Rosacea 101

 

 

Although it is not within my scope of practice as an aesthetician to diagnose any skin condition, here is some in-depth, clinical information regarding the diagnosis, treatment and management of the common skin condition of Rosacea. This affects more than 16 million Americans annually. If you think you have Rosacea, see your Dermatologist for a proper diagnosis, and then, see your aesthetician for a customized skincare regimen to meet your skin’s unique needs!

 

What is it? How is it diagnosed?

 

Primary features:

  • Flushing
  • Persistent redness of facial skin (known as erythema)
  • Dome shaped papules with or without pustules; nodules may also occur (medical lingo for pimples)
  • Telangiectasia (Visible broken capillaries on the surface of the skin)

 

Secondary Features:

  • Burning or stinging with or without scaling or dermatitis (inflammation of the skin)
  • Elevated plaques (a broad, raised area on the skin)
  • Dry appearance that may be rough or scaling
  • Soft or hard edema (swelling)
  • Manifestations in the eye which may include burning, itching, hyperemia, inflammation, styes, chalazia, and/or corneal damage
  • Peripheral location (located somewhere other than the face)
  • Phymatous changes (affecting sebaceous or oil glands)- possibly including patulous follicles, skin thickening or fibrosis, and bulbous appearance- this most commonly affects the nose giving the nose a very large and often cauliflower appearance.

 

Subtypes and Stages:

 

Stage/Subtype 1: Erythematotelangiectatic Rosacea

 

Flushing, persistent erythema with or without telangiectasia, edema, stinging, or roughness

 

Stage/Subtype 2: Papulopustular Rosacea

            Persistent erythema, papules, pustules and burning/stinging

 

Stage/Subtype 3: Phymatous Rosacea

            Thickening skin, Irregular nodularities, and enlargement (Bulbous appearance of nose most common in this stage)

 

Stage/Subtype 4: Ocular Rosacea

            Foreign body sensation in the eye, burning/stinging, dryness, itching, photosensitivity and blurred vision.

 

Is it Acne or Rosacea?

 

Acne is seen most commonly in teens, while rosacea occurs most commonly in persons between 30 and 60 years of age. In acne, blackheads are generally present, and papules and pustules on extra facial locations such as the chest, back and arms are more common. Only a dermatologist can know for sure.

 

Treatment and Management:

 

  • Prescriptions -oral and topical therapy to bring the condition under control, followed by long-term use of the topical or oral rosacea therapy alone to maintain remission. See Table 1 below.
  • Light devices including nonablative lasers and intense pulsed light or IPL to address telangiectasia and erythema
  • Lifestyle Modifications- Limiting sun exposure, exposure to temperature extremes as well as extremes in dryness and humidity, limiting exposure to wind, limiting heavy exercise and alcohol consumption.
  • Appropriate Skin Care: (This is MY department!)

 

Rosacea skin is often also oily skin. The tendency to treat the irritated skin with products that are very emollient such as thick creams and milky cleansers can actually worsen the papules associated with Rosacea. I recommend a gentle rose water toner to cleanse the skin in the morning, and in the evening using a gentle gel cleanser with a mild AHA exfoliant and cleansing with cool water and a soft cloth (nothing abrasive). My favorite cleanser is Simply Clean by Skin Ceuticals. Cleanse with Lukewarm water and dry the skin thoroughly before applying topical medications- wait 5 to 10 minutes before applying moisturizer and sunscreen.

To exfoliate the skin, never use anything with “scrub” in the title. No micro beads, no apricot seeds, nothing! Use only gentle enzymes such as papain from papaya, AHA, BHA, lactic acid or a glycolic acid peel with a higher pH to reduce irritation and burning.

 

Salicylic acid is Rosacea skin’s best friend. The tiny molecules found in this BHA can easily penetrate at the epidermal junction and exfoliate dead skin cells commonly found in the rough and scaly patches of the skin. Salicylic Acid also helps clear skin pores of demodex folliculorum, a skin mite commonly found in skin pores but that causes excessive inflammation in rosacea patients if they penetrate into underlying skin layers. Further, Rosacea skin needs to receive more oxygen to promote healing- one of my favorite products is the Blemish and Age Control Serum by SkinCeuticals with the PhytoCorrective Gel on top in the evening. This makes a huge difference in the overall appearance of the skin. Another secret? The Advanced Pigment Corrector by SkinCeuticals contains a high concentration of Salicylic Acid-used in the evening the patient will notice a huge improvement in the overall appearance of the skin.

Use a moisturizer that is for combination skin. As I said before, it’s easy to fall into the trap of wanting to soothe the skin with thick, cooling creams but this can actually make the problem worse. Souffle Marin by Phytomer  is the perfect moisturizer options for Rosacea skin- it was designed for oxygen deprived skin (think smoker’s) to improve micro-circulation, but I have had a lot of success with it on my Rosacea patients.

 

Treat the skin twice per week with a barrier mask in the evening- the Bio Cellulose Mask from SkinCeuticals is a water-based mask that coats the skin for 48 hours so that it can’t re-epithelialize. The benefit of this is increased barrier function for the acid mantle of the skin- barrier function is something that is frequently compromised in rosacea skin.

 

 

An Oral and Topical Medication Guide- Table 1

 

Medication:     Trade Name:     Delivery Route:            Description:

Doxycycline               Oracea          Oral                 For papules & pustules

Ivermectin                 Soolantra        Topical            For inflammatory lesions

Brimonidine               Mirvaso          Topical            For facial eryethema

Azelaic acid                Finacea           Topical            Papules and pustules

Metronidazole           Metro-gel       Topical            For lesions

Sulfur formulations                          Topical            For lesions

 

 

 

Resources:

 

  1. Consultant Magazine; October 2016, Vol. 56 No. 10, John E Wolf Jr, MD, MA Rosacea: Diagnosis and Management of a Complex and Signifigant Disorder
  2. Granulomatous rosacea-like demodicidosis Dermatology Online Journal; 2007 study by Julia Yu-Yun Lee, MD and Chao-Kai Hsu, MD
  3. Images taken from http://www.rosacea.org

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