What Is Rosacea for Those Unsure?
There are various theories as to the causes of rosacea, it appears to be a combination of genetics and environment like many skin issues. Rosacea can present in different ways, and the pathophysiology is not entirely clear. It appears to be a dysregulation of inflammation, certain triggers cause a release of inflammatory chemicals that cause various manifestations including flushing, development of papules and pustules, thread veins, with increased skin sensitivity mainly on the central face. Demodex mites seem to play a role, certainly treating them is often a successful therapeutic intervention. The gut microbiome also seems to play a part, again this is not entirely clear, and more research is needed. So, essentially the development of rosacea appears to be multifactorial, and successful treatment should be aimed at tackling all these potential triggers. At Tarrant Street Clinic we have been documenting carefully our interventions in rosacea. We have so much experience now and so many incredible success stories that we feel we have found a truly balanced and evidence-based approach that works time and again.
Is It a Common Condition? Who Is Most Affected?
Rosacea is very common. It seen more frequently in women and in those with a lighter skin tone, although it can affect all skin types, and it is important to consider it I those with a darker skin tone where it is commonly missed. Statistics suggest 1 in 10 people suffer with rosacea in the UK.
What Are the Key Symptoms? How Does It Differ to General Inflammation?
The key symptoms are intermittent flushing often following common triggers such as exposure to UV exposure, including longer wavelengths, cold wind, alcohol, spicy food, stress amongst other things. We often see facial papules or pustules usually in the midface, most commonly cheeks but also forehead and chin. There are often visible telangiectasia and usually the skin barrier is sensitive and reactive. To distinguish from acne can sometimes be difficult but this distribution is a hint, and you see open and closed comedones with acne e.g. blackheads and whiteheads
How Can You Reduce Symptoms/If at All?
For me the first step is to ensure a robust skin barrier. We underestimate the impact of skin barrier dysfunction in rosacea. So, I have a very specific skin care regime that I recommend that is as gentle and hydrating as possible and geared to restoring skin balance whilst encouraging a healthy skin microbiome. For me when skin care routines become too complicated, especially if ‘active heavy’ we often start to see skin issues such as peri-oral dermatitis or rosacea, which signifies for me a disrupted skin barrier. I think most patients I see have suboptimal skin barrier function which underpins their skin issues. For me it’s simple. Find the gentlest cleanser available, always remove any oil, dirt, pollution at night. In the morning cleanse any soap, shampoo off delicate facial skin after the shower. Add an effective ant-oxidant such as vitamin C if tolerated (not all rosacea skin can tolerate at first). Then add a hydrating serum that contains a humectant to hold moisture in the skin, seal that hydration with an effective moisturiser that has as few ingredients as possible such as perfume and preservatives but is highly effective at soothing and locking in moisture. Follow this with an excellent broad-spectrum SPF that protects against UVA, UVB and longer wavelengths. At night to aid repair, again a hydrating serum and an effective soothing moisturiser. Those suffering with rosacea will really benefit from this approach, as a robust skin barrier is much less likely to flare when it meets irritants and external aggressors such as pollution or swimming pool water etc.
What Are Some Big No No’s with Rosacea?
For me we so often start patients on long term antibiotics, which as they are anti-inflammatory will work whilst the individual takes them, but almost always the rosacea comes back with a vengeance. So firstly, when assessing a someone with rosacea I will take a very careful history and look at common triggers, gut issues, stress levels, history of antibiotic use and day to day skin care. I don’t believe you just wake up one day with rosacea, it is a usually a confluence of events that eventually presents in the skin. Any antibiotics if prescribed(rarely) are a short, targeted course with gut health carefully considered.
I will frequently start probiotics and encourage a pre-biotic diet to feed a healthy gut. I work with an amazing therapist who helps to support individuals with stress and other mental health issues, if stress is a trigger this should ideally be tackled to give a sustainable solution. I then prescribe almost always topical prescription treatments, in different combinations depending on the clinical presentation. If I give antibiotics which is extremely rare it is for a short period to gain control before continuing with topical medications and gut- boosting probiotics. Another big issue is people don’t realise that UV is such a common trigger and that is there all the year round, wearing an effective high factor broad spectrum sun cream is so important. Finally getting the diagnosis is key. So often, rosacea is mistaken as acne, or indeed the two co-exist. Using retinoids or benzyl peroxide on a rosacea skin can often exacerbate symptoms, so diagnosis is vital here.
What Are Some Common Things People Don’t Understand Around Rosacea?
My view is that people don’t realise what a difference they can make by making some simple lifestyle changes such as diet, managing stress and finding the right skin products to use day to day (consistency is key) including the right sun protection. The skin is often the visible sign, but there may well be underlying inflammation and it is important to tackle this, looking at all triggers and variables that can be improved. I know first-hand from my practice that we can create sustainable solutions and that the changes we recommend not only help the skin, but I have no doubt, contribute to overall health in the long term.
“Having suffered with my skin for over 5 years, within five minutes of my first appointment at Tarrant Street Clinic I was told it was Rosacea. I started the prescribed skincare routine and have only had a few sessions of laser. The improvement in my skin has been amazing and I can’t thank them all enough for how much that have helped me and my confidence”
LG – Rosacea patient
