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Rosacea and sensitive skin usually go hand in hand, however rosacea is a separate skin condition that causes pronounced burning, itching and stinging for sufferers, and this can be exacerbated by the skin care products used. Sometimes called Acne Rosacea, it is a non-contagious skin inflammation that exclusively affects the face. Capillaries become more pronounced and create the appearance of a permanent flush and pimples appear on the forehead, cheeks and chin. Trying to find the best skin care routine and products that calm rather than exacerbate can be challenging.
The condition was first medically identified as couperose by a French surgeon 600 years ago, although in that time we have not made a great deal of progress in finding a lasting treatment. It is thought that 2-10% of people have rosacea. We are now discovering that it does not exclusively affect adults and those with fair skin, although it is more easily detected among these two groups.
Rosacea is diagnosed most commonly between the ages of 30 and 50 years, starting with frequent flushing or blushing. Over time the redness, erythema, becomes permanent as capillaries develop and pustules begin to form. Severe rosacea in men can cause the nose to become reddened and enlarged, a distressing condition called Rhinophyma. It can also affect the eyes, with symptoms initially starting out as dry or irritated eyes.
Rosacea impairs the skin barrier, causes inflammation, dilates blood vessels and degrades the collagen and elastin, which are critical to the skin’s structural layer.
The cause or causes are unclear, although it is known that there are nervous, vascular and immune system factors involved, and the symptoms worsen with age.
Current research suggests that people with rosacea are sensitive to Demodex mites. The Dermodex folliculorum mite is found in much higher numbers in those with rosacea. Demodex folliculorum like to make their home in the hair follicles on the face and the meibomian glands of the eyelids. During its immature and adult stages, Dermodex follicullorum feeds on skin cells. Demodex brevis is the other Demodex mite found to overpopulate the skin of those with rosacea. These equally troublesome microscopic creatures live in the sebaceous glands of the skin, which are connected to the small hair follicles. Here they feed on the gland cells. While most of us have Dermodex mites on our skin, those with rosacea have a 4-10 times higher count.
These mites are found in concentration on the cheeks, nose, chin and forehead, and even in rosacea papules and pustules. It is not entirely clear yet whether these mites have a direct or indirect role in causing rosacea.
Research funded by the US National Rosacea Society has connected Demodex folliculorum to a distinct bacterium called Bacillus oleronius. In one study in Ireland, Bacillus oleronius was found to stimulate an inflammatory response in 79% of patients with papulo pustular rosacea. Another study in Australia of a small group of people with rosacea found that Staphylococcus epidermidis, another bacterium, may play a role in the development of rosacea. Staphylococcus epidermidis was identified at the base of the eyelashes in those with papulo pustular rosacea.
We also know that those with rosacea have increased levels of inflammatory proteins, cathelicidins, in their skin and that these contribute to the redness, capillaries and bumps that are present.
At this stage, there is no permanent cure. Some over-the-counter products may help in managing milder symptoms, however prescription medication will be needed for more severe cases, such as oral antibiotics, oral acne drugs and topical gels or creams.
Intense Pulse Light (IPL) and Broadband Light (BBL) are also available to improve the redness and capillaries.
Anyone who has rosacea needs to have a good skin care routine as part of their treatment plan to ensure they are calming, rather than flaring up, their rosacea.
If you have rosacea, avoid trigger factors and find the right products for you. We know that applying some products, or too many products, can feel uncomfortable, however it is essential you have your rosacea correctly diagnosed and you take action to prevent it progressing further, particularly if it is not improving or responding to more simple measures.
Make sure you talk to your doctor or dermatologist to determine what stage of rosacea you have and ensure the right management of this condition.
Certain factors can trigger the rosacea blush and make symptoms worse, including extreme temperatures and changes in temperature, over-exposure to sunlight, pH changes in the skin, micro-organisms, emotional stress, exercise and physical stress, certain medications, alcohol, hot drinks, spicy foods and irritating skin care products and cosmetics.
The top 10 triggers are:
Some skin care ingredients also can cause flare-ups. A survey by the US National Rosacea Society found that the most common ingredients in skin care products causing irritation are: alcohol, Witch Hazel, Menthol, Peppermint, Eucalyptus Oil, Clove Oil and Salicylic Acid. Respondents also said they avoided astringents and exfoliants, as they were too harsh for their sensitive skin.
This raises the question for us as why so many skin care companies and aesthetic practices still recommend rosacea sufferers use products with alcohol, AHAs, BHA, Benzoyl Peroxide, essential oils, fragrance and Witch Hazel. Hydroquinone is another harsh ingredient that is best avoided, as it can inflame and burn rosacea skin.
Men should look at any shaving creams or gels they use to ensure they do not contain irritating ingredients, and they should steer clear of aftershave.
Look for skin care products that are gentle, non-irritating and contain antioxidants and botanicals that are soothing and anti-inflammatory. Tranexamic Acid and Azelaic Acid are two skin care ingredients that have scientific research behind them showing they can be helpful for rosacea skin, the latter being used in prescription topical medications.
Make sure you observe effective sun protection. Even though the causes of rosacea are not fully understood, cumulative sun damage plays a role and can cause flare-ups.
Visit our page on Sunscreen Ingredients to find out how to protect your skin from UV exposure and choose the right sunscreen.
If you would like more indepth information on caring for rosacea skin and a customised skin care routine, visit our Services page.