Understanding Rosacea
Julie Scott on identification, diagnosis, causes, triggers, and treatment approaches
Rosacea is a chronic skin condition that I frequently encounter in my practice. It primarily affects the face, causing redness, visible blood vessels, and sometimes acne-like bumps. While often misunderstood or misdiagnosed, rosacea is quite common and can significantly impact a person’s confidence and quality of life. In this article, I’ll share how I identify and diagnose rosacea, explore potential causes and triggers, discuss various treatment options, and describe my personalised approach to managing this condition in a clinical setting.
Identifying and diagnosing rosacea
Interestingly, many patients don’t initially come to me with concerns about rosacea. More often, they present with other aesthetic concerns, such as fine lines, wrinkles, pigmentation issues or even menopausal symptoms. However, because I digitally analyse all of my patient’s skin, I’m able to diagnose underlying rosacea and inflammation early – sometimes even before my patient is fully aware of it.
This early detection is crucial. By identifying and addressing rosacea in its early stages, we can prevent the condition from worsening, which is vital since rosacea can be a truly debilitating skin disease. Addressing it early helps to preserve the integrity of the skin and prevents the more severe complications that can develop if the condition is left untreated.
Diagnosing rosacea can be challenging because its symptoms often mimic those of other skin conditions, such as acne or eczema. However, there are several signs and symptoms that I look for when diagnosing rosacea:
- Persistent facial redness: The most common sign of rosacea is persistent redness or flushing in the central part of the face. This redness often resembles a blush or sunburn that doesn’t go away.
- Visible blood vessels (telangiectasia): In some cases, I notice small blood vessels that become visible on the surface of the skin, particularly on the nose and cheeks.
- Bumps and pimples: Unlike typical acne, the bumps and pimples associated with rosacea do not contain blackheads. They appear as small, red, pus-filled bumps.
- Thickened skin: In more severe cases, the skin may thicken and enlarge, especially around the nose (a condition known as rhinophyma). I’ve observed that this symptom is more common in men.
- Eye irritation (ocular rosacea): Many individuals with rosacea experience symptoms affecting the eyes, such as dryness, irritation, swollen eyelids, or a feeling of grittiness.
Potential causes and triggers of rosacea
While the precise cause of rosacea remains unknown, I consider several potential factors that may contribute to its development:
- Genetic predisposition: Many of my patients with rosacea have a family history of the condition, suggesting that genetics may play a role. Abnormal immune response: Some studies suggest that an overactive immune response may contribute to rosacea.
- Specifically, the presence of certain antimicrobial peptides in the skin, such as cathelicidin, may provoke inflammation and vascular changes seen in rosacea.
- Demodex mites: These tiny mites live on the skin of most people without causing problems. However, higher numbers of Demodex mites have been found in the skin of people with rosacea, leading some researchers to speculate that these mites could trigger an inflammatory response in susceptible individuals.
- Environmental factors: External environmental factors like sun exposure, wind, and temperature extremes can contribute to rosacea flare-ups and inflammation
- Vascular abnormalities: Abnormalities in the facial blood vessels may contribute to rosacea by causing persistent facial redness and visible blood vessels. The exact cause of these vascular changes is not fully understood but could be linked to neurovascular dysregulation or other factors.
- Microbial factors: The bacterium Helicobacter pylori, linked to gastrointestinal infections, has been associated with rosacea. It may increase levels of the digestive hormone gastrin, potentially causing flushing and redness.
Once rosacea is identified, a critical part of management involves understanding and avoiding common triggers. Over the years, I’ve observed that several factors consistently aggravate symptoms in my patients:
- Sun exposure: UV radiation is a well-known trigger for rosacea flare-ups. I advise my patients to protect their skin from the sun with broad-spectrum sunscreen and protective clothing.
- Hot or cold weather: Extreme temperatures can cause rosacea symptoms to worsen. Both hot, humid weather and cold, windy conditions can irritate the skin and lead to flare-ups.
- Stress and emotional upset: Stress, anxiety, and other strong emotions can trigger rosacea due to their impact on the body’s hormonal and vascular systems.
- Dietary triggers: Spicy foods, hot beverages, and alcohol, particularly red wine, are common dietary triggers for rosacea.
Skincare products: Harsh skincare products, especially those containing alcohol, fragrances, or other irritating ingredients, can worsen rosacea symptoms.
Tailored treatment approaches
While managing triggers and using topical or oral medications are crucial, I’ve found that in-clinic treatments can make a significant difference in strengthening the skin and reducing the severity of rosacea symptoms. Here’s how I approach these treatments:
- Medical-grade facials: Specifically tailored to rosacea-prone skin, focusing on soothing and strengthening the skin barrier. I use high-quality, medical-grade products that reduce inflammation and hydrate the skin, helping to calm redness and prevent flare-ups. Regular facials help maintain skin health and provide significant improvements in the skin’s overall barrier function.
