My Rosacea Skincare Routine
2020 photo - my skin - left side with makeup, right side without makeup
It’s rosacea awareness month so let me share my rosacea skincare routine with you. This is a subject very close to my heart as I have battled with acne rosacea since my early teens. Blazing through life with rosy cheeks might be considered healthy to some, but if your pink cheeks turn into a balisha becon face when you walk into a warm room or your skin is prickly and burning for no apparent reason, it’s no laughing matter. Rosacea affects as many as 1:10 people, although many of these cases will be mild and easily covered by makeup (with women obviously), so we are less aware as to who may have the condition. Women are generally more affected than men by the condition and it is more prevalent in fair (white Caucasian) skin types than darker skins. I’ve managed to get my rosacea under control on and off, but it has never completely gone away. I'm hoping that my rosacea skincare routine will change that and after several months of homing my regime, I believe that I'm winning the battle. I fluctuate between Type I and Type II rosacea. Type I is characterised by inflammation and flushing and often manifests itself as butterfly of redness around the nose and cheeks, as well as chin and forehead. Type II manifiests itself by papules, little raised red dots, that make my skin look even more angry and these sometimes become infected. The acne rosacea part is the most distressing, when, rather than just the normal papules and inflammation, I can get pustular lesions. What I didn’t understand until several years later is that, unlike acne, these spots come from the vascular capillaries. The bad news is that, if a spot becomes infected, it can quickly spread through the capillaries and become systemic, so one spot can turn into pizza face overnight!
My rosacea, April 2019. Papules and pustular lessions and inflammation around the eyes.
My Rosacea June 2019. Type 2 characterised by angry red papules.
Rosacea April 2020. My skin after 12 months of skincare (no antibiotic)
April 2021 - My rosacea - Type I.
You cannot treat it in the same way as acne because it’s not acne. Acne sufferers normally have an increase in sebum production as well as the presence of Propionibacterium acnes, a bacterium characteristic of acne. Rosacea sufferers, on the other hand, are more likely to have a dry skin and a compromised skin barrier.
Types of Rosacea
Not all rosacea is equal. In fact, rosacea has been categorised into four categories. Whilst I would currently classify myself as Type II, when I have it under control, my symptoms are more aligned with Type I rosacea. Should you feel the need to classify your redness, here are the categories;
There are several stimuli which can trigger the vasodilation or flushing. If you are a rosacea sufferer, you may already have worked out some of the triggers that affect you personally. Triggers can include environmental factors, such as changes in temperature or sun exposure but also hot drinks, alcohol, spicy foods or even just physical exercise (not that I’m discouraging anyone from exercising!). This constant flushing leads to broken capillaries, so the condition appears worse over time. It is important to keep triggers under control as much as you can.
Whilst I don’t live like a saint, I do avoid spicy foods, coffee and drink alcohol in moderation. I prefer to only drink white wine because it is said that the tannins in red wine are particularly irritating for my rosacea. I avoid sunbathing and always wear a factor 50 SPF. The part I find hardest to control is changing environments, particularly in winter, when you come in from the cold into a warm house or office. Rosacea family, I’m sure you can relate to this? I take drinking water with me everywhere, particularly on car journeys as I find sitting in the confines of a car is equal to sitting in a greenhouse! Windows can amplify heat and, being surrounded by them, I can feel quite claustrophobic, not to mention a little paranoid by the added exposure to uv light. Whilst I’m constantly fiddling with the air-conditioning to control my flushing, my husband, in the driving seat, is drinking copious amounts of caffeine to try to stop the shivering! On long journeys I have often opted for the back seat, to save my skin!
I have cut down my white wine intake even further in the last year, because drinking alcohol of any kind does prompt flushing. So, my weekly intake has cut from around 7 units a week to 2-3 units per week and I often will drink white wine as a spritzer, rather than neat, which can reduce flushing further.
What causes Rosacea?
The root cause of rosacea is not clearly defined, although genetics and skin type are believed to be factors. It is probable that there is more than one cause and causes and triggers may even overlap. Whilst we can avoid some triggers, if we cannot identify and eliminate the source of the problem, we will not rid ourselves of the condition, only mitigate it. Whichever way we look at it, rosacea is autoimmune. Our body is attacking itself, recognising something as ‘foreign’ and issuing an immune response that triggers inflammation. Inflammation causes blood vessels to dilate, which leads to reddening of the skin.
