Rosacea Awareness Month
April is Rosacea Awareness Month, and with 10% of the Irish population affected by Rosacea, we would love to shed some light on the “Curse of the Celts” and ways that it can be managed.
Rosacea is a chronic skin condition that affects the skin of the face, and appears in four forms (1):
1. Redness/flushing type: There remains uncertainty as to whether this type is actually similar to the others and whether it belongs within the same process. This form is likely mostly vascular (coming from the blood vessels) and may not be inflammatory like the other forms of rosacea. Traditional rosacea treatments may not work here but it can be treated with antidepressants or beta blockers and lasers/IPL.
2. Papules/pustules and redness: This form of rosacea can be mistaken for acne and it is important to differentiate between the two as their management is very different.
3. Granulomas or phymatous reaction: This form is characterised by irregular thickening of the skin, and is often the result of chronic untreated rosacea.
4. Ocular rosacea: This form may present on it’s own or coupled with one of the others and is often noted by inflammation and discomfort of the eyes.
While it is believed to be more common in women and people with lighter skin tones, symptoms can be more severe in men when present (2). Studies have found, however, that rosacea symptoms have a greater effect on women’s quality of life(3). More recently, rosacea is being viewed as a systemic condition as opposed to a process limited to the skin. The involvement of the gut, as well as other comorbidities (e.g. gastro-oesophageal reflux disease, irritable bowel syndrome, migraine) are becoming clearer. Research has some way to go to fully elucidate the connections, but there is greater acknowledgement that this chronic inflammatory skin disease may indeed be more of a systemic inflammatory condition.
The pathophysiology of rosacea lies in genetic and environmental triggers, ultimately leading to alterations in immune functioning and skin barrier disruption. Common environmental triggers include skin microbiome dysbiosis, heat, UV exposure, stress, certain food etc.. Some triggers are lifestyle choices that are modifiable and these can be quite unique to each individual. It is advisable to consider starting a trigger diary to track your own triggers.
Therapies at Home
Most importantly, we must understand that rosacea is a chronic condition and while we are very good now at managing its symptoms a full cure remains elusive. The majority people find that rosacea flares after particular triggers, which can come from food or the environment. Common triggers to watch out for include
sun exposure,
wind exposure,
spicy food,
alcohol,
caffeine,
hot drinks,
cheese
and aerobic exercise.
Learning how to navigate your own personal triggers is very important as it gives you agency over the symptoms. Understanding what triggers your rosacea helps you to prepare for times when you may need more skin support.
Some tips we love to highlight include:
Humidifiers for people who are triggered by dry environments.
Cool packs for the wrists and iced water bottles for those triggered by exercise to keep the temperature down.
Wind breakers for long walks in the wind for those triggered by wind.
SPF SPF SPF for EVERYONE and a wide brimmed hat.
Fermented foods to help improve gut biome diversity especially if encountering trigger foods.
It is also recommended to use gentle skincare products, as strong actives can bring on rosacea flares. Gentle cleansers coupled with nourishing moisturisers are great foundational products for any rosacea patient. Mineral sunscreens are also incredibly important especially as we know UV exposure is a common environmental trigger. Beyond these products lie a realm of potentially helpful ingredients, but these should only be tested when the skin barrier is calm and the skin is feeling strong.
As with most dermal conditions, the issue is not skin deep. Stress can be a cause of rosacea flares, and while easier said than done, managing stress can sometimes help to prevent flare ups. We like to manage stress by creating a consistent routine in our daily life, and taking time to ourselves when possible to do something that calms us, such as reading or walking in nature.
Recent research has found that dietary antioxidants can have an impact on managing rosacea, with foods rich in vitamin C, E, carotenoids and polyphenols having a positive effect (4). These can be taken in the form of supplements, however adding them to your diet through food will have an accumulative positive effect for one’s skin condition as well as overall health.
Continuing with the theme of As Above, So Below, there is evidence to suggest that certain microbes in the gut can be a causal link to rosacea, while other bacteria can help to combat it (5). Further research is needed to explore this finding in clinical settings, however, the seemingly unending discoveries that our outer issues are reflected deep inside ourselves never ceases to amaze us at Le Formulaire.
