Rosacea remedies and causes
The flushing redness caused by rosