Table of Contents
I focus on rosacea chapters in The Skincare Bible by Anjali Mahto.
What is the cause of rosacea? Rosacea remains poorly understood. We still do not know the exact cause, although there are several hypothesized factors, including hyper-reactive blood vessels that dilate more easily than they should. Other possibilities include an abnormal immune response in the skin, the presence of microscopic skin mites known as Demodex, genetics and the presence of inflammatory factors. The likelihood is that all of these have a role to play in causation.
Ongoing medical research into rosacea suggests it may also be related to other medical conditions associated with inflammation. It has also been linked to migraines and gastro-oesophageal reflux, which can cause heartburn. Those who suffer with severe rosacea may be at a higher risk of heart disease.
Is there a cure for rosacea? Unfortunately, rosacea is a chronic disease so there is no cure. It goes through cycles of remission (where it can get better) and flare (where it can get worse). Over time, it is possible to get worsening of the condition if no treatment is given. That said, it can be kept under control using a variety of methods.
What makes rosacea worse? There are several well-recognized triggers for rosacea that can make it worse. The biggest culprit is sun exposure, which can affect the skin in over 80 per cent of those who suffer. Other common triggers include emotional stress, change or extremes of temperature, wind, exercise, alcohol, cheese, spicy food, hot drinks and certain skincare products (detailed below).
How is rosacea treated? One of the most crucial aspects of managing rosacea is adequate sun protection. Daily sunscreen with a minimum SPF of 30 offering protection against UVA and UVB rays from the sun is vital. Sun exposure can drive the condition and this vital step must be incorporated into daily routine.
UV rays have the ability to penetrate cloud cover so sunscreen should be worn in the winter months too. There are also a number of prescription agents and other forms of treatment that can be used to control rosacea. a) Creams and gels
There are several cream therapies for rosacea. These can reduce inflammatory bumps or spots, reduce redness, improve skin sensitivity and reduce the number and intensity of flare-ups. These include agents such as: azelaic acid ivermectin brimonidine metronidazole.
Avoid Triggers
Is there anything I should avoid? Trigger avoidance is key in rosacea. Whilst this may not always be possible, limitation of triggers is the next best thing. Sun avoidance and adequate protection is of value to everyone but other triggers are likely to be specific to each individual. Many people with rosacea can be sensitive to ingredients in skincare products. It’s a good idea to trial a new product on a small area of skin first to make sure it does not cause redness, burning or irritation. Behind the ear, on the side of the neck or the hairless part of the forearms are a sensible place to do this
It can be helpful to avoid skincare products that contain alcohol, witch hazel, menthol, camphor, fragrance, peppermint, eucalyptus, propylene glycol, parabens, sodium lauryl sulphate, glycolic and salicylic acid. Retinoid creams, which are often used for their anti-ageing properties, should be used with caution.
Sunscreen
What type of sunscreen should I use? I cannot emphasize this enough: broad-spectrum sunscreen with an SPF of 30 should be worn on a daily basis for those with rosacea, even in the winter months. As the product is being worn every day it needs to be non-irritating to the skin. Sunscreens containing dimethicone or cyclomethicone are often tolerated better than products without. Alternatively, many rosacea sufferers find that mineral or physical sunscreens suit them better than those containing chemicals. These products can easily be identified as they usually contain either titanium or zinc.
How should I look after my skin? The skincare regime of someone with rosacea needs to be kept relatively simple. The more you manipulate the skin and layer products, the greater the opportunity for unnecessary irritation. Skin should be cleansed morning and evening. The ideal cleanser leaves minimal residue on the skin, is ‘non-comedogenic’ and has a neutral or slightly acidic pH. In general, scrubs and toners should be avoided. If using a rinse-off cleanser, wash with cool or lukewarm water. Examples of suitable products include: Avène Extremely Gentle Cleanser, La Roche-Posay Toleriane Cleanser, Eucerin Redness Relief Soothing Cleanser and CeraVe Hydrating Cleanser.
Moisturizing daily in the morning, and evening if needed, is important to maintain skin softness and elasticity. Some people with rosacea may have naturally dry skin and others may be using prescription medications that can lead to dryness. Regular moisturizing (e.g. with La Roche-Posay Rosaliac Anti-Redness Moisturizer) will improve hydration and the skin’s natural barrier function.
Opt for creams rather than lotions.
