Last month, pharmaceutical company Galderma asked me to take part in a discussion about Rosacea hosted by Dr Ellie Cannon and journalist Sally Whittle in order to raise awareness of rosacea and to discuss treatment options.
Prior to attending, I decided to have a chat with some friends who suffer from rosacea to discuss how it affects them. I was surprised at their responses – some had been told by doctors that they suffered from acne (due to the papules and pustules that are symptomatic of a form of rosacea), others had been accused by friends of indulging in one too many drinks (the redness of skin that is common to rosacea sufferers mimics the appearance of alcohol abuse).
All felt their rosacea significantly impacted their confidence. And those were just the ones who knew their skin condition by name; a large proportion of rosacea sufferers are undiagnosed and left untreated. Those who were given advice by doctors tended to find it prohibitive – telling a busy 20-something girl to ‘avoid the sun’ is a nigh on impossible rule to follow.
The Galderma discussion centred on what is known about rosacea followed by a brain storm about which treatments and skincare might be effective in treating and managing the condition. I was, as you can probably imagine, a proponent of the holistic and longterm approach. Here’s a summary of all things rosacea, I do hope it helps some of you who might be suffering:
What is rosacea?
– Rosacea is a common chronic inflammatory skin condition that remits and relapses.
– Primary symptoms of rosacea are: persistent flushing (erythema), visible blood vessels and bumps and pimples (papules and pustules).
– Secondary symptoms that may be present include: a burning or stinging sensation, dry appearance of facial skin, skin thickening (particularly around the nose), and dry, itchy bloodshot eyes that are sensitive to light.
– These symptoms generally affect the central face (cheeks, chin nose and central forehead), though not everyone experiences all of them and they differ from person to person.
Vascular erythematotelangiectatic rosacea
– Most cases of rosacea can be divided into two subtypes based on symptoms: 1) ETR (vascular erythematotelangiectatic), symptoms of which include flushing for over ten minutes, redness and visible blood vessels; 2) Inflammatory papulopustular, symptoms of which include redness, papules, pustules and visible blood vessels.
Inflammatory papulopustular rosacea
– Additionally, there are two other types of rosacea that are less common: phymatous (which is characterised by thick skin, nodules, irregular skin surface or a type of nose enlargement called rhinophyma) and ocular rosacea (eyes will experience foreign body sensations, burning and stinging or dryness and itching).
Phymatous rosacea
What causes rosacea?
– The precise cause of rosacea remains unknown. Chronic inflammation appears to play a key role. Without knowing the cause, management focusses on either avoiding triggers through lifestyle or treating symptoms.
– Lifestyle factors that trigger rosacea flare-ups by causing blood vessels in the face to dilate include: sunlight, heat, stress, menopause, exercise, alcohol, cold weather and wind, caffeine, hot showers and spicy food. Food high in histamines (such as cheese, yoghurt, beer and pork) can also set off episodes of rosacea.
Who gets rosacea?
– The onset can occur at any age but symptoms most commonly emerge between 30 and 50 years of age.
– There is a female predominance (the ratio of female to male sufferers is about 2-3:1), though cases seem to be more serious in males.
– A typical patient is fair-skinned and of Northern European descent.
– Rosacea is estimated to affect one in ten in the UK.
How to treat rosacea //
– Treatment can be divided into ameliorating symptoms and avoidance of triggers. My thoughts on this is that managing rosacea is a more effective approach than slapping on product or taking antibiotics when symptoms flare up. Though good to have a treatment to fall back on when symptoms worsen, looking after skin daily and identifying and eliminating lifestyle triggers as much as possible is the most sound approach.
– Topically, doctors generally prescribe azelaic acid (a cream or gel that helps unblock pustules and papules and reduces inflammation – it is therefore ideal for treating inflammatory papulopustular), or metronidazole (an antibacterial cream or gel that reduces inflammation and redness though may make skin more photosensitive so, while it’s good at calming symptoms, may contribute to overall sensitivity and therefore rosacea).
– Orally, doctors often prescribe an anti-inflammatory dose of doxycycline (an antibiotic that treats the papules and pustules but not redness) or tetracycline (an antibiotic that’s particularly effective at treating ocular rosacea).
How to manage erythema //
– Lifestyle management is vital to minimising the redness and identifying what makes your rosacea flare up key. In many cases, SPF helps enormously – see below for recommendations.
– Doctors have sometimes prescribed beta-blockers for particularly bad erythema (though this approach is not without side-effects), but will now have the option of Galderma’s new rosacea treatment, brimonidine (the first licensed topical treatment of erythma).
– Cosmetics to camouflage redness are popular – see my list of products below for recommendations.
– Laser and light therapy can also be employed to treat erythema.
Products to try //
Skincare is important to rosacea sufferers for two reasons: to minimise adverse effects and to – hopefully – help reduce instances of flare ups. I asked my friends who have rosacea to test some products. Their favourites were:
– KALME skincare kit, £49.95 here. This kit includes an SPF25 moisturiser, a night moisturiser, water-free cleanser and tinted moisturiser to cover redness. The active ingredient in the range is taken from caper buds which have been proven in clinical trials to reduce redness. The products also contain anti-inflammatory liquorice and perilla seed, which is extremely high in moisturising and anti-inflammatory Omega 3.
– Coconut Oil. Rich in fatty acids, coconut oil is antibacterial (thanks to the lauric acid content), moisturising and soothing. Use it to cleanse, moisturise or cook with to help relieve rosacea. I use an organic one from GoNutrition.com, £9.99.
– Skin Repair Sensitive/Rosacea Kit, £59.98 here. This kit contains a moisturiser, cleanser and refreshing toner. The team at Skin Repair are focussed on repairing damage to the skin barrier and restoring equilibrium. My testers said that this kit did just that, helping to relieve itching and bring down redness as a result.
– Advanced Nutrition Programme Skin Omegas, £22 here. Supplements can be very effective in helping to combat symptoms of rosacea. Omegas particularly so, thanks to their anti-inflammatory and skin nourishing properties.
– Other products that have been recommended to me by rosacea sufferers: Jurlique Calendula Redness Rescue Serum, £36 here, Darphin Intral Redness Relief Serum (£53 here), S5 Nourish Cleanser, £32 here and Emma Hardie Amazing Face Cleanser, £36 here.
– Foundations and cover-ups that have been recommended to me by rosacea sufferers: Clinique Redness Solutions Make-Up SPF 15, £24 here, Vichy Dermablend Corrective Stick, £15 here and Smashbox Colour Corrector Primer, £25 here.
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