- Microneedling: This minimally invasive treatment is effective in improving the skin’s texture and reducing the appearance of visible blood vessels associated with rosacea. By creating controlled micro-injuries, microneedling stimulates the skin’s natural healing process, promoting collagen production and strengthening the skin over time. While it’s not suitable for everyone, when used appropriately, microneedling can significantly improve the skin’s appearance and reduce the frequency of flare-ups.
- LED therapy: LED therapy is particularly beneficial for rosacea patients. This treatment uses specific wavelengths of light to penetrate the skin, reducing inflammation, calming redness, and promoting healing. Red light therapy, in particular, is excellent for reducing inflammation and strengthening the skin’s barrier. Regular sessions of LED therapy can lead to noticeable improvements in skin tone and a reduction in overall skin sensitivity.
In addition to traditional in-clinic treatments, I’m currently undertaking studies using more advanced treatment options to help strengthen the skin and improve its resilience against rosacea:
- Profhilo: Although primarily known for its hydrating and rejuvenating properties, I’ve observed that Profhilo, despite being a pro-inflammatory treatment, often improves the skin condition of my rosacea patients. Profhilo works by stimulating the production of collagen and elastin, which can enhance the skin’s structural integrity and hydration. This, in turn, can help to calm the skin and reduce the frequency of flare-ups, even though this was not its original intended use.
- Polynucleotides: I’ve also been incorporating polynucleotides into treatment plans. These molecules play a crucial role in improving the skin’s cellular matrix, which helps in strengthening the skin’s overall structure and function. Polynucleotides work by promoting tissue regeneration and improving skin elasticity, which can be particularly beneficial for rosacea patients. By enhancing the cellular matrix, these treatments help to fortify the skin against external triggers and reduce the severity of rosacea symptoms over time.
Finally there are several medical-grade skincare ingredients that I find effective in treating rosacea. These ingredients help address the inflammation, redness, and sensitivity often associated with the condition.
- One key ingredient I often prescribe is niacinamide. Known for its anti-inflammatory properties, niacinamide helps reduce inflammation and soothe irritation, making it ideal for patients with rosacea. Additionally, it strengthens the skin’s barrier function, enhancing its resilience and hydration.
- Another effective ingredient is azelaic acid, which is excellent for reducing inflammation. It works by targeting acne-causing bacteria and helping to minimise hyperpigmentation, redness, and uneven skin tone often seen in rosacea patients.
- Sulfur is an underrated yet highly effective ingredient due to its anti-inflammatory and antibacterial properties. I frequently recommend the ZO Sulfur Mask for my patients as it helps reduce inflammation and the risk of breakouts by absorbing excess oils, which can be a contributing factor to rosacea flare-ups.
- Retinol can also be beneficial in improving skin texture and accelerating cell turnover, which helps prevent clogged pores that could exacerbate rosacea. However, I use retinol cautiously with my rosacea patients because it can increase skin sensitivity, so it’s not typically my first choice.
- Ceramides are another essential ingredient. They help repair and protect the skin barrier and shield the skin from environmental irritants that can trigger inflammation. Ceramides are also excellent for hydration, as they are lipid molecules that lock in moisture and reduce inflammation.
- Lastly, hyaluronic acid is a favourite among patients due to its superior hydrating properties. It provides deep moisture without clogging pores, which is particularly beneficial for those experiencing dryness and irritation from rosacea.
Overall, these ingredients work best when used together as part of a comprehensive skincare regimen. It’s important to start with a tailored skincare routine, maintain it consistently, and integrate other in-clinic treatments for optimal management of rosacea.
Final thoughts from my practice
Treating rosacea effectively requires a holistic approach that combines medical interventions with lifestyle changes and in-clinic treatments designed to strengthen the skin. What I find most rewarding is seeing the transformation in my patients—not just in how their skin looks, but in how it feels and how they feel about themselves. Rosacea, when left unchecked, can have a debilitating effect on the skin, leading to discomfort and a significant loss of self-esteem. By getting this chronic condition under control, I’ve seen patients regain their confidence and enjoy not only clearer skin but also healthier skin that feels good from the inside out.
For anyone dealing with rosacea, finding a practitioner who understands the condition and can offer a personalised, multi-faceted treatment plan is crucial. With the right strategies in place, it’s entirely possible to manage rosacea effectively, preventing it from worsening and minimising its impact on daily life.