Therapies in Clinic
In cases in which rosacea cannot be managed by lifestyle changes, we can create treatment plans in the clinic in order to help with symptoms. Prescription creams such as Azelaic Acid and Ivermectin can be helpful to treat rosacea and achieve skin barrier control. Isotretinoin (commonly known as Roaccutane) may also be beneficial to some patients under the guidance of a consultant dermatologist. Low dose antibiotics may also be considered.
LED Light Therapy can help to calm as well as strengthen the skin, which can be extremely helpful for managing rosacea and keeping the skin barrier under control.
Laser and Intense Pulsed Light (IPL) treatments are commonly used for the amelioration of Type 1 Rosacea (redness and telangiectasia). By targeting the vascular element of rosacea these treatments have the potential to improve the appearance as well as strengthening the epidermal barrier.
New Emerging Therapies
At Le Formulaire we always keep an eye on emerging treatments from the literature and here are two novel approaches that we are excited about.
Heparan Sulfate Analog (HSA): Some studies have suggested the potential anti-inflammatory role of a low molecular weight HSA in treating rosacea. It works by inhibiting a peptide called LL-37 which is known to trigger an inflammasome in rosacea. The Senté Dermal Repair Cream, which is based on HSA technology, is available through Get Harley following a consultation with us.
Probiotics: Several studies have linked Rosacea with gut disorders such as small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and Helicobacter pylori infection. The cross -talk that occurs between the skin and the gut is something we are very passionate about at Le Formulaire. Inflammatory skin disorders are often accompanied by symptoms of an unhappy gut (6). While we have yet to reach a consensus as to whether probiotics can help rosacea, a promising number of studies have eluded to its potential. One study demonstrated an improvement of gut microbiome diversity coupled with rosacea symptom improvement using an oral Escherichia coli Nissle strain (7).
We believe that future therapies should encompass the individuals health as a whole and we think looking at gastrointestinal inflammation and micriobiome alterations as a means to improve the global immune system regulation and consequently the skin manifestations of rosacea.
We are here to help
As with any skin condition, rosacea is not a reflection of something you have done wrong. While we can do our best to manage these issues, life can be chaotic, and we cannot always stick to routines or lifestyle changes as much as we would like to. Managing rosacea can be a frustrating journey, and it is always important to remember that the condition of your skin is not a reflection of your gorgeousness. At Le Formulaire, however, we understand that our face can feel like your armour to the world, and when we do not feel confident in it, it can have a tremendous effect on our self esteem. We will always do everything we can to help you to feel your best in your own skin.
Happy Rosacea Awareness Month!
References:
Searle T, Al-Niaimi F, Ali FR. Rosacea. Br J Hosp Med (Lond). 2021 Feb 2;82(2):1-8. doi: 10.12968/hmed.2020.0417. Epub 2021 Feb 27. PMID: 33646026.
Zujko-Kowalska K, Masłowska J, Knaś-Dawidziuk M, Hamulka J, Zujko ME. Dietary Antioxidants May Support Cosmetic Treatment in Patients with Rosacea. Antioxidants (Basel). 2024 Mar 21;13(3):381. doi: 10.3390/antiox13030381. PMID: 38539914; PMCID: PMC10968324.
Zujko-Kowalska, K.; Masłowska, J.; Knaś-Dawidziuk, M.; Hamulka, J.; Zujko, M.E. Dietary Antioxidants May Support Cosmetic Treatment in Patients with Rosacea. Antioxidants 2024, 13, 381. https://doi.org/10.3390/antiox13030381
Li J, Yang F, Liu Y, Jiang X. Causal relationship between gut microbiota and rosacea: a two-sample Mendelian randomization study. Front Med (Lausanne). 2024 Mar 22;11:1322685. doi: 10.3389/fmed.2024.1322685. PMID: 38585146; PMCID: PMC10995375.
Holmes AD. Potential role of microorganisms in the pathogenesis of rosacea. J Am Acad Dermatol. 2013;69(6):1025–1032.
Manzhalii E, Hornuss D, Stremmel W. Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917. World J Gastroenterol. 2016;22(23):5415–5421.