There is a train of thought that rosacea is not a skin condition at all but is in fact a systemic inflammatory condition. This hypothesis makes total sense to me and I strongly believe that a holistic approach is the best approach. Some schools of thought that have been discussed for causes of rosacea are listed below;
There are several studies that connect rosacea patients with a higher prevalence of gastrointestinal disease, including celiac disease, Chrone’s disease, ulcerative colitis, Small Intestinal Bacterial Overgrowth (SIBO) and H Pylori. SIBO or Small Intestine Bacterial Overgrowth is a condition where large amounts of bacteria are present in the small bowel. The small bowel is supposed to be sterile and these bacteria are normally found in the colon, so their presence in the small bowel has been linked with rosacea.
A mite that lives on the skin (Demodex folliculoru) has been associated with rosacea, although it is not clear if this is a cause or a trigger.
Compromised skin barrier
Some studies show that there is an imbalance of fatty acids in the sebum of patients with papulopustular rosacea, with a higher concentration of myristic acid and lower concentrations of long chain fatty acids.
2021 – Me – brave enough and happy enough to go out and about without make-up!
A healthy skin secretes antimicrobial peptides (AMP’s) which is an important defense mechanism but, if it is not regulated, it can cause tissue damage. In normal skin, AMP’s are broken down by enzymes but in rosacea patients there appears to be an increased production of certain AMP’s and enzyme activity (proteases) breaks these peptides down into fragments, which then cause inflammation. Inflammation can lead to disruption of lipid synthesis, which in turn affects barrier function. In support of a compromised skin barrier being a key factor to the onset of rosacea, my rosacea returned when I hit menopause at age 50, having been in remission for nearly a decade. Whilst I suffered with rosacea from teenage, I would say that I had it under control from 40 years of age. Admittedly I was living in Spain at the time, but it continued to be good for several years after I returned to England, until I hit the menopause in 2018. Then all hell broke loose and my face erupted into red papules and small itchy pustules. Synonymous with the start of menopause, is the cessation of oestrogen production. Oestrogen is associated with increased collagen production, skin thickness, skin hydration, wound healing, and improved barrier function. So, there are clearly changes to skin health when we reach menopause. It is likely that my barrier function is compromised due to the lack of oestrogen production, and this has been the trigger for my rosacea returning with a vengeance. I am convinced that skin barrier has a lot to do with it. But then, as our skin health is often a reflection of our gut health, these two ‘causes’ could be connected. Whichever way we look at it, a holistic approach is best, but as I am more disciplined with my rosacea skincare routine than I am with my eating habits, I feel I have more opportunity to make headway with a skincare first approach.
My Rosacea Skincare Routine to help Manage Rosacea
Firstly, a couple of disclaimers. I am not a doctor or dermatologist and I cannot therefore help you with a diagnosis or offer advice for treatment. Firstly, my rosacea skincare routine is what has worked for me and may not work for you. And, secondly, my rosacea skincare routine has helped manage my symptoms of rosacea and is not necessarily a cure for it. Let’s not forget that I have visited a dermatologist on more than one occasion. I cannot dismiss that when flareups are really bad, a doctor’s diagnosis is vital, and antibiotics may be necessary to get you over the worst. Over the years I have been prescribed Rosex (metronidazole cream), Soolantra (ivermectin) as well as the oral antibiotic, Vibromycin. Understanding that antibiotics cannot be a long-term strategy however, at some point you may need to brace coming off these and look for ways to calm your skin and strengthen your skin barrier. That’s where my rosacea skincare regime could pay dividends. I stopped taking Vibromycin in 2019. My rosacea immediately flared up again but, undeterred, I homed my rosacea skincare routine and I believe I am winning the battle against this distressing condition.
