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Rosacea: Skincare and Treatments That Work! | Dr Sam Bunting

Are you one of the ten percent who’s prone to a long blush or even a flush, or are you getting spots here that are different to acne type spots or maybe you’re someone who’s got skin? That just looks red all the time and it’s super sensitive, especially to skin care. Well, you might have rosacea now april is rosacea awareness month. So today i wanted to go deep in this common and distressing condition. So you have all the information you need to determine if you’ve got it, how to treat it, how to choose skin care and what not to do now, i’m speaking as somebody who’s prone to rosacea myself, it kicked in around the age of 30.

I suddenly noticed that a glass of red wine, my favorite, made me redder for longer than all my friends. I don’t want any photographs taken after a certain time in the evening um. I didn’t really tend to get spottiness as such and i was definitely sensitive to ill-chosen skin care choices um. So i would have to be very careful about what i used on my skin um. So if any of that resonates with you, then do keep watching, because we’re going to go into this in a bit more detail.

But the good news is there’s loads. That can be done with the right choices of skin care, with finding the right treatment to manage your type of rosacea. But the key in the first instance is to know what kind of rosacea you have. So, let’s get into that. So there are four different types of rosacea now, the one that we all know commonly, i think, is the papulo pustulotype, which is often mislabeled as acne rosacea, because of the presence of spots, red bumps and red bumps with white heads of papules and pustules.

But there are some key differences to distinguish rosacea from acne. The time acne is really a misnomer. So the key thing really is that there are no comedones as part of the rosacea process. Now, what can be confusing is that people rosacea can sometimes be also prone to acne, but the distribution tends to be different, so typically with rosacea we’re talking about mid-face disease and the spots themselves have a different quality they’re. What we call dome shape, so the tops are rounded where acne spots tend to be more prone to pointing so that’s really key.

So no comedones and any sort of different shape lesions in a different distribution. Adult acne is typically in the: u of the face. Teen acne in the t zone, so that’s type 2, rosacea now type 1 is what we call erythema telangiectatic rosacea. So that’s a bit of a mouthful, but basically it means redness and broken vessels. So that’s someone who probably doesn’t get the spotty aspect, but it’s just constantly a bit red on the cheeks or the nose and when you peer closely we’ll have little broken vessels broken capillaries and they have this pronounced flushing.

Then the third type is phymatus rosacea, where basically the ongoing inflammatory process, activates fibrosis and thickening of the skin – and that’s typically seen over the nose something we call rhinophyma. Now it’s rare and it’s more common in men, but it is an important type to recognize. We want to really prevent that type of rosacea and then the final type is ocular rosacea, so rosacea’s disorder that can affect the eyes and the eyelids. So you tend to see reddening and injection along the lid margins and it can occur with conditions like blepharitis as well, but someone will typically describe their eyes as being dry gritty, um, a feeling of discomfort and that’s a common manifestation of rosacea. It’S one.

That’S often missed now, one of the hallmarks of rosacea, aside from those physical findings, is the description of discomfort of the skin, so burning and stinging, especially in association with skin care, and we know that people with rosacea are prone to barrier dysfunction. So this is something that practically can really cause problems: difficulty using skin care products, finding a suitable, sunscreen everything burning or stinging when applied to the skin. Now that is a big and common trigger, especially for women, but additional triggers exist as well, and it really is important to get to know your rosacea and know what your triggers are for some people, winter cold, weather low humidity, will be a real aggravate um. We know we’ve already got barrier dysfunction, but that low humidity, cold air chafing with winds and things can really make the skin even drier and more sensitive. On the other hand, there’s a group where sunshine and uv is a big part of it, and we know that uv is probably a big part in the whole ideology of rosacea.

It tends to happen in fair-skinned individuals, as we said, but summer can be particularly troublesome and you factor in sunscreen problems. It can often get really quite stressful, as i mentioned before. What you consume can have a big impact. So for me, as i said, red wine and that’s common because red wine – not only um – is a vasodilator from the point of view of having alcohol in it. But it’s also histamine releasing which can be a double whammy for redness prone skin.

