Rosacea: a very delicate aesthetic disorder

Rosacea is a very common skin condition that can cause discomfort in both men and women, but is much more likely to affect the latter.

What does rosacea look like?

Rosacea is the permanent reddening of the cheeks, nose or central parts of the forehead. It may also affect the chin.
While always present, reddening will be even more evident at certain times including during considerable changes in temperature; moments of high emotion or fatigue; before or after exercising, or during digestion. The caliber of blood vessels is controlled by the skin’s nervous system and their size can change frequently throughout the course of the day, meaning the skin can appear redder or paler from one moment to another.

Sometimes, vascular dilatation looks similar to the branches of a tree.

In some cases of rosacea, folliculitis or micro pustules appear in the affected area. This is mostly due to an intolerance of products that are often applied to the skin in an attempt to mask rosacea redness.

What are the causes of rosacea?

There is not thought to be one specific cause of rosacea but it is likely there is a genetic predisposition to having the condition, to the extent that multiple members of the same family may have it.
In those already predisposed to rosacea, stress is a notable trigger.

Aggravating factors

Some factors can aggravate rosacea. These include: moments of considerable emotion; the digestion of a heavy meal; any activity that exposes the individual to abrupt transitions between hot and cold; alcohol intake; being overweight, systemic or local cortisone use; thermal treatments (laser therapy, radiofrequency etc.).

Sun exposure

Unlike many believe, responsible sun exposure does not worsen rosacea. On the contrary, the sun can improve some cases of rosacea, as it helps to strengthen the skin, synthesize vitamin D and increase the thickness of the stratum corneum. Prior to sun exposure, those with particularly fair skin must use a photo protectant. However, this cannot be in the form of a traditional sun cream, as the chemical filters will activate inside of the skin and cause increased inflammation. Instead, the mineral UV-reflectors can be used to protect against UV rays and, partially, infrared rays.

Diet

Many believe that rosacea is the result of poor digestion, the presence of Helicobacter pylori bacteria, food intolerances or intestinal dysbiosis. However, a link between the condition and the gastrointestinal tract has never been found, nor has a connection with food allergies or intolerances. Although there is no specific dietary cause of rosacea, spicy foods and alcohol can trigger or worsen it.

When does acne rosacea appear?

In some individuals, rosacea is complicated by the appearance of acne, which is referred to as acne rosacea.

Treatment

As there is no one cure for rosacea, different treatments can be adopted to improve its appearance.

DermaClub suggests…topical treatments

• Enriched with zinc oxide and magnesium silicate, the astringent Soothing Cream soothes redness and inflammation. Apply a small amount of product throughout the day and massage well.
• 2S Cream helps to calm pustule papules and folliculitis. Rich in the anti-inflammatory sulfur, and the stimulating salicylic acid, a small amount of 2S Cream can be applied in the evening and massaged well.
• For individuals wishing to cover areas affected by rosacea, apply the mineral photoreflector, Sun Clay and/or the opaque Argillina Skin Color. The two products can be also used together.
• During the summer, Sun Clay can be used instead of sunscreen to provide protection. Sunscreens should be avoided as they can only offer protection against UV rays and are often poorly tolerated by the skin on the face. Instead, Argillina Sole offers protection against the full range of solar irradiation, including some infrared rays which are particularly bothersome to those with rosacea.
• To cleanse the face, use potassium permanganate solution (see ‘Topical Therapy’), which has astringent and anti-inflammatory properties.

Products with vasoconstrictors

There are many commercially-available topical products with vasoconstrictor drugs that cause the muscles around the blood vessels to constrict. After application, constriction occurs and rosacea whitens. However, these products are not without side effects and, in the long term, can completely paralyze the muscles of the vessels, which will considerably worsen rosacea. While these products can still be used, they should not be considered a treatment for rosacea, and must only be applied sparingly on an absolutely as-and-when basis.

Needling

Needling is the only ‘invasive’ treatment that, in most cases, can help cases of rosacea. During needling, the dermis is pierced with very fine needles to reshape collagen fibers which, in turn, strengthens the skin while partially (and sometimes completely) concealing rosacea.

To be avoided…

Cortisone creams will provide an apparent improvement at the beginning but, over time, the rosacea will become progressively worse.
Antibiotics should be avoided because they do not solve the problem, and will instead cause toxicity and increased bacterial resistance.
Products with metronidazole and azelaic acid should be avoided as they are not very active on rosacea, and in some cases completely inactive.
Other more invasive treatments (including laser therapy, radiofrequency, ultrasound, intense pulsed light (ITL) therapy, electric needles and cryotherapy with liquid nitrogen) will likely provide an immediate improvement in cases of rosacea, but often worsen the condition in the long run.