Can diet help? Alcohol, cheese, spicy foods and hot drinks have been implicated in triggering rosacea, and limiting these can help with the skin. Both cayenne and red peppers, furthermore, can be potential triggers in addition to citrus fruits and tomatoes. Dietary supplementation with omega-3 fatty acids and flaxseed oil seems to help ocular rosacea and may also have a role in reducing inflammation of the skin.
Medical treatments
a) Creams and gels
For the majority of people, the most convenient way to treat dark eye circles is with the application of topical creams or agents. Many of these have limited scientific trials to back their use, but from personal experience I would say they are effective in reducing the amount of pigment or melanin in the skin, as well as improving the appearance of darkness, shadows or pigmentation. A number of agents can be used, often in combination. When looking for over-the-counter brightening agents, products that contain the following ingredients can be helpful: vitamin C (magnesium ascorbyl phosphate, sodium ascorbate) arbutin kojic acid soy liquorice extract mulberry extract aloesin niacinamide azelaic acid retinol Prescription products are likely to contain hydroquinone (2–4 per cent) and retinoids. These have the ability to produce irritation around the delicate eye area, and therefore use should be built up gradually under the guidance of a dermatologist.
b) Oral medications
Inflammatory rosacea that consists of many red bumps (papules and pustules) responds well to oral antibiotics. These are used for three to four months or until remission is achieved. Standard antibiotics include tetracyclines and erythromycin. These particular drugs have been used for decades and have a good safety profile. Antibiotics in the context of rosacea are used more for their anti-inflammatory, rather than their antibacterial, effects.
For severe cases of rosacea, the medication isotretinoin (Roaccutane) can be used to reduce bumps and inflammation. It is usually used in lower doses than for acne treatment and can produce good results. Careful monitoring under the guidance of an experienced dermatologist is required. Flushing or blushing can cause extreme frustration for many and there are oral tablets that can help with this symptom. Medications such as clonidine and propranolol are usually given to control this challenging aspect of rosacea.
c) Laser and light treatments
These treatments can be highly effective for treating the redness and enlarged blood vessels (telangiectasia) associated with rosacea. Intense pulsed light (IPL) and pulsed-dye laser (PDL) are used most commonly. A course of treatment is required and this could range from three to six sessions carried out at monthly to six-weekly intervals. Redness often recurs over time and maintenance treatment (e.g. annually) may be required. The treatments are not particularly painful and can be carried out by an experienced cosmetic dermatologist with laser experience. The benefit of seeing a dermatologist is that he or she will also be able to provide other aspects of rosacea care, such as prescribing appropriate creams and oral treatments. Before arranging appointments, ensure that your treating dermatologist has access to light and laser devices.
Are you tired of dealing with the redness, irritation, and discomfort of rosacea? Look no further! “Living with Rosacea,” offers practical and effective tips for managing the symptoms of this common skin condition. From dietary changes to skincare routines, you’ll learn how to take control of your rosacea and enjoy a happier, healthier complexion. Order your copy today and say goodbye to confusion about rosacea!
Sunscreen
Look for a broad-spectrum sunscreen that offers protection against both UVA and UVB rays from the sun. This should be a minimum of SPF 15–30. Sunscreens can be of two kinds – mineral and chemical. Chemical sunscreens need to be applied at least twenty minutes before going outdoors; mineral sunscreens contain zinc and titanium, and work as soon as they are applied. Sunscreens need to be reapplied every ninety minutes to get the stated protection factor on the bottle and most of us are guilty of not reapplying it as frequently as we should. Also remember to reapply after swimming and sweating.
It is best to avoid once-daily formulations, as they are not likely to be as effective. Most of us also do not use the correct quantities of sunscreen for it to be effective. Sunscreen needs to be used on all areas not covered by clothing. About one shot-glass-full (or 35ml) should be about right for an average-sized adult. A rough rule of thumb is about a teaspoon per body area: one teaspoon for your face, head and neck, one for each arm, one for each leg, one for your chest and abdomen and one for your back and the back of the neck. Don’t forget your ears and the tops of your feet; these are commonly missed sites.