But all types of alcohol can make the skin more prone to flushing, as can spicy foods. Hot caffeinated beverages so really be conscious of what you’re eating and how that plays into where your skin behaves. Other things to think about is environmental things, so you know i tend not to recommend saunas to my patients. We have a disorder, that’s characterized by broken vessels by vessels opening up in response to the environment and staying open for longer. We don’t want to promote that by going into a hot environment for long periods of time.

Similarly be conscious of your room temperature where you’re working, you might well find that a cooler room suits you better. It certainly does for me. So why does rosacea happen in the first place? There’S lots of different theories, and it’s not fully yet understood, but the main philosophy that we adopt nowadays is the understanding of the innate inflammatory system in the skin and how it goes wrong and causing rosacea. So it’s thought to be uv triggered, as i mentioned, but in those who are genetically predisposed and what the key finding is is the presence of something called catholicidine, which is an inflammatory mediator that we’re seeing in the skin in response to environmental stressors like sunshine.

And it’s abnormally processed in rosacea, and it tends to cause a whole cascade of inflammatory mediators that are released into the skin that attracts something called neutrophils, which are a type of white blood cell that really kickstarts the whole process, leading to ongoing inflammation. That leads to these changes involving the tissues, both in terms of the dermis and its structure and the blood vessels. So the innate immune system is there to protect us, but it’s overly sensitive when you have rosacea. So i’ve always likened it to the smoke alarm going off whenever the kettle boils, rather than when the oven is on fire. So it’s misbehaving and the the red alert is going off too soon.

So when it comes to managing rosacea, i think it’s very important to look at your approach to your skin holistically. So it’s not just about what you use in terms of the treatment elements. It’S about the skin care approach that you adopt too, and there are some important steps i think that are worth considering so with rosacea. The most important thing is simplicity. Now i know that simplicity is something i’m i’m an advocate of.

You know in in all situations really, but never more so than in rosacea, so i think that we know that biodysfunction is a big part of what goes wrong with the skin. So it’s really important that what you do does not additionally deplete the skin barrier. So the first thing to look at is your cleansing. No double cleansing, keep it gentle non-foaming. I tend to recommend non-clogging as well, stick to a single cleanse and use tepid, not hot water, and when you’re patting your skin dye do so very gently.

It’S really important that you do no harm with your cleanse, then, as part of a barrier repair approach seek out a moisturizer that offers that so not just something with humectants hyaluronic acid. Really won’t. Do you much good when it comes to rosacea, you want nice occlusives. You want barrier repair ingredients like ceramides and niacinamide if your skin can tolerate it to help really ensure that barrier stays nice and robust sunscreen with rosacea is really important to give you that uv protection, and actually it’s amazing, how patients really do start to appreciate how Important daily sunscreen is all year round with their skin, but i find that the best tolerated sunscreens are those that are all minerals, so containing zinc, oxide and titanium dioxide to give broad spectrum cover, but nice gentle filters that won’t tend to irritate skin. Now.

Moving on to treatments for rosacea, so i think it’s really important to make sure that that’s what you’ve got in the first instance, i mean. Usually it’s pretty straightforward. If you’ve got the symptoms and the signs that i’ve described, but if you’re in any doubt do go and see your doctor get referred to a dermatologist to be sure, that’s what you have and then really you will find that prescription creams do work best when it Comes to managing rosacea, at least in the first instance, i think it’s relatively rare, particularly with the papillary posterior type you’ll, get a handle on it with just over-the-counter products, so things that might get used in the first instance. Um antibiotics such as metronidazole and that comes in the form of metro, gel or rosex cream. I have to say that i’ve moved away from using this as much in my practice, but it’s still one of the standard treatments that um that you’ll find being used.