With rosacea I think it’s as much about knowing what not to put on your skin as knowing what will help. For me, I avoid anything with fragrance, including essential oils as they can be irritants to the skin. And most moisturisers break me out, but I have managed to find a couple that my skin does get on with. So here are my top tips;
La Roche Posay Toleriane Dermo Cleanser, Skin Sapiens Facial Cleansing Gel, Harborist Balm Gel Cleanser
Admission, I don’t always use a cleanser in the mornings, but if I do, it’s a gentle, non-fragrance, gel cleanser in the shower, such as Harborist Gel Balm Cleanser or Skin Sapiens Facial Cleansing Gel. In the evening, I need something that is effective at removing light makeup and SPF, so I use La Roche Posay Toleriane Dermo Cleanser. This cleanser is suitable for sensitive skin. I don’t think anyone with rosacea would say they have anything other than sensitive skin. Sensitive skin is not a skin-type but it does flag up that that we are reactive to things. This is a milk cleanser, unfragranced with a minimalist formulation. I cannot get on with oil cleansers or balms. Most of them contain essential oils or comedogenic oils that block pores. I don’t know whether that is something that is specific to me or rosacea. So, this light-weight gel-cream cleanser is the first step in my rosacea skincare routine.
Pyunkang Yul Essence Toner
If I have removed makeup with a cleanser, then I prefer to follow up with a toner, so for me, toner is the second step in my rosacea skincare routine (PM). There are many choices here, but the most important things are that, for everyday use, a toner should be pH balancing, non-fragranced and hydrating (i.e. not a resurfacing toner). My favourite is Pyunkang Yul Essence Toner, which is a Korean product. Astragalus membranaceus root extract Astragalus,or milk vetch has been used in traditional Korean Medicine for centuries for its medicinal benefits. This lovely hydrating, pH balancing toner has just seven ingredients and has no added fragrance or colour.
Using an exfoliating toner two-to-three times a week will help skin turnover. Many exfoliating toners are formulated with glycolic acid as an Alpha Hydroxy Acid [AHA], but this ingredient is too irritating for sensitive and rosacea prone skin. Lactic acid, also an AHA, is a much larger molecule and therefore does not penetrate the skin as deeply, although still maintains its resurfacing properties by melting the ‘glue’ that holds dead skin cells together. Lactic acid occurs naturally in our skin as a Natural Moisturising Factor and is a naturally occurring carbohydrate found in many foods. Lactic acid helps keep skin hydrated, fades pigmentation and brightens the complexion by sloughing away dead skin cells.
Maysama ABP11 Green Rooibos Gentle Resurfacing Toner
Maysama's ABP11 Green Rooibos Gentle Resufacing Toner is the perfect balance of Alpha, Beta and Poly Hydroxy Acids to gently exfoliate, whilst respecting your skin barrier. Formulated with a total of 11% mild resurfacing acids, this light-weight, tea-scented (natural fragrance) toner, also moisturises and brightens the skin. Lactic acid at 5% is the sweet spot for sensitive or rosacea-prone skin. Salicylic acid at 1% is at the lower end to avoid irritation and helps to keep pores clear. And gluconolactone [PHA] is mildly resurfacing, whilst hugely moisturising for the skin.
Together with green rooibos as a powerful antioxidant and anti-inflammatory agent, to soothe skin, and kombucha for its probiotic and brightening properties, Maysama's ABP11 Toner has you covered. No added fragrance, no essential oils or drying alchols. I use it 2 to 3 times a week to improve skin tone and texture.
Rooibos has great skin healing properties. First and foremost, rooibos is a healing herb, from the plant Aspalthus linaris, and a powerful anti-inflammatory agent, which is just what’s needed for rosacea. Moreover, rooibos is a potent antioxidant, rich in minerals and vitamin D needed for healthy skin and has anti-glycation and photo-protective properties. Basically rooibos packs a punch when it comes to skin protection and rejuvenation.
Maysama Green Rooibos Pressed Serum is the perfect SOS serum for rosacea-prone iskin and a compromised skin barrier. Formulated with 1.3% pharmaceutical grade Green Rooibos extract and 3% niacinamide for strengthening the skin barrier. This serum also contains a highly purified form of Centella asiatica, which has found fame in Korean Beauty for its healing properties and baobab and argan oil for skin conditioning. The base is Aloe Vera, rather than water, which is extremely soothing for irritated skin.
