The facial blushing of rosacea.
Unlike the youthful blushing of our teenage years, the redness caused by rosacea is entirely different and as awkward as blushing can be, especially if you’re shy. A youthful blush is not an acquired skin condition.
And later in life, when the hot flushes of menopause have you turning up the air conditioner to arctic conditions while others look on miserably, freezing their proverbial’s off. Well, as disturbing as a hot flush is, it’s not likely to lead to a skin condition either. Although if you are predisposed to rosacea, menopause could be a trigger.
Both of these instances of flushing skin are momentary. Usually, over as quickly as they started.
The facial blushing caused by rosacea, on the other hand, is a medical skin condition and usually starts with prolonged redness across the cheeks that takes a long time to subside and overtime, the underlying blood vessels become overgrown and visibly prominent.
Rosacea is a big topic.
So, let’s start with the four main dermatological subtypes: Erythematotelangiectatic rosacea, Papulopustular rosacea, Phymatous rosacea and Phymatous rosacea.
#1 Erythematotelangiectatic rosacea, a type of rosacea typically represented as redness with or without visible capillaries. Probably the most common type of rosacea and worth discussing in more detail.
As the name is a bit of a mouthful, let’s refer to this subtype as vascular rosacea. In most cases, it can begin as flushing in the skin, perhaps caused by spicy food, alcohol or even triggered by an overheated room.
The flushing and redness associated with rosacea are slightly different from the blush of embarrassment as the redness remains, sometimes for ten minutes or a few hours. Persistent facial redness can lead to a vascular condition underneath the flushed skin; capillaries become visible, and the skin’s texture can begin to change.
#2 Papulopustular rosacea is also known as acne rosacea and appears as small pimples and blemishes, usually showing up in specific areas such as the cheeks.
Most people with this condition are likely never to have experienced acne before.
It’s the location and acne history that can be the clues to whether this is what you have. But, an experienced and qualified skincare professional or dermatologist will be able to diagnose this skin condition.
Acne rosacea is not like other types of acne, such as teenage or adult acne. It usually appears in middle adulthood and is mostly located on the cheeks with small pimples, blemishes and underlying redness. And just like vascular rosacea, the skin may look and feel hot.
The next two subtypes of rosacea are not treatable with skincare, and if you have either of these conditions, you need to seek out the care of a dermatologist.
#3 Phymatous rosacea will initially appear as redness and broken capillaries affecting the nose.
If left untreated and when the condition has been present for a long time, it can lead to an overgrowth of the sebaceous glands and the blood vessels, giving the skin of the nose a knobbly appearance.
The nose can become more prominent and is the most defining feature of this rosacea subtype.
#4 Ocular rosacea affects the eyes. A lesser-known subtype of rosacea, the eye’s inner-skin can become red, and the eyes can feel itchy and gritty as if there’s something in the eye.
Don’t try and work this out on your own.
Google might give you clues, but if your eyes feel this way, the first stop is your general practitioner, who can refer you to a dermatologist or ophthalmologist for a proper diagnosis and subsequent treatments to relieve the symptoms.
So what causes rosacea?
Unfortunately, the cause of all these subtypes of rosacea is yet to be determined.
Still, medical scientists have theorised that the main reasons for developing rosacea could be one or a combination of the following, leading to the perfect storm we know as rosacea.
Possible Cause #1: Sun exposure.
While exposure to UV radiation from the sun may not be the cause of rosacea, it’s the number one trigger and can exacerbate your rosacea.
It may be useful to keep in mind the impact the sun has on the skin’s immunity, which, when overheated due to the sun, can cause your skin cells of immunity known as Langerhans to retreat, impairing your skin’s ability to repair itself naturally.
While not the cause of rosacea, too much sun makes you far more susceptible to flare-ups.
Ultraviolet (UV) radiation can also lead to the production of vascular endothelial growth factor (VEGF), which can cause an overgrowth of blood vessels that become visible on the surface of the skin over time.
Possible Cause #2: Problems with your immune system.
When your immune system is not functioning as it should, it can create abnormal proteins. Some of these abnormal proteins have shown up in the skin of people suffering from rosacea. Immune system inefficiencies can lead to long-term inflammation and blood vessel dysfunction, as we see in rosacea.
Possible Cause #3: Micro-organisms in the skin.
Demodex mites are microscopic and a natural part of the skin’s microbiome. However, they have shown to be present in more significant numbers in those suffering from rosacea. But the actual connection to rosacea could be the link to a specific bacterium associated with the mites known as Bacillus Oleronius, which can activate an inflammatory response and the onset of the inflammatory acne rosacea.
Possible Cause #4: Poor blood vessel function.
If blood vessels’ growth becomes overactive, as can be the case with UVB exposure, it can play a role in this challenging skin condition’s neuro-vascular aspect.
Possible Cause #5: Genetics.
It seems like rosacea runs in the family; however, no specific gene is related to this. While it may be genetically linked, there is no scientific data to support this or the gene responsible, so it remains a theory.
We don’t know what we don’t know.
We could delve deeper into each of these causes; however, no matter what’s causing rosacea, successful treatment can be limited until the root cause is confirmed. Presently, it remains elusive.
If you can determine what’s triggering your rosacea, you can avoid those things and reduce flare-ups and severity.
The typical triggers can be the sun, heat, spicy food, alcohol, harsh cleansers, mechanical scrubs, and stripping astringents. But it can also be triggered by medical conditions and medications.
