Rosacea Treatment- a Dermatologist’s Guide
In this article, our dermatologist Dr. Teo Wan Lin of TWL Specialist Skin & Laser Centre breaks down how skin specialists diagnose and treat skin redness.
Rosacea is a common skin disease that characterizes the tendency to blush or flush more easily than others. The redness can spread slowly between the nose and cheeks, to the chin and forehead. Even the ears, back and chest can be red all the time.
Dermatologist talks subtypes of rosacea
The following are the clinical subtypes a rosacea dermatologist will use to categorise the disease.
Redness, flushing, visible blood vessels
Redness, swelling, and acne-like breakouts
Thickened skin and a bumpy texture
Irritated, red eyes, swollen eyelids, may have what looks like a sty
Causes of rosacea
The exact cause of face redness is unknown. Redness can result from abnormal dilation of facial blood vessels, leading to constant inflammation that causes chronic swelling and skin thickening changes, also known as phymatous effects.
Demodex Mite Hypothesis
It is hypothesized that there is a role that demodex mite, a type of mite that lives on individuals’ skin, may play a role in the development of rosacea. Demodex folliculorum is a common commensal of healthy skin but overproliferation leads to eyelid inflammation and signs of ocular rosacea.
Immune System and H.Pylori in Rosacea
The immune system can affect the way the skin of rosacea patients reacts to a certain bacteria, known as Helicobacter pylori. Treatment to eradicate H. pylori such as metronidazole, also beneficially influence the clinical outcome of rosacea. Cathelicidin is a protein that is present on the skin to protect it from infections. However, this can cause redness and swelling in rosacea. Antimicrobial peptides (AMP) can bring out an exaggerated response of the innate immune system. In short, doxycycline, tetracyclines and azelaic acid can block this inflammation.
Treatment for Rosacea
There is no cure for rosacea, but with help from a rosacea dermatologist, you can successfully control it. While medicine or laser treatments can help to reduce symptoms of rosacea, your everyday lifestyle habits are important in treating rosacea and preventing flare-ups.
Currently, there are 5 topical agents approved by US FDA for use in rosacea, i.e. topical metronidazole, azelaic acid, sodium sulfacetamide-sulfur, brimonidine and most recently, topical ivermectin. For oral agents, only tetracyclines are US FDA approved. For individuals with mild to moderate rosacea, topical treatments with light and laser therapy may be sufficient. Moderate persistent or severe types of papulopustular rosacea may require oral medication. For all subtypes, cosmeceutical active ingredients mentioned below are helpful adjuncts, as they are anti-inflammatory. Aloe and polyphenols in skincare particularly help reduce inflammation in rosacea.
The Dr. TWL Girl Beauty Journal is used by Dr. Teo’s patients as a mindfulness exercise and to keep track of their skin improvement during the treatment journey. The journal’s paper is perfect for hands-on creativity with watercolour pencils. It contains perforated sheets of colouring pages for the perfect mindfulness activity during the day to relax.
For example, if emotions make your condition worse, consider documenting how you can replace the negative emotion with a positive one. This is a form of cognitive behavioural therapy, also known as cognitive reframing. Journalling is a form of mindfulness exercise that is proven to reduce stress levels, a known trigger for many skin diseases.
Here is a helpful checklist to help record your triggers before your trip to a rosacea dermatologist for treatment.
Finding your triggers:
To identify your triggers, start by taking a look at this list of common triggers. Do you think any of these could be causing your rosacea to flare up?
- School/work stress
- Feeling emotional
- Spicy foods
- Certain skincare or makeup products
- Wind and cold
- Certain medication
Once you have a good idea of what is causing your rosacea to flare, document common triggers in your daily life, and keep note of any rosacea symptoms when exposed to these triggers. Keeping track of these for a longer term can help you to pinpoint what exactly causes your flare ups.
- Sun protection: People who have rosacea often find that their skin is sensitive to the sun. To protect your skin from the sun, apply a broad spectrum sunscreen every day before going outdoors, avoid the midday sun, seek shade when outdoors, wear sun protective-clothing and sunglasses.
- Change your skincare routine: Many skin care products can irritate and worsen rosacea. Some skincare habits such as scrubbing the skin clean can cause rosacea to flare up. Use gentle cleansers such as the Miel Honey Cleanser, which has natural anti-microbial properties and leaves the skin barrier moisturised.
The right skincare routine that incorporates effective active ingredients can help to treat and manage the symptoms of rosacea. Now, we will go through the benefits of cosmeceuticals as treatment for rosacea. The right skincare routine that incorporates effective active ingredients can help to treat and manage the symptoms of rosacea. At Dr.TWL Dermaceuticals, we develop a range of cosmeceutical actives based on functional dermatology. Moving on, we’ll go through the benefits of cosmeceuticals as adjunct treatment for rosacea. Additionally, we will cover beneficial ingredients and ingredients to avoid and specific ingredients to look out for.