Additional treatments might include sulantra or ivamectin, which targets the might in the skin demodex, possibly due to the effect against demidex mites, but possibly just due to an anti-inflammatory effect on the skin. As we see with antibiotics, it’s really not about targeting a bacteria. As far as we can see it’s about the anti-inflammatory effects that these products have on the skin, hence the benefits of azelaic acid, which is not targeting a particular organism. It’S targeting this innate immune system malfunction. So those are the three that tend to be used in context of acutely active rosacea.

Now, if the skin is particularly active and usually again we’re talking about the papillary pasteurity, we’ll use oral tetracyclines now again we’re using them for their anti-inflammatory effect, tetracyclines lower the activity of matrix metallic proteinase enzymes in the skin, which are part and parcel of what generates This inflammatory amelia with increased catholicism, abnormal processing of catalyst in the skin, so we can use them at lower doses than we would when we’re trying to treat bacterial infections, which is good news, because any treatment for rosacea is likely to be needed for at least six. If not 12 weeks, and sometimes beyond that, sometimes we need to keep people on long-term therapy. It’S a disease, that’s chronic tends to relapse and remit and for some people it just plods on and needs ongoing treatment. But you know we’re seeing a condition here where we’re using drugs that have antibacterial properties but also anti-inflammatory properties, and i have to say that the best result tends to be when you combine topicals and normals together. There’S a synergy that comes into play and i find myself using a lot of cilantro in the acute phase and then i’ll often phase azoleic acid in when things are a bit calmer with tetracyclines.

In the background now in difficult cases, we do sometimes use low-dose, isotretinoin, raccotine or accutane, depending on where you are in the world, and we also use alpha blocker drugs for somebody who’s particularly prone to flushing its causing issues. So those are other treatments that we do sometimes use, but the mainstay of rosacea treatment are those topicals i mentioned plus or minus tetracyclines, which can be used sporadically when needed, and i find that for many patients, that’s a successful toolkit for managing rosacea. Now, when it comes to skin care don’ts, i think it’s important to be cautious when using anything outside of the list i mentioned before so things, i would actively discourage you using because i think they just potentially cause too many problems and offer a little upside. So i think double cleansing is a no-no. I think pretty much.

All toners are of little to no benefit and quite likely to cause problems. Almost all face masks will be problematic. Very few masks are formulated to redness prone skin. I think, in a way, that’s useful in addition to those topicals that we mentioned, that are much more important when it comes to regulating your skin physical exfoliants. I think, for obvious reasons, are a no-no chemical sunscreens, i would advocate using with caution.

My experience is that all mineral sunscreens are infinitely more comfortable and easy to use, and if you use a tinted one, you have the added benefit of a little bit of redness masking and then as far as treatments. I really would encourage caution um when it comes to facials and redness. Really. The principles of managing rosacea are about consistent, daily use of the right skin care and topicals, and i think that the concept of a facial once a month, every six weeks really has little benefit to offer and is much more likely to cause flares. So i don’t think facials are particularly good idea in this instance.

So in conclusion, i’d say that rosacea can be tricky to manage and i definitely think that, if you’re just starting out on your rosacea journey, you think you’ve got that as a problem with your skin. But you’re not sure it really is invaluable to go and get some professional guidance on this, both in terms of getting it under control with the right topicals um in the short term, but also you know a longer term plan you’re likely to need a longer term Maintenance schedule to keep your skin well controlled, but i have to say that, with my rosacea patients, they’re often pleasantly surprised by how easily it we get their skin under control, but also how we’re then able to evolve their skin care routine into the realms of treating Premature aging and i’ll get into that in next week’s video, because i think it’s an important topic to cover um, but i think don’t be despondent. I think there are lots of great options now in terms of treating it getting it under control. I can speak from first hand that my skin is a lot easier to manage now that i’m on a regimented and simple effective, skincare routine. So if you have rosacea, you know someone who has rosacea, please feel free to share this video.

If you found it helpful. Um come back next week to dive into rosacea treatment and beyond and i’ll see you guys again soon bye for now.

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