Understanding Rosacea

It may not garner the same level of attention as other dermatologic issues like acne or eczema, but rosacea—an inflammatory skin condition that causes blemishes, facial redness, visible blood vessels, and sensitive, dry skin—is surprisingly common. In fact, it affects an estimated 16 million Americans, according to the National Rosacea Society. One reason it’s still somewhat under the radar? Most rosacea sufferers don’t even know they have it. The organization “found that 95 percent of rosacea patients had known little or nothing about its signs and symptoms prior to their diagnosis.”[1]

 Inflammation is the root cause

Previously thought to be an infectious disorder, rosacea has traditionally been treated with oral or topical antibiotics and other pharmaceuticals—medications that are often coupled with laser or intense-pulsed-light therapies that use heat to combat redness and shave down bumps[2]. But a growing number of studies showing rosacea to instead be a chronic inflammatory condition point to botanical oils and other natural ingredients as effective, gentler alternatives to the more aggressive therapies.

According to the AAD, “most people with acne-like rosacea react to a bacterium … called bacillus oleronius,” triggering a reaction that “causes their immune system to overreact.”[3] Indeed, according to an article appearing in the Journal of Clinical and Aesthetic Dermatology, some of the most effective agents in combating rosacea are those that offer anti-inflammatory properties.[4] Other researchers have published similar findings, reporting that the therapeutic efficacy of certain antibiotics in the treatment of rosacea have been attributed to anti-inflammatory antioxidant effects. [5]

All of which opens the door to the benefits of treating rosacea topically with botanical oils and other vitamins and compounds renowned for their anti-inflammatory properties. “Natural cosmeceutical options serve as an additional branch of the market available to rosacea patients,” notes a scientific journal report on managing the disorder.[6]” Natural ingredients reported in the literature that provide hydrating, anti-inflammatory properties capable of calming the manifestations of rosacea include colloidal oatmeal, niacinamide, feverfew, licorice, teas, coffeeberry, aloe vera, chamomile, turmeric, and mushroom extracts. Other vitamin-rich botanicals that work to fight inflammation include helichrysum, rose hip oil, grape seed oil and pomegranate seed oil.

The biggest trigger is sun exposure

Given that rosacea is a chronic inflammatory condition, “the goal of treatment should be to subside acute flares,” according to a study published in Clinical, Cosmetic and Investigational Dermatology.[7] The report further notes that avoiding “triggers, particularly ultraviolet light exposure, is critical for long-term improvement and disease control.”

In fact, although rosacea can also be precipitated by “hot or spicy food and drinks, alcohol, physical exercise, high temperature environments or abrupt changes of temperature,”[8] the number one trigger for rosacea is sun exposure. UVA rays aggravate the ruddiness associated with rosacea, which means preventing sun damage is critical; hats and the regular use of sunscreen are mandatory. Further, it’s imperative to choose a non-nano, zinc-oxide-based sunscreen. In addition to acting as an anti-inflammatory, zinc oxide remains on the surface of the skin, reflecting UVA rays. Chemical sunscreens, by contrast, absorb radiation, thus exacerbating inflammation.

Exfoliation can help—so long as it’s gentle

Then there’s the issue of exfoliation. While regular sloughing of the skin improves its health, tone and all-over appearance by unclogging pores and removing dead skin cells—thereby aiding the absorption of moisturizing products, preventing breakouts, shrinking pores and mitigating the appearance of wrinkles—harsh scrubs can also erode the skin’s protective barrier. Such erosion, naturally, aggravates rosacea; research shows that rosacea “patients tend to be more sensitive to topical treatments and may experience skin irritation with use.”[9]

Those with rosacea (and sensitive skin in general) should instead seek out exfoliators containing alpha hydroxy acids (AHA) such as lactic acid. According to a study in the Journal of Clinical and Aesthetic Dermatology, alpha hydroxy acids are ideal because they resurface skin, improving texture and tone, without causing irritation.[10] This last part is crucial: any irritation is a sign that your skin barrier is weakened, and researchers note that rosacea “symptoms improve when the skin barrier is strengthened.”[11] 

Its impact is more than just physical

Left untreated, rosacea tends to worsen with time and can result in permanent redness and even bumpy and thickened skin. Not to mention that rosacea’s effects extend well beyond the skin’s surface, exacting a psychological toll that transcends its physical impact. National Rosacea Society research reveals that more than 90 percent of rosacea sufferers report that “their condition had lowered their self-confidence and self-esteem, and 41 percent reported that it had caused them to avoid public contact or cancel social engagements. Among rosacea patients with severe symptoms, 88 percent said the disorder had adversely affected their professional interactions, and 51 percent said they had even missed work because of their condition.”[1] As Dr. Lisa Stein Gold noted when interviewed for an article on rosacea, “When people walk around with papules and pustules, [other] people think there is something wrong with them.”[2]

Quality of life is no small matter, and rosacea sufferers should explore all options. But if encouragement to look beyond pharmaceutical, heat and other medical treatment is needed, just consider, for example, that the most common adverse side effects of oxymetazoline—approved last year by the FDA as a topical treatment that reduces redness in the face by constricting blood vessels—include dermatitis, pruritus (severe itching) and headaches.[3]

Dealing with rosacea is hard enough; having to contend with uncomfortable and even harmful side effects as well only aggravates the situation. Instead, look to natural, antioxidant-rich products to control rosacea. Your skin will thank you.

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[1] National Rosacea Society

[2] Dermatology News: Rosacea responds well to laser, IPL therapies

[3] American Academy of Dermatology

[4] The Journal of Clinical and Aesthetic Dermatology: Rosacea, Reactive Oxygen Species, and Azelaic Acid

[5] Journal of Pharmacy and Pharmacology: Scavenging properties of metronidazole on free oxygen radicals in a skin lipid model system

[6] Clinical, Cosmetic and Investigational Dermatology: Update on the management of rosacea

[7] Clinical, Cosmetic and Investigational Dermatology: Update on the management of rosacea

[8] Brazilian Society of Dermatology: Skin barrier in rosacea

[9] Clinical, Cosmetic and Investigational Dermatology: New developments in the treatment of rosacea

[10] The Journal of Clinical and Aesthetic Dermatology: The Tolerability and Efficacy of a Three-product Anti-aging Treatment Regimen in Subjects with Moderate-to-severe Photodamage

[11] International Journal of Women’s Dermatology: The effect of probiotics on immune regulation, acne, and photoaging

[12] Brazilian Society of Dermatology: Skin barrier in rosacea