The serum smells like tea because of the rooibos but there is no added fragrance or essential oils. It’s a light-weight gel-textured serum, which absorbs easily into your skin. You can use this in your morning or evening routine and layer it with other serums if you choose to. I use Maysama Green Rooibos Pressed Serum as my first serum in the morning and apply directly to clean skin. I also use it in the evening after cleansing and toning.
Garden of Wisdom Azelaic Acid 12%
After MAYSAMA Green Rooibos serum, I always apply Azelaic acid - a popular treatment for rosacea. Azelaic acid is a naturally occurring acid found in grains such as barley, wheat, and rye. It has antimicrobial and anti-inflammatory properties, which make it effective in the treatment of skin conditions like acne and rosacea. The acid can help prevent future outbreaks and keep pores clear, helping to prevent breakouts. I have tried several different formulations, but my favourite is Garden of Wisdom Azelaic Acid serum, formulated with 12% Potassium Azeloyl Diglycinate, an azelaic acid derivative. The texture is silky smooth and this serum absorbs easily and layers really well
Stratia Liquid Gold, The Ordinary Natural Moisturising Factors + HA
My rosacea skincare routine always wraps up with a moisturiser to lock in that moisture. As I said at the beginning, I struggle with many moisturisers as some oils can be comedogenic and block pores, but it will depend on the formulation. Two moisturisers that my skin seems to love are; Stratia Liquid Gold – formulated with rosehip oil for anti-aging, and ceramides, cholesterol and fatty acids, which are just brilliant for barrier repair. This is not easy to get hold of in the UK, but I got mine on ebay. And a more budget option is The Ordinary NMF + HA. This beautiful, light weight moisturiser is formulated with amino acids, fatty acids, hyaluronic acid and other compounds that are naturally present in skin.
Elta MD Broad Spectrum SPF 46
Last but not least, for our day-time routine, we should all be wearing an SPF but for rosacea sufferers its all the more important. EltaMD UV Clear Broad Spectrum SPF46 is formualated specifically for rosacea-prone skin. It is oil-free and its lightweight silky texture makes it easy to apply, with no white-cast. It also contains a host of skin barrier boosting ingredients including niacinamide, hyaluronic acid and lactic acid. It is available in tinted and untinted options.
Medik8 Crystal Retinal 6
Having got my rosacea under control in recent years, I have opted to introduce retinoids in my rosacea skincare routine. Retinoids are a group of vitamin A derivatives, which boost cell turnover, improve skin tone and texture and stimulate collagen production to ward off fine lines and wrinkles. The purest form is Retinoic Acid, the form we find in tretinoin, which is a prescription drug only. Retinol and Retinal are gentler forms and can be bought OTC (over the counter). Retinoic acid is the only retinoid that your skin can use. Other retinoids need to be converted to retinoic acid before your skin can use them and the more conversion steps the retinoid has to go through before it becomes retinoic acid, the weaker the retinoid is. In order of conversion;
Retinyl Palminate > Retinol > Retinaldehyde > Retinoic acid.
As my doctor advises against tretinoin for patients with rosacea, I decided a good place to start would be with Medik 8 Crystal Retinal. Retinaldehyde, aka retinal, is a stable form of Vitamin A and a powerful derivative but less irritating and sensitizing than tretinoin and more powerful but just as gentle as retinol. Not many brands formulate with retinaldehyde because it is expensive and difficult to formulate with. Medik8 Crystal Retinal range allows you to start low and work your way up from Crystal Retinal 1, 3, 6, to 10 and now even 20. Within the last 12 months I have worked my way up from 6 to 10 and have now just started to incorporate Crystal Retinal 20 2-3 times per week in my evening routine. I have had no irritation or skin peeling and I would highly recommend this product as part of my rosacea skincare routine once you are ready to introduce more actives.