Cosmeceuticals for rosacea
Currently, the treatment for Rosacea patients by a rosacea dermatologist include pharmaceuticals. These aim at inflammation reduction, primarily with the use of topical and oral antibiotics. Therefore, the use of cosmeceuticals including cleansers, moisturizers, cosmetics, sunscreens, and anti-inflammatory botanicals is effective as adjuvant therapy in combination with traditional therapies.
Which active ingredients help in treatment for rosacea?
Adding active cosmeceutical agents to moisturizers can improve reduction of facial redness. Most of these ingredients are botanical anti-inflammatories that can reduce facial redness by interrupting the inflammatory cascade.
For example, Gingko Biloba contains terpenoids such as ginkgolides and bilobalides, flavinoids and flavonol glycosides. Research has shown that these active constituents decrease circulation, which reduces inflammation through antiradical effect.
Green tea, or Camellia Sinensis contains polyphenols that function as an antioxidant, helping to reduce UVB-induced inflammation in the skin.
The Vitá C Gold™ Serum contains camellia sinensis extract and nano-formulated, stabilized Vitamin C, making it suitable for inflammed, sensitive skin.
The Amino Acid 360 Masque is an anti-inflammatory gel mask with plant-based cosmeceutical actives to reduce facial redness. Rich in polyphenols such as Camellia Sinensis, it also contains aloe vera, which helps to reduce skin inflammation.
Aloe Vera contains many active constituents such as aloin, aloe emodin, aletinic acid, choline and choline salicylate. Research has shown that these help to reduce inflammation, decrease skin bacterial colonization and enhance wound healing. Therefore, cosmeceuticals that contain this ingredient can help to reduce and treat the symptoms of skin inflammation.
The Elixir-V Total Recovery Serum contains centella asiatica for acne scar lightening, potent oligopeptides for lifting and repair, and aloe vera extract for soothing and enhancing wound healing.
The Elixir-V Eyes is enriched with potent oligopeptides for lifting and repair, niacinamide for brightening, and aloe vera extract to soothe and heal the delicate skin under the eyes.
Allantoin is an extract from the comfrey plant and has healing and soothing properties. It is one of the oldest anti-inflammatory ingredient, added to many moisturizers and labeled as appropriate for use on sensitive skin. Allantoin’s main active constituent is a diureide of glyoxylic acid. In short, this works to enhance the water holding capacity of the extracellular matrix, improving barrier function as a result. Hence, allantoin is an effective active ingredient for the management of rosacea symptoms.
The Radiance Fluide Hydrating Emulsion is specially formulated for a light-weight feel to impart a radiant glow without make-up. It contains actives such as amino acids for repair, niacinamide for brightening, and allantoin as an anti-inflammatory.
How does facial cleansers as a cosmeceutical help in Rosacea?
Facial cleansing is important in patients with rosacea because rosacea represents a disease of the biofilm.
It is important for patients with rosacea to cleanse their faces thoroughly. This includes the removal of excess sebum, environmental debris, unwanted organisms and old skincare and cosmetic products while preserving the skin barrier. Skin barrier preservation is essential, because patients with rosacea form a subset of sensitive skin sufferers who experience adverse events after exposure to mild irritants or substances that produce noxious sensory stimuli.
The Miel Honey Cleanser is a gentle and effective cleanser as treatment for rosacea that stabilises the skin microbiome.
Cleansers are effective in removing lipids from the skin surface, however, surfactants cannot distinguish between sebum and intercellular lipids. Hence, as sebum is thoroughly removed, the intercellular lipids may also be damaged. As a result, barrier damage that manifests as increased facial redness, stinging, burning, and itching can occur. Selection of the right cleanser is very important in treating rosacea
How does color correcting cosmetics help in skin redness?
Color correcting concealers are useful for camouflaging the underlying redness in Rosacea patients by either blending colors or concealing the underlying skin to achieve a more desirable appearance. Since green is complementary to red, we can apply cosmeceuticals with a slight green tint can be to tone down the redness in the skin.
The base of our Dream Concealer color correction makeup primers are a peptide-enriched emulsion that is lightweight and instantly absorbed for skin healing.
What are some facial cosmeceuticals that may induce skin redness?
The following is a list of skincare active ingredients that may induce skin redness. Popular cosmeceutical ingredients that induce irritation include retinol, alpha-hydroxy acids, and beta-hydroxy acids. Additionally, creams and lotions containing alpha-hydroxy acids may help in the reduction of fine lines, irregular pigmentation and age spots. However, its side effects include skin irritation and sensitivity to the sun. Rosacea is a photosensitive disorder. If you suffer from any form of face redness, avoid these ingredients and consult a rosacea dermatologist.
Many over-the-counter “anti-aging” skincare products contains retinol, a derivative of vitamin A. It is proven to improve mottled pigmentation, fine lines and wrinkles, skin texture, skin tone and color. However, Retinol is known to cause irritation and excessive peeling and dryness.
Do you have rosacea? Dr. Teo Wan Lin is an accredited dermatologist treating rosacea in Singapore who specialises in the diagnosis and treatment of facial skin diseases. She is also the founder of cosmeceutical skincare line Dr.TWL Dermaceuticals, which develops evidence-based cosmeceutical actives for the adjunct treatment of rosacea.
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