Monday, 27 April 2020 13:34

Can You Spot the Difference? Couperose Versus Rosacea

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These two conditions are often confused; however, they are two diverse skin concerns. Couperose skin presents as red, dry, and tight but is not inflamed. Meanwhile, rosacea symptoms include inflammation, flushing, papules, pustules, and in some cases, changes in the tissue itself.


Couperose indicates the presence of weakened blood vessels, due to the lack of elasticity in the skin. Rosacea is a vascular disorder with the client presenting more blood vessels that are closer to the surface of the skin, so more blood flows through the area. The skin care professional must be able to analyze the skin correctly before recommending a treatment plan and products. Without an accurate assessment, the client may not achieve effective results, or worse yet- no results at all.





Caused by loss of elasticity

Chronic inflammatory disorder

Blood flow dilates the capillary; however, it is unable to contract to its normal size

Hypersensitive skin, burning, stinging, and itching

Thickened skin tissue

Redness, dryness, and sensitivity

Flushing and Persistent Redness

Common in fair skin types

Papules, Pustules, and Rashes

Easily seen when a client has thin skin

Styes and Conjunctivitis (Ocular Rosacea)

Commonly found on nose and cheeks

Presents through the central third of the face (forehead, nose, cheeks, and chin)


Couperose is a vascular condition that affects both large and small blood vessels and appears as localized redness in specific areas.


  • Couperose occurs due to insufficient elasticity of the capillary walls resulting in dilated capillaries with lingering blood cells, making them appear defined and red on the skin’s surface. Capillaries should dilate with increased blood flow, then contract and return to their original size afterward. Clients with weakened elasticity have capillaries that dilate but are unable to return to their normal size. They remain dilated, which eventually causes couperose skin.
  • Both external and genetic factors cause couperose. Darker ethnicities with thicker skin and normal or slightly increased sebum are less prone to develop couperose, due to its increased insulation, while thin, fair, and dry skin types are much more vulnerable. When intrinsic factors combine with external aggressions, the development of couperose accelerates.
  • Various stimuli, including heat, cold, and alcohol cause the skin to respond by vasodilation. Blood flows through the capillaries (dilation) then closes when needed. Weakened capillaries lacking elasticity cannot close, which creates permanent dilation and redness.



  • Extreme and sudden changes in temperature
  • Sun exposure
  • Stress
  • Exercise or working in high temperatures
  • Pollution
  • Hot drinks and spicy foods
  • Alcohol and cigarettes
  • High blood pressure
  • Using abrasive skin care products
  • Heredity
  • Menopause
  • Females are at higher risk
  • Excessive or long term corticosteroid use



Be sure to see a dermatologist as soon as symptoms occur. A treatment followed immediately after the first symptoms can stop the condition and prevent a recurrence. Here are some treatments that have shown to help with couperose skin:

  • Cryotherapy is a newer treatment where the body is exposed to frigid temperatures to promote healing.
  • Chamomile extract reduces redness, soothes, and calms the skin.
  • Moisturizing is crucial in reducing the appearance of redness; anti-inflammatory ingredients with hydrating properties fight redness while maintaining moisture.
  • Cleanse with lukewarm water as extremely hot or very cold water can cause blood to rush to the surface of the skin, leading to more redness.
  • Use broad-spectrum SPF 30 or more – exposure to ultraviolet rays exacerbates couperose symptoms, so apply a broad-spectrum sunscreen daily, and don’t forget to reapply every two hours when outdoors.
  • Intense Pulsed Light (IPL) can reduce the signs of couperose in a non-invasive way, without pain or deterioration of the skin. A gel is applied, then the intense pulsed light passes through the skin without damaging it, feeling like snapping rubber bands. The heat from the IPL reaches the veins in the treatment area, causing the to blood to clot then close.
  • CO2 laser treatments can also be useful in minimizing or eliminating couperose.




Avena Sativa Extract

Oat kernel extracts are rich in avenanthramides, bioavailable polyphenols acting as antioxidants, which are known for their anti-irritant and anti-redness properties.



Ascophyllum nodosum extract and asparagopsis armata extract has been proven to increase elasticity in clinical studies.



Elafin, peptidase inhibitor 3 suppresses elastase, the enzyme that destroys elastin.


Horse Chestnut

A plant extract with bioflavonoids (vitamin P) that strengthens capillary walls and reduces redness.


Bisabolol (from chamomile)

A popular analgesic ingredient that also calms redness, irritation, and inflammation.


Nonsetting Masks

Nonsetting masks are designed to stay moist and are more hydrating and are also referred to as gel or cream masks, they are not formulated to dry. They nourish or treat the epidermis and are beneficial for sensitive, couperose, aging, or dry skin because ingredients such as collagen, aloe, and seaweed have excellent hydrating properties.


