Although I didn’t set out to become something of a rosacea expert over the years I’ve acquired an increasingly large group of patients who I’ve treated – and continue to treat – with this condition. Men and women. And most come to see me through recommendations following treatment success stories which is always very rewarding. As a consequence, and as this condition is something that needs to be managed ongoing – sadly it can’t be eradicated – I’ve develop a flow chart programme to help treat rosacea so the condition can be managed and patients can happily get on with their lives.
So although there is no cure there are lots of positives to focus on! And permanent remission is possible.
WHAT CAUSES IT?
We don’t really know. You inherit a genetic predisposition to getting the condition (pale Celtic skin for instance) but why then does everyone not get it in a family? Like all diseases there has to be other factors that come into play – a bit like the perfect storm. One of these is undoubtedly hormone imbalances. I have a huge group of women who have developed rosacea during or after pregnancy which proves this theory. Stress is a factor and we all know that stress sends our hormones all over the place.
WHAT DOES IT LOOK LIKE?
This is why it is so difficult to diagnose as this varies considerably.
- Facial flushing. Especially on the cheeks and nose.
- Small red blood vessels. Especially on the cheeks and nose
- Papules or little white and red bumps which are often mistaken for acne.
- Watery irritated eyes.
- Enlarged shiny and uneven nose.
WHAT ARE THE TRIGGER FACTORS?
These differ from person to person. Common ones are:-
- Sun exposure
- Extremes of temperature, humidity, wind, cold, going from a cold environment outside to a centrally heated house. Hot baths.
WHAT IS IT?
Essentially rosacea is chronic inflammation which results in the signs of redness, bumps, broken blood vessels and unevenness.
The problem with inflammation is that it is self perpetuating, a bit like infection. If the inflammation is not turned off the rosacea continues.
HOW DO WE TREAT IT?
Chronic subliminal inflammation is one of the ways in which we age. This is how I became interested in rosacea and have had so many patient success stories. I work in the world of anti-ageing and one of my areas of interest is turning off or stabilising chronic subliminal inflammation. I started to look at using some of the treatments for anti-ageing to treat the chronic inflammation of Rosacea.
DOES MY DIET AFFECT ROSACEA?
Firstly we know there are certain trigger foods for rosacea. These are not the same for all patients. These trigger foods must be a key ingredient to the perfect storm I talked about earlier.
Some common ones are:-
- Spicy foods
- Soy sauce
- Oranges, strawberries
- Red wine
- Dairy produce
- Marinated foods.
- Fasting and detoxing diets are a bad idea as the stress they cause on our bodies cause swings in our hormones that aggravates the inflammation.
An insulin lowering anti-inflammatory diet is the best course of action. That is one that won’t cause big swings in sugars. So low starch and sugars and high anti inflammatory vegetables are the way forward and if you do eat/drink sugar remember to add protein to balance.
Good foods are things like yams and sweet potatoes as these are natural sources of Oestrogen often deficient in rosacea sufferers.
DO ANTIBIOTICS WORK?
Certain antibiotics have anti inflammatory properties. So it is the inflammation not the antibiotic effect that helps. Certain antibiotics can make the condition worse – see probiotics below.
DO ORAL PROBIOTICS WORK?
Bacterial overgrowth in our gut has been linked to the way our bodies mediate inflammation. When this bacterial overgrowth is reduced many rosacea suffers have shown significant improvement. Bacterial overgrowth is caused by many of the triggers for rosacea.
Bacterial overgrowth can be reduced by an insulin lowering low carbohydrate diet (see above) By alkalisation (see blog on lemon juice) or by taking Probiotics. Sometimes we use certain antibiotics to treat bacterial overgrowth.
The problem with taking foods that have Probiotics (yoghurt etc) is that they are dairy products which in themselves are triggers.
The 2 options I like are:-
- An oral probiotic supplement. My favourite is Omni-Biotic
- Or my favourite – home brewed Kefir (I will write a blog on this next week)
DO TOPICAL PROBIOTICS WORK?
The simple answer is NO
WHAT OTHER ORAL SUPPLEMENTS HELP?
- Zinc gluconate – my favourite anti-inflammatory. Take 30mg a day
- Vitamin D. Patients with bacterial overgrowth often have poor Vitamin D absorption. Sunlight is also a trigger for rosacea so a poor source of Vitamin D.
- Calcium and Magnesium supplement (at night)
WHY DOES IPL WORK?
Intense pulsed light (IPL) works by shrinking down the blood vessels that become dilated as a result of the inflammation. It does not work on the inflammation itself.
LED and PDT
LED therapy works by dampening down the inflammation and flushing through the stagnant blood in the dilated blood vessels and encouraging healthy new collagen and elastin formation
PDT works in a similar way but also uses a topical agent to literally “kill” the abnormal cells and allow for new healthy cells to replace them. I have seen a significant number of patients who after PDT have had no further flare ups of their rosacea.
In my clinic we have a rule with rosacea – change one cream at a time. If a patient is sensitive to a particular cream we will know which one by the process of elimination.
The number one topical ingredient to look for is Azelaic Acid. We use this a lot in anti-ageing treatments as it is such a powerful anti-inflammatory.
Metrogel which will often be prescribed by your GP is a form of antibiotic cream that works as an anti-inflammatory not as an antibiotic. I have never found it very helpful.
What I have found to be amazingly helpful is a cream I have formulated with a natural bio-identical plant based oestrogen for the face only which I combine with other plant based anti-inflammatory ingredients.
In the first instance I recommend a mild cleanser with tepid water, some patients do not tolerate harsh water and gently tissue off the cleanser. No scrubs or electronic scrubbing devices as this will aggregate the condition. Konjac charcoal sponges are genius and gentle. A simple moisturiser with no actives at night and a physical sunscreen during the day. Once patients tolerate this then we start adding more active topical anti inflammatory creams. I do not use topical steroids.
Physical not chemical sunscreens will protect from the trigger of the sun. Zinc oxide is better than Titanium Oxide as Titanium may irritate.
I like a physical sunscreen that has Niacin in it. WARNING, Niacin can cause facial flushing. If it does not it is a powerful anti-inflammatory and helps enormously to relieve symptoms.
It is the easiest to say and the most effective treatment of all, but the hardest to do!
Keep a detailed diary. Work out your trigger factors both physical and emotional. When you know one of your emotional triggers is occurring, take 5 minutes to close your eyes and ask yourself “is all this stress worth it?” take a few slow breaths and try to let the stress pass. If possible try and take a short walk away from the situation.