NIOD Copper Amino Isolate Serum
As my love affair with skincare began with Korean Beauty, it is perhaps no surprise that this girl is partial to a sheet mask! Sheet masks are the bread and butter of Korean Beauty. Korean Beauty concentrate far less on strong actives like retinol and high concentrations of Vitamin C than their western counter parts and focus on skin hydration, protection and repair to achieve that ‘glass skin’ look. Centella asiatica is a highly popular active from Korea and one of my favourite ingredients in skin care for its healing properties. This Goodbye Redness Centella sheet mask from Benton is just packed with hydrating and healing actives, without added fragrance or skin sensitizing ingredients. I absolutely love it and it’s just perfect for those irritated skin days, so this sheet mask now has a permanent place in my rosacea skincare routine.
Maysama Green Rooibos Brightening Mask
If, like me, you have suffered rosacea breakouts, which can lead to post-inflammatory hyperpigmentation (those little pesky red spots) or your skin just feels tired and irritated, then Maysama Green Rooibos Brightening Mask can really help. This high-performance treatment mask is formulated with an 11% brightening complex, including niacinamide 4%, tranexamic acid 3%, alpha arbutin 2%, and Kombucha (Saccharomyces ferment) at 2% to gradually help fade dark spots, pigmentation, or just improve skin radiance.
This wash-off treatment mask is free from added fragrance, essential oils or drying alcohols and is really soothing for sensitive or irritated skin, thanks to the Aloe vera and green rooibos extract. My skin craves this treatment mask on ratty days! It is immediately calmed, hydrated and nourished after use. It is my absolute favourite mid-week and weekend skin treat.
Faustina Home-use IPL Device
Laser treatment can be effective for rosacea, but it comes at a price. On recommendation by aesthetician and You Tuber Penn Smith, I have recently bought the Faustina IPL Home Treatment device. I am carrying out a course of treatments, one a week for eight weeks. This is not a cure but can breakdown those broken capillaries that leave you with the residual redness, whether your rosacea is flaring or not. Having seen the results that a friend achieved, I’m optimistic that this will give some improvement to my skin tone and reduce the redness, but it is not a cure for the condition.
Red Light Therapy
If you asked me what I think has been the biggest game changer for my skin in the past year, I would hands down say that I believe it to be the introduction of Red Light Therapy. Twelve months ago, I was completely unaware of the benefits of Red Light Therapy, also known as Photo biomodulation. In a nutshell, photo biomodulation uses light energy to affect biological processes. There is a lot of scientific evidence to support that Red Light Therapy, using wavelengths 630nm and 850nm (Near infrared), has anti-ageing benefit and can help reduce inflammation. The anti-inflammatory properties of LED therapy is great news for rosacea and the more I learn about this technology, the more convinced I am of the benefits for skin rejuvenation. I have been incorporating Red Light Therapy as part of my rosacea routine since September 2020, with just 5-7 minutes per day. I have definitely noticed a change in my skin tone and texture. There is some supporting evidence that using antioxidants with red LED light treatment as a combination therapy can help realise results for skin rejuvenation sooner. Combination therapies involve combining two or more agents that have complementary actions to achieve better results. The action of LED light depends in part on the production of free radicals, which act as signalling molecules to stimulate biological events, including cell migration, cell proliferation and collagen production. High fluence red LED light however produces excess free radicals which, if allowed to accumulate, can lead to oxidative stress and damage to cellular components. Combining an antioxidant with your LED light therapy can offer protection against oxidative stress because antioxidants act as free radical scavengers and therefore have a complementary action to the LED light.
Combination Therapy – Red Light Therapy + Antioxidant serum.
My rosacea skincare protocol therefore starts with applying MAYSAMA Green Rooibos Pressed Serum in the morning for antioxidant protection, waiting 20 minutes (generally having breakfast) and then starting my Red Light Therapy. Data also supports that hydrated skin absorbs light better. MAYSAMA Green Rooibos Pressed Serum is also packed with humectants including glycerine, Aloe Vera and sodium hyaluronate, ensuring that your skin is hydrated. You can read more about Combining ‘Green Tea’ Antioxidants with LED Light Therapy in my recent blog.
If you are part of our rosacea family, I hope you have found my rosacea skincare routine helpful. If you have any questions, please do not hesitate to drop me a comment below or message me directly. And if you like this blog post, please do subscribe to my blog for more skincare related content.
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