It’s rosacea awareness month! 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 have Type II rosacea, which 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. I often get 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.
Rosacea April 2020. My skin after 12 months of skincare (no antibiotic)
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 tannin 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!
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.
Some schools of thought that have been discussed for causes of rosacea are
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.
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 skincare routine than I am with my eating habits, I feel I have more opportunity to make headway with a skincare first approach.
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. My skincare routine is what has worked for me and may not work for you. My 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 a good skincare regime will pay dividends.
I stopped taking Vibromycin twelve months ago. My rosacea immediately flared up again but, undeterred, I have homed skincare routine and I am definitely winning the battle.
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 fragranced 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
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.
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 an additional step that I include in my evening skincare routine. 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.
Maysama Green Rooibos Pressed Serum
Well, naturally, I would recommend my own serum, MAYSAMA Green Rooibos Pressed Serum. I formulated this for sensitive skin and as an SOS serum, as well as an antioxidant serum. And as someone with rosacea, I think it’s fair to say that you know I would only recommend it if it was suitable for rosacea prone skin.
Rooibos has great skin healing properties. First and foremost, rooibos is anti-inflammatory, 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 photo-protective properties.
Studies at the Nelson Mandela Institute on the therapeutic potential of rooibos on diabetic wounds, which are notoriously difficult to heal, showed that green rooibos contributes greatly to the latter stages of healing. Excessive oxidative stress delays wound healing, so the antioxidant capacity of rooibos is beneficial to wound healing. Rooibos also inhibits the formation of Advanced Glycation End Products (A.G.E). Understanding the negative association of A.G.E. on wound healing, inhibition of protein glycation using rooibos may offer therapeutic value.
Aside from the 1.3% pharmaceutical grade Green Rooibos extract, MAYSAMA Green Rooibos Pressed Serum is formulated with 3% niacinamide, which is popular in the treatment of rosacea for strengthening the skin barrier, 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.
Garden of Wisdom Azelaic Acid 10% serum
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 prevent future outbreaks and keep pores clear, helping to prevent breakouts. I first heard of this acid for treating rosacea from Dr Sam Bunting, a London based dermatologist. I have tried several different formulations, but my favourite is Garden of Wisdom Azelaic Acid 10% Serum. It’s reasonably priced, absorbs easily and layers really well.
If you have rosacea, your skin type is likely to be on the drier side, so hydration is key for a healthier skin. The most commonly used ingredient for skin hydration is or Hyaluronic Acid (HA) or its sodium salt, sodium hyaluronate. There are many HA serums available on the market, actually they are having a bit of a moment! Hyaluronic acid is said to hold a thousand times its weight in water, so is great for hydration.
That said, the newer kid-on-the-block is Polyglutamic acid, which holds four times as much water as hyaluronic acid! I tend to use the Polyglutamic Acid serum from The Inkey List, which pairs really well with my serum, as MAYSAMA already contains hyaluronic acid at efficacy levels.
Stratia Liquid Gold, The Ordinary Natural Moisturising Factors + HA
It’s important to lock in that moisture, so do end with a moisturiser if you can. 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.
Heliocare 360 COLOR gel oil-free, Purito Centella Green Level Unscented Sun SPF50
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. Here are two that I absolutely love;
Another Korean product. Well, let’s face it, they know a lot about formulating sunscreens! This one is absolutely gorgeous in terms of how it glides on and absorbs into your skin but I love that it is formulated with Centella asiatica for all its skin benefits as well.
If you are a woman of a certain age, you may well be including a Vitamin C serum and a retinol serum in your routine. It’s perfectly fine to layer these serums with the above routine, although you would alternate Vitamin C or retinol on alternative nights or retinol at night and Vitamin C in the morning. Just a word about Vitamin C in skincare. Firstly, if you have rosacea, you have sensitive skin. A lot of Vitamin C serums are formulated with L-Ascorbic Acid at 20%, which is the purest form of Vitamin C. At this level it can be sensitizing, so I would not recommend it. If you insist on using a Vitamin C serum (which I personally don’t at the moment), then it would be better to opt for one of the more stable forms of Vitamin C such as Tetrahexyldecyl Ascorbate or Ascorbyl Glucoside, depending on whether you more concerned with targeting pigmentation or for collagen production. These derivatives are generally formulated at a higher pH and better for drier and sensitive skin. There are plenty of recommendations in You Tuber Gothamista’s Vitamin C video.
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.
As I discussed earlier, there is evidence that gut health plays an important part in rosacea, so diet management is a key strategy. Aside from avoiding ‘trigger’ foods, we should pay attention to not eating foods that may feed the ‘bad’ bacteria and encourage their colonisation.
Foods to Reduce or Cut Out
Avoid food triggers such as caffeine, alcohol, spicy foods, hot peppers.
Reduce sugars, honey, maple syrup, agave.
Consider cutting out oats – there is some evidence that supports that the yeast Candida albicans is associated with rosacea. If this is the case, avoiding oats may help.
Eat more of the following
Fiber promotes a diverse healthy gut bacteria, which supports the immune system. So, eating more fibre or prebiotic fibers like under-ripe bananas, garlic, asparagus could help.
Boots Good Dut – live friendly bacteria
Probiotics can be helpful in the treatment of rosacea. While probiotic foods like yoghurts, kimchi, sauerkraut etc exist, it may be safer to opt for a probiotic supplement, as these foods contain histamine, which in some cases can exacerbate the situation.
Aside from avoiding ‘trigger’ foods, I am currently trialling a probiotic supplement from Boots, as pictured below.
I hope you have found this 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, please do subscribe to my blog for more skincare related content.