getting into the open pores.

It’s not well known that skin, like the gut, contains both good and bad skin bacteria. The skin needs good bacteria to stay healthy, strong and balanced and to keep the skin barrier protection layer intact. Many cleansing products contains harsh detergents and anti-bacterial agents (basically bleach) that, while effectively killing bad skin bacteria that can lead to spots and inflammation, they also strip the skin of all good skin bacteria.

Regularly reducing or removing good skin bacteria from the surface of your skin via a daily cleansing and/or exfoliating routine leaves skin drier and weaker. Lack of good skin bacteria allows bad skin bacteria to take hold and multiply on the skin’s surface which leads to spots as the bad bacteria easily gets into weakened areas of skin from blocked pores, causing puss and inflammation.

So the key to helping manage your rosacea is to redress the balance of skin bacteria by preserving and nourishing good skin bacteria while reducing bad skin bacteria as part of your daily skincare routine.

Skincare products are now being developed which do this for you. These smart anti-bacterial products help multiply good skin flora to make skin more resilient at fighting off bad skin bacteria.

 

Cleansing

Avoid all chemical anti-bacterial cleansing washes and wipes aimed at acne prone skin. Strictly avoid products containing anti-bacterial chemicals such as salicylic acid, benzoyl peroxide or azelaic acid. Also avoid all products containing alcohol.

It may sound strange, but if you have rosacea, cleaning your skin with water may also make the condition worse.

Many people with rosacea often admit to washing their faces several times a day in order to try and help their skin stay cooler and fresh.

However if you are suffering from very sensitive skin, skin prone to redness and rosacea, washing your face twice daily with water can actually make your skin worse rather than better.

Water evaporates on the skin, making it dry out quickly, meaning that skin prone to dryness will suffer.

In addition any sudden temperature changes, especially cold to warm as when using warm water during winter time when the air outside is cold, can cause skin to flare or react. In addition warming the face will also increase circulation to the surface of the skin, which for a condition such as rosacea, will make the skin redder and more inflamed.

Water is also quite a caustic substance, making it fairly abrasive to sensitive skin.

If you have very sensitive and dry skin, and especially if you have skin prone to rosacea, you should practice water-free cleansing to help protect and preserve your skin as much as possible.

Cleansing without water and with moisturising agents is the key to keeping skin clean but balanced.  Asian beauty regimes believe in cleansing the skin with actual oil, although this can cause problems for skin prone to rosacea.

However water-free cleansing products with moisturising ingredients in them will help sensitive skin stay hydrated and avoid skin flare ups.

Chose a chemical-free water-free cream cleanser for very sensitive skin and cleanse with a natural cotton cleansing pad.

 

Exfoliating

Scrubs and abrasive exfoliating products typically used for acne should be avoided as they are too harsh for rosacea prone skin.

 

Foundations/concealers

If cosmetics are to be used, which often they are in order to disguise redness and blotches, chose ones that have minimal chemicals and preservatives in them and preferably ingredients that treat and calm rosacea at the same time as covering it up.

Using ‘normal’ every day cosmetics will often make rosacea worse, so specialised foundations and concealers are a must for skin prone to rosacea.

 

Opt for lighter tinted moisturisers and concealers that don’t clog the open and vulnerable skin pores of rosacea prone skin and avoid heavy foundations and powders.

Opt for treatment-based spot concealers to cover and treat ‘patches’ and spots to disguise problem areas and then use a lighted tinted moisturiser for the rest of the face that is less effected to minimise the risk of clogging.

 

Perfumes/scents

Most people with rosacea are very sensitive to scents and perfumes both in skincare products and fragrances. Avoid all perfumed skincare products and only use perfumes on clothes and never directly onto skin on the face, neck or behind the area.

 

Natural solutions for rosacea?

Caper extract

Skin treatments containing concentrated caper extract have been shown to help reduce skin redness, inflammation and sensitivity and is particularly effective for acne rosacea.

Birch bark extract

Birch bark products, soaps, facial oils and also elixir’s to drink, can help reduce inflammation from adult rosacea-type acne.

Liquorice extract

The anti-inflammatory properties of liquorice extract have been shown to be beneficial to skin prone to rosacea. Drinking liquorice tea may also help.

Palm date seed extract

Topical treatments containing palm date seed have been shown to reduce cell proliferation and reduce redness and inflammation caused by rosacea due to the high anti-oxidant activity of the palm date seed extract.

Zinc

Sun creams or daily moisturisers contain pure zinc can also help with rashy and inflamed or rosacea-type adult acne as the zinc acts as potent anti-inflammatory.

 

Lifestyle management of rosacea

Alleviating the facial flushing involves reducing the triggers caused when blood vessels expand excessively in response to factors such as extremes of temperature changes (so saunas, central heating, air conditioning), sun exposure, strenuous exercise and changes of mood.

 

What’s next in skincare for rosacea?

 

Bacterial shields

 

These are new ingredients in the latest skincare products that literally produce an organic ‘shield, over the skin’s surface to prevent bad bacteria from entering. Worn over areas prone to spots or over forming spots, these bacterial shields help create a surface that bacteria find hard to grip on to and so help prevent bacteria growing in the spot or the weakened skin barrier areas.

Bacterial shields are made by a special bacterial fermentation process and are known as polysaccharides.

 

Skin Prebiotics

 

Skin prebiotics are literally ‘food’ for good skin bacteria.

A skin prebiotic works much the same as a food supplement prebiotic for the gut, except it’s for the skin.

Good skin bacteria feeds on the prebiotic and so grows faster making skin stronger and less prone to infection or weakened skin barrier, while bad skin bacteria are reduced as they don’t ‘palate’ the skin prebiotic as well as the good skin bacteria.

Skin prebiotics maintain a healthy balance of good and bad skin bacteria which helps skin fight off environmental damage which can leads to weak spots and allow bad bacteria to rush in a multiple leading to spots and inflammation.

 

Sebum preservers

Sebum is a protective substance that sits in the pores of the skin to protect it. We produce more sebum due to a number of factors including hormonal fluctuations, stress and to a degree diet. Besides various fatty substances and water, sebum also contains salts, amino acids and urea. Like any other natural substance, sebum rots when exposed to warmth, which is what often makes spots swell up, become painful and go yellow, green or black (blackheads).

Sebum is a very attractive breeding ground for bacteria as it has a highly nutritious content for bacteria to feed off so it starts to rot quite quickly. Fresh sebum is almost clear or white. It goes yellow and sometimes green or black when it rots.

A new breed of skincare products contain special ingredients that act as ‘sebum preservers, so they effectively stop the sebum rotting so quickly and so prevent the formation of puss and swelling. 

 

Prevention of Skin Mites

It is also thought that microscopic mites on the skin’s surface are present in higher concentrations on the skin of rosacea sufferers. This is an area of research which is expanding and will hopefully throw up some new treatments.