Lucas Championaire

Use a cool misting sprayer on a client with sensitive skin. Today’s steamers have an option of cool or hot mist, and many multifunction machines have a spray mist attachment.



To avoid overstimulation and damage to capillaries, do not use excessive hot steam or hot towels on couperose skin. Inform clients why extreme heat is not suitable for the skin.



Advise the client to avoid vasodilators, including heat, the sun, spicy foods, and stimulating products as they dilate capillaries. Steam or warm towels should be used carefully on couperose skin.



Educate clients, so they understand that excessive or deep massage is too rough for facial tissue in couperose skin.


Rotary Brush

The primary purpose of the rotary brush is to exfoliate the skin lightly. The brush machine also assists in the cleansing process. Brushes stimulate the skin and help soften excess oil, dirt, and cellular buildup. Avoid abrasive brushes and scrubs on acne, couperose, or inflamed skin.


Steam – Hot Towels

Avoid excessive use of steam or hot towels, because they dilate the capillaries and follicles, causing more redness and irritation.


Ventouse Suction

Do not use vacuum suction or microdermabrasion on couperose.


Galvanic current

Galvanic, especially desincrustation, should be avoided as it increases circulation. Iontophoresis decreases circulation, so it is okay.


High frequency also stimulates circulation and hot stones cause temperature fluctuation.



Rosacea is a vascular skin condition with four specific subtypes, and one variant that presents with permanent redness in the central third of the face that involves the capillaries, rashes, textural changes in skin tissue, and in up to 50% of patients and can affect the eye.



Females are more likely to develop rosacea than males; however, males often experience subtype three phymatous rosacea, which presents as bumpy tissue. Lighter Fitzpatricks of European descent tend to have a higher risk of development. Still, all ethnicities can develop this sensitive skin condition, and it is less evident on a darker skin tone. Most cases occur in women from 30 to 50 years of age. And, typically most have a family history of rosacea, usually a sister, mother, or aunt. Although extremely rare, it also can begin in childhood and adolescence.


There are three subtypes of pediatric rosacea, including vascular, papulopustular, and ocular. Ocular rosacea and papulopustular disease are common clinical findings in younger patients. Pediatric rosacea tends to persist into the adult years.



Light therapy is an option for those individuals with visible facial telangiectasias. There are two options:


Laser therapy and Intense Pulsed Light (IPL). The Mayo Clinic reports that studies have concluded that light therapy may reduce facial redness, flushing, and telangiectasias. Both options involve multiple treatments to achieve and maintain improvements. Minimal side effects include temporary redness, loss of skin color, and bruising.


  • Hot drinks and spicy foods
  • Red wine and other alcoholic beverages
  • Temperature extremes
  • Overexposure to ultraviolet rays or wind
  • Letting emotions get the best of you – stay calm
  • Excessive exercise. Stick to moderate amounts of low impact to avoid overheating and flushing
  • Vasodilators, including some blood pressure medications
  • Skin care products with ingredients that cause vasodilation
  • Skin care products with heating effects like menthol, eucalyptus, and peppermint




  • Aldavine - ascophyllum nodosum extract and asparagopsis armata
  • Aldavine inhibits vascular endothelial growth factor – a protein that stimulates the development of blood cells.
  • VEGF is also a key contributor to the formation of new blood vessels (angiogenesis).



  • Brimonidine (Mirvaso) is a topically applied gel that tightens blood vessels.
  • Finacea (15% azelaic acid) kills bacteria associated with rosacea, therefore, reducing the papules and pustules associated with subtype two.



Both conditions are made worse by specific triggers which vary from person to person, the most common include environmental factors such as exposure to hot or cold temperatures, wind, sun, humidity, and pollution (including cigarette smoke), as well as pollen. Psychological factors, including stress and anger, which can trigger flareups. Adrenaline, a stress hormone, can trigger inflammatory processes in the skin. External factors found in fragrance, detergents, topical medicines (including cortisone creams), hot baths, strenuous exercise, alcohol, and spicy foods affect both rosacea and couperose conditions. Clothing can also trigger inflammation. Skin-irritating dyes and chemicals can trigger skin irritation and allergies.


Both conditions are easy to confuse. The educated skin care professional can differentiate through a thorough medical background consultation and skin analysis.



Brenda Linday




Brenda Linday is a licensed aesthetician, licensed aesthetic instructor, and certified aesthetic consultant with over 16 years’ experience in the medical aesthetic industry. Linday serves as a consultant for medical and aesthetic companies desiring to build strong sales and education teams. She develops clinical and sales education content, and trains sales and educational units, clinicians, physicians, and distributors around the world. Linday is also a featured author in many industry publications. Her passion is sharing her wealth of knowledge with other like-minded professionals who believe that education is the key to building lasting relationships with our clients, making each clinician more successful by increasing client satisfaction. Reach her at This email address is being protected from spambots. You need JavaScript enabled to view it. or @LindayConsult.

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