HOW TO MANAGE ROSACEA


The global Rosacea Consensus Panel recommends “general skincare” as a fundamental management strategy for rosacea and it consists of the holy trinity:

1) Sun protection 
2) Gentle skincare 
3) Trigger avoidance (see my previous post on Rosacea Triggers)

SUN PROTECTION – SUN PROTECTION – SUN PROTECTION
Exposure to sun is believed to be both an initiating and aggravating factor of rosacea ☀
And there seems to be a dose-response correlation between sun exposure and rosacea severity:

The severity of the erythemato-telangiectatic subtype correlates with the degree of sun exposure. In other words, the more you’re exposed to the sun, the worse your rosacea gets. 


UV light sparks inflammation and oxidative stress leading to defects in the tiny blood and lymph vessels in the skin, which is what we see as telangiectasias (also called thread veins), chronic redness and the swollen skin.


I prefer to wear a hat as much as possible, stay in the shadow and use inorganic sunscreens (aka physical filters), SPF 50+ with a tint to knock back my chronic redness 😎

What’s your preferred sun protection? 

REFERENCES: 
1) Schaller et al. “Rosacea treatment update: recommendations from the
global ROSacea COnsensus (ROSCO) panel” Br J Dermatol 2017; 176:465–471 
DOI 10.1111/bjd.15173

Rosacea triggers

The mechanisms behind what triggers the development of rosacea are still poorly understood, however an unfavorable inflammatory immune response to the demodex mite (normally present in our skin) is considered to play a key role.

However, when rosacea is first present in the skin certain triggers can worsen the symptoms.


FLUSHING 
Specific triggers (see below) can lead to rosacea flushing, which is a transitory intensification of the redness, due to dilation of the tiny vessels in the skin, with a simultaneous burning and stinging sensation.
An episode of flushing can last from minutes to hours, be painful and leave the skin sore.

I’ve divided potential triggers into external and internal triggers.
What triggers flushing is different to each individual. And identifying them can be a lifelong quest.


EXTERNAL TRIGGERS
Sun exposure (UV light)
Alcohol
Hot beverages
Spicy foods
Tobacco
Certain skincare ingredients Friction on the skin (cleansing, applying products)
Season changes (especially summer/winter)
Heat, cold, wind

INTERNAL TRIGGERS
Physical activity 
Emotional stress (excitement, discomfort) 

What are your triggers and how do you manage your flushings?

REFERENCES:
1) et al. (2018). Rosacea Triggers: Alcohol and Smoking. Dermatologic Clinics, 36(2), 123-126. DOI 10.1016/j.det.2017.11.007
2) Tan et al. Updating rosacea diagnosis to improve treatment strategy: Recommendations from the Global ROSacea COnsensus (ROSCO) panel. (2017). Journal of the American Academy of Dermatology, 76(6), AB275-AB275. 
DOI 10.1111/bjd.15122

Rosacea

Rosacea is a common chronic inflammatory skin condition affecting the face primarily cheeks, nose, chin, central forehead and includes eye symptoms. It’s believed to be highly under-diagnosed, as mild to moderate cases can go on untreated without consulting a doctor.

SYMPTOMS 
It’s characterized by redness, flushing, inflammatory papules and pustules, telangiectasia (dilated blood vessels) and phymatous changes (thickening of the nose). Read more about subtypes here.

The clinical features of rosacea subtypes

SENSITIVE SKIN
People with rosacea often have inherently compromised skin barrier with increased transepidermal water loss and decreased epidermal hydration leading to dryness and sensitive skin. 


IN NUMBERS
5.46% of adults are estimated to suffer from rosacea. Women & men are affected equally (contrary to previous knowledge). Typical onset age 30 to 65. Fair skinned people and familial disposition are more likely to get rosacea.

CAUSES
The exact pathogenesis of rosacea is still unclear, however we know:
Microorganisms, like the skin mite Demodex folliculorum and staphylococcus epidermidis, may contribute to development of rosacea by stimulating the innate immune system driving the inflammatory response causing the papules and pustules.
Neurogenic dysregulation of the vessels in the skin may contribute to rosacea symptoms such as flushing and burning.
Genetic heredity also plays a role.

Triggers initiating a cascade of inflammation in rosacea skin around the hair follicle
The inflammation around a hair follicle creating the papules and pustules

REFERENCES: 
Gether. L et al. Incidence and Prevalence of Rosacea: a systematic review and meta-analysis. Br. J. Dermatol 2018 DOI: 10.1111/bjd.16481

Two AM et al: Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 72(5):749-58 DOI: 10.1016/j.jaad.2014.08.028

Gallo RL, Granstein RD, Kang S et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018; 78:148–55.