Rosacea

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Problem: Rosacea

Rosacea is a chronic skin disorder that primarily effects facial skin. Those afflicted with rosacea are often plagued by persistent symmetrical flushing and redness on their cheeks, forehead, chin, and nose. The redness may be accompanied by small, red, solid bumps or pimples and visible blood vessels at the surface of the skin called telangiectasias or spider veins. Other symptoms may include eye irritation, facial burning or stinging, very dry appearance to the skin, raised red patches of skin, skin thickening known as hyperplasia, and edema. Rosacea can manifest in a variety of ways.

Doctors have classified rosacea into four subtypes, including erythematotelangiectatic, papulopustular, phymatous and ocular.
Rosacea is most common in persons age 30 to 50. Although the condition can occur in adults of any ethnicity, people with fair skin and light hair are at higher risk of experiencing rosacea and it is more prevalent in women than in men. However, men with rosacea tend to experience more severe symptoms.
Rosacea symptoms seem to come and go in its earliest stages. Symptoms are often brought on by rosacea triggers. The most common rosacea trigger is sun exposure. Individuals suffering from early rosacea can help keep their symptoms at bay by avoiding sun exposure and using a sunscreen daily. Another common trigger is emotional stress, so sufferers should be mindful of their stress levels and work to manage them. Other triggers include strong winds, extreme heat, hot baths, heavy exercise, cold weather, and spicy foods. Avoiding environmental triggers, food triggers, and emotional stress are helpful in the prevention of worsening symptoms.
Rosacea is a chronic condition that tends to get progressively worse. For this reason, it is important for clients to seek professional consultation early on. The symptoms of the condition are easier to treat in the earlier stages.

Case Study:

A regular client comes in for her scheduled facial. As you cleanse her skin and prepare for the treatment, you notice unusual redness on her cheeks and chin. When you ask about her recent activity, she explains that she has been training for a marathon. Her cheeks have been noticeably red and hot when she finishes her workout. She adds that her face has always flushed while she works out, but it quickly disappears. Now when she cools down from her run, her cheeks and chin remain red. You examine her facial skin to find is very dry and taut. She admits that it stings and seems particularly sensitive to the strong winds and cold air while exercising. You can confirm that she appears to have persistent flushing and extreme dryness. The client also has visible blood vessels on the face. This client is 36 years old and, although she uses light sunscreen, she admits to recreational sun exposure and dealing with emotional stress. Her client intake form lists using skin care products with retinol, alcohol and vitamin C.

As a skin care professional, what solution would you propose to treat
this case study on rosacea?

Solutions:

Linda Gulla, L.E., founder of International Institute for the Advancement of Aesthetic Medicine

“With rosacea, preventing transepidermal water loss (TEWL) is important to a strong skin barrier function. Therapy using ceramides will protect cells from excessive water loss due to evaporation while niacinamide has been shown to strengthen skin barrier and integrity. Pantothenic acid (vitamin B5) and dexpanthenol have been shown to reduce erythema, reduce TEWL, and improve skin barrier. Preventing TEWL and exfoliation is the key to improving skin barrier function. With rosacea, there are better choices, such as amino acid filaggrin based antioxidants, or polyhydroxy acids, that enhance the skin’s ability to retain moisture and promote a healthy skin barrier. Other hydroxy acids such as mandelic acid, can address the bacterial component associated with rosacea. I recommend that the client exfoliates with polyhydroxy acids, AFAs, and mandelic acid. To prevent TEWL and strengthen the skin barrier, I suggest the use of ceramides, niacinamide, pantothenic acid, and hyaluronic acid. In order to reduce erythema, he or she should use L-ascorbic acid. I would not recommend using retinols with sensitive skin conditions.”

Janel Luu, CEO of Le Mieux Cosmetics

“A three-fold solution to chronic rosacea would consist of lifestyle, diet and skin health management. Lifestyle reduces and manages stress through deep breathing, meditation, and yoga, which can help lessen inflammation. Diet nurtures skin from within by eating whole foods rich in omega-3 fats, vitamins, minerals and enzymes. In regards to skin health, it is important to keep skin clean and protected while exposed to external environments and during sports activities. It is important to keep skin care products to a minimum whenever rosacea flare-ups occur. The professional should use products that soothe, calm and de-stress the skin: mild cleansers instead of exfoliators and harsh peels. Look for ingredients that support, condition and strengthen the skin: serums and/or moisturizers containing hyaluronic acid, argan oil, avena sativa (oat), squalene, ceramides, glycolipids, tocotrienols, minerals and bisabolol. Apply titanium dioxide-based sun protectors throughout the day and avoid chemical sunscreen ingredients that may actually irritate
the skin.”

Erin Holder, RN-BSN, owner of Mod Skin Nutrition, Ltd. Co.

“The first signs and symptoms of rosacea are often triggered by environmental or lifestyle factors. Being able to identify and avoid these triggers to minimize flushing and irritation of the skin is essential. A common trigger, alcohol, is considered a circulating vasoactive agent and exacerbates rosacea by creating a dry flushing effect. To decrease flushing, use topical anti-inflammatories and antihistamines like hydroxyphenyl propamidobenzoic acid. Vitamin C is routine for overall skin health, but depending on the formulation, it can cause irritation as well. Look for magnesium ascorbyl phosphate; it is a water-soluble, nonirritating derivative of vitamin C. Retinol is still recommended to repair the dermis and decrease telangiectasia from occurring. Physical exfoliation, such as microdermabrasions, dermaplaning and scrubs, are not typically indicated as these can cause flare-ups. Do not be afraid to recommend laser therapy or intense pulsed light. They are both indicated to treat background erythema. Alternating non-ablative light treatments with retinol-based chemical peels at four-week intervals can help keep rosacea controlled. And daily use of a broad-spectrum sunscreen cannot be stressed enough.”