Does your skin flush with alcohol consumption? If yes, then consider cutting back or stopping altogether. Likewise, if spicy and chilly hot foods cause your skin to heat up and flush then consider eliminating them from your diet.
Avoid sitting too close to the fire or in an overly heated room, and try to keep your skin cool and comfortable.
As the facial redness of vascular rosacea and acne rosacea is challenging to treat, it’s best to avoid what triggers it.
Okay, I know, there’s are quite a few things to avoid, and you’d don’t want to live like a monk. I get it! However, rosacea can go into remission, so managing your triggers to suppress your symptoms will help overall management.
So, let’s look at the external triggers that top the list.
The primary triggers for rosacea are:
- Sun Exposure (81%)
- Emotional Stress and could include hormonal fluctuations like menopause (79%)
- Hot weather or a heated room (75%)
- Wind and environmental exposure (57%)
- Intense exercise (56%)
- Alcohol (52%)
- Spicy foods (45%)
These are the known triggers and shows how common each trigger can be, but this can differ from person to person.
Nothing is absolute. It’s a personal thing. Managing rosacea is trial and error. You may want to keep a record of those things that specifically trigger your rosacea and look for a pattern so you know what to avoid.
Naturally, the sun is a trigger!!
UVB radiation from the sun is not only damaging to your skin long-term and will burn the skin if you let it. UVB radiation has recently been associated with triggering an overgrowth of the blood vessels that can visibly appear on your face.
So, wear a broad-spectrum sunscreen, preferably one with Zinc Oxide. And, if you can’t find one that doesn’t leave a white cast on your face, opt for a Zinc-based lightweight tinted sunscreen.
How will skincare help?
First up, no one should be making promises of eliminating your rosacea with skincare alone. However, being mindful of how you’re looking after your skin will make a big difference to the severity of the condition and the skin’s ability to cope.
Treat it as if it’s sensitive skin (sort of).
Although rosacea is different from typically sensitive skin, it’s probably a good idea to treat it as if it is.
Treating your skin as sensitive doesn’t mean seeking natural or organic skincare. Many so-called natural ingredients like essential oils can be quite irritating to the skin and best avoided if you have rosacea.
What do I mean, then?
First, begin with cleansing the skin with a mild cleansing lotion or milk; anything that foams up on your skin will take more from your skin than dirt and makeup and leave you with a compromised barrier function struggling to protect your skin.
If you have signs of rosacea, you need a healthy skin barrier, and proper, gentle cleansing is the first step.
Skip the scrubs.
These are the exfoliating facial scrubs with granules in them? Not in a pink fit would I be caught with a scrub coming anywhere near the skin on my face, and, if you have rosacea, this is especially true.
If you’ve got a mechanical scrub in your bathroom cabinet, use it on your feet or some other more resilient part of your body. Not your face!
Identifying your triggers will help to minimise the severity. The triggers for acne rosacea can be the same as vascular rosacea and treated in the same way.
Keeping the skin calm will be vital as you begin to control the onset of vascular or acne rosacea.
What skincare ingredients are best for vascular rosacea?
Even though you’re treating your skin as if it’s sensitive, it doesn’t mean you should forgo active skincare ingredients—quite the opposite.
But there will be a period of trial and error with patience and commitment.
After cleansing, the essential skincare ingredients your skin will need are niacinamide to protect your skin’s barrier function and a low vitamin A concentration to support the skin. You should include both of these ingredients in your skincare routine every day.
Whether these ingredients appear in your moisturiser or serum doesn’t matter so much, the important thing is they are present in adequate amounts to protect and nourish the skin.
Personally? I prefer my niacinamide as the first layer on my skin in a serum or essence, followed by a protective moisturiser with a vitamin A ester.
Adding vitamin A can be very beneficial, but a trial and error and a go-slow approach are best. Vitamin A can be irritating, and if this happens to you, don’t mistake the irritation for an allergic reaction. Just allow your skin time to build a vitamin A tolerance by starting with low strength vitamin A esters.
Remember, what you’re doing is strengthening your skin, so the facial redness caused by rosacea goes into remission and prevents the condition from becoming worse or more visible.
Skincare ingredients for acne rosacea?
Controlling any infection in the skin with tea tree oil can be helpful, although it can also be irritating for some.
My suggestion is to dilute tea tree oil with other ingredients calming to the skin.
Chemical exfoliants such as salicylic or azelaic acid will reduce inflammation and gently clear sebaceous glands without upsetting the skin’s barrier.
Where to from here?
What’s important to note is a proper skin diagnosis and following the advice recommended for you will help.
If you suspect you have any of the subtypes of rosacea and you’re not finding any relief with conventional skincare, you should consider a dermatologist visit.
A dermatologist can determine if you have rosacea and whether the Demodex mite and the associated bacterium are present in your skin and prescribe the necessary medications.
But don’t stop there. I’ve met people who’ve been prescribed medication and have remained on it for years without ongoing consultation. If you’re not entirely happy with the advice, then find a new doctor.
And now you?
Do you think you may have rosacea? If you’re struggling to get advice or you’ve seen a dermatologist, and you need extra help with the best skincare to keep your skin healthy and calm, then get in touch. There are three ways to get advice, and you can find out more here.
Once you’ve booked an online consultation, we’ll go through everything you’re currently doing at home and any treatments you’re considering and give you a plan to move forward.
See you next time,