Rosacea is more than just redness, and it's not the easiest of skin conditions to treat. In fact, it can be pretty frustrating, which is why we called on three different skin-care experts to share their insights on the skin condition, as well as their top tips for how to manage your rosacea flare-ups for a calmer, healthier complexion.
What is Rosacea?
"Rosacea is a vascular inflammatory skin disorder," said facialist Kate Kerr. "It's an oily skin condition where the sebaceous glands are overproducing oil and produce inflammation."
According to Mervyn Patterson, cosmetic doctor at Woodford Medical in Essex, "rosacea ranges from acne-like spots through to facial redness and veins. Some people have both the spots and the redness."
There are degrees of severity, Dr. Patterson adds. "In the initial phases of the condition, there may just be some slight elevation of facial color," he said. "Many sufferers are completely unaware they have the condition; they just accept that they are prone to having a high cheek color or that they blush and flush easily. Others may actually be told by their opticians when they go to get relief from their red eyes. Blepharitis, an inflammation of the edge of the eyelids, is very common in rosacea and may be present in a majority of rosacea cases."
What Are the Symptoms of Rosacea?
Dr. Patterson says the symptoms people with rosacea typically experience include intermittent-to-persistent flushing, bumps and pimples, visible blood vessels, moderate-to-extreme sensitivity, and atrophy of the skin. Other less common symptoms include raised red patches, scaly skin, swelling, eye problems, and enlargement of the nose.
Simran Deo, a GP with a special interest in dermatology at UK-based online doctor Zava UK, notes that "rosacea affects around two to 10 percent of the population," adding that rosacea is "classified according to different phenotypes or facial appearance. The diagnosis is based on how many of these major or minor phenotypes you have."
The major phenotypes, or facial appearances, that lead to a diagnosis of rosacea are, according to Dr. Deo: an area of defined redness over the central region of the face (which may worsen after certain triggers), and phymatous changes (i.e. thickened skin with enlarged pores and irregular surface, predominantly occurring on the nose).
Or, the patient can exhibit two of the following phenotypes: papules (smooth dome-shaped raised lesions) and pustules (pus-filled spots), flushing of the face, thread veins on the cheeks, chin, and forehead, ocular rosacea (which is where symptoms include a persistent itchy or gritty sensation in the eyes), inflammation of the eyelids, and/or redness of the eyes and the skin around them.
What Causes Rosacea?
Rosacea is a "genetic predisposition that makes the skin and the external skin barrier more vulnerable to elements entering," said Dr. Patterson. But beyond that, Dr. Deo notes that the exact causes of rosacea are not well understood. "It is understood to be multifactorial with flares due to triggers such as stress and alcohol, and it is thought to have an autoimmune element with the immune system causing an inflammatory response in the skin."
What Triggers Rosacea Symptoms?
Triggers vary from person to person and can include — but are not limited to — sun exposure, exposure to extremes of temperature, stress, alcohol, smoking, spicy foods, caffeine, and chocolate.
Are Certain People Prone to Rosacea?
According to all three experts, rosacea affects people with pale skin. "They say it's the curse of the Celts," said Kerr, although it can affect anyone with pale skin. Dr. Patterson added,"Individuals with very pale skin types tend to have poorer barrier function as well as increased sensitivity to UV rays. This means that external elements penetrate the skin more easily triggering chronic inflammation, which in turn leads to the formation of more new blood vessels. A recurring cycle of inflammation, poor barrier function, and ever-increasing redness can then ensue."
Rosacea also mostly affects women and typically starts between the ages of 30 and 60 years (but not always), said Dr. Deo. "Although less prevalent, when it does occur in men, it is much more severe."
Can Rosacea be Cured?
Like other skin conditions including acne, eczema, and psoriasis, rosacea can't be cured — but it can be managed. "Be sure to take care to avoid triggers that can cause a flare," said Dr. Patterson. "To help control and prevent rosacea progression, focus on topical products that optimize the structure and function of the skin barrier while reversing chronic inflammation, said Dr. Patterson, who suggests recommends Epionce products, a line that he stocks at his clinic.
"It's a matter of controlling oil, using medical-grade skin care, and having regular treatments with clinical facialists," said Kerr, adding that even a Roaccutane prescription can sometimes help but won't cure you for good. "It can get worse as you get older, so it's really important to control it. Even if you have mild symptoms when you're young, I would recommend starting treatment then to prevent the exacerbation of it."
What Treatments are Known to Help Rosacea?
When it comes to rosacea treatments, it's worth going to a dermatologist or aesthetician who can recommend the ideal treatment plan for your skin. But, as a rule, Patterson notes that "some laser, IPL, and LED treatments can help," which should be left to a professional to administer.
Dr. Deo explains that certain prescribed topical creams can "reduce redness or kill surface bacteria," while oral antibiotics can reduce inflammation for the most serious cases. "Isotretinoin capsules require a prescription from a consultant dermatologist, and is only prescribed for very severe cases when there has been no improvement with all other treatments."
What Skin-Care Ingredients and Products Should be Used and Avoided?
Since sun exposure is a trigger, SPF 50 is a must all day, every day. "Look for one that protects cells against HEV light, too, and be strict with it. You need to apply it every morning," said Kerr. We love SkinCeuticals Physical Fusion UV Defense SPF 50 ($35).
Rosacea can lead to a compromised skin barrier, so you want to factor a barrier cream into your routine after cleansing, and look to anti-inflammatory products, too. Dr. Patterson suggests Epionce Medical Barrier Cream ($48), and Epionce Lite Lytic TX ($56), which takes down inflammation in more congested rosacea flare-ups.
"Since rosacea is an oily-skin condition, try to remove any oil from your skin care and makeup choices," said Kerr. "A lot of skin-care brands treat by soothing and calming the skin, but it's actually really important to control oil, stimulate cell turnover, and force the skin to work for itself to repair. We use a lot of salicylic acid in our treatments, which not only helps to control oil but also helps kill bacteria and inhibit inflammation."
Can Lifestyle Changes Help Rosacea Sufferers?
In the winter, "dipping in and out of hot and cold temperatures can cause redness and rosacea, as it causes the capillaries to dilate," said Kerr. "If you're susceptible, cover your face as much as you can with scarves wrapped right up round your nose." Similarly, you should avoid heat treatments like saunas, steam rooms, and anything that can compromise a delicate skin barrier like microdermabrasion.
Dr. Deo suggests factoring in self-help treatments — like meditation and other relaxation techniques — to reduce stress. Changing the type of exercise you do to something that's low impact, like walking and yoga, may also improve your symptoms, as high-impact exercise for long periods of time can be known trigger of rosacea. Avoidance of alcohol and smoking can help improve symptoms, too. "Try to learn what works for you," said Dr. Deo. "Everyone will react slightly differently, so, unfortunately, it's all about trial and error. It is useful to keep a diary to identify when and why your symptoms are getting worse, so you know what activities or foods may not be working for you."