Many people do not use sunscreen on cloudy days. This is, in fact, the time we often see the worst sunburn due to false security that there is no sunshine around. The truth is that you still need your sunscreen on cloudy days. I often get asked if it is necessary to wear sunscreen every day, including the winter months. It is true that there is less UVB radiation in the winter in the UK, the main ray that can cause burning. However, as many skin cancers develop due to cumulative UV exposure, it is worthwhile getting into the habit of wearing sunscreen on your exposed sites daily. For those who are concerned, it will also have benefits for your skin from an anti-ageing perspective.
Sunburn
Despite one’s best intentions, it is still possible to get caught out by the sun and get burnt. Sunburn causes direct damage to DNA, resulting in inflammation and death of skin cells. The skin can become hot, red, tender, swollen and blistered. This normally develops two to six hours after sun exposure and peaks at twelve to twenty-four hours. Clearly, this is not an ideal situation, but should it occur, it is important to know how to manage it.
1. Get out of the sun
This seems entirely obvious but is the single most important thing to do! Cover up all affected areas and stay out of the sun until sunburn heals. Wear loose cotton clothing that allows your skin to breathe.
2. Analgesia (pain control)
Take over-the-counter anti-inflammatory painkillers (e.g. ibuprofen). These not only reduce pain but also help with inflammation. They can be taken for forty-eight hours if there are no allergies.
3. Cool the skin
Take a bath rather than powerful shower, which can potentially damage the affected skin, particularly if there are blisters. Keep water temperature below lukewarm. Cold compresses against the skin (e.g. a towel dampened in cold water) may provide some relief.
4. Moisturize
After a bath or shower, use an unperfumed cream or lotion to soothe the skin. Repeated applications are necessary to reduce the appearance of peeling and this may need to be continued for several weeks. Aloe vera or soy-containing gels or lotions can be beneficial in soothing the skin. Aloe vera not only cools the skin but also acts as an anti-inflammatory. If possible, avoid using creams or lotions that contain petroleum, benzocaine or lidocaine. These can either trap heat in the skin or cause local skin irritation.
5. Drink water
Stay hydrated as sunburn can encourage fluid loss through the skin. Alcohol should ideally be avoided as it is a diuretic and can lead to further fluid loss and dehydration when you least need it.
The Vitamin D Saga
I have no doubt that many of you are reading my sun protection advice and thinking about how you are supposed to get your vitamin D if you follow these instructions. The vitamin D story is incredibly complicated and has become messy and confused by the media and medical profession, resulting in much conflicting advice.
Evidence shows that rigorous sun protection can lead to vitamin D deficiency but people like me still advise that dangers of sun exposure outweigh the benefits. Vitamin D is a fat-soluble vitamin essential for maintaining bone health. It also provides protection against some types of cancer, heart disease, multiple sclerosis and diabetes, as well as having positive benefits for mood and well-being.
Unprotected sun exposure is the major source of vitamin D production for most of us. Sunlight, in particular UVB radiation, is needed for vitamin D synthesis in the skin. The amount of available UVB varies significantly depending on the time of day, season and latitude. Vitamin D production also varies from person to person, with pigmented skin types requiring a longer period of exposure to make the same quantity of vitamin D.
Most dermatologists agree that the time taken to make vitamin D in the skin is relatively short, and less than the time needed for skin to become red and burn. Of more interest and a less-commonly known fact is that continued sun exposure does NOT result in ongoing vitamin D production. After prolonged UVB exposure, vitamin D is converted into inactive substances. There is, therefore, little point sunbathing for long periods of time in order to ‘top up’ your level
Current UK dermatology guidance recommends going outdoors for a few minutes around midday without sunscreen to improve vitamin D levels. Individuals are encouraged to recognize their own skin to get some idea of how long one can spend outdoors without burning. This time is clearly going to be shorter for someone with pale skin than a comparable person with dark skin.
One of the problems that we have in the UK is that due to our latitude we do not get sufficient UVB radiation to produce vitamin D from sunlight between October and March.
So, firstly, it is worthwhile trying to improve vitamin D intake from dietary sources, particularly during the winter. Foods rich in vitamin D include oily fish (e.g. mackerel, salmon, sardines), fortified margarine and cereals, and egg yolks. Failing that, consider taking an oral supplement during this time of year. Total daily dose of vitamin D should be 800 IU.
Based on current data, the conclusion remains that there are safer ways to get enough vitamin D, which do not involve prolonged sun exposure. There is probably no benefit in over-supplementing or taking more than necessary, as high levels of vitamin D have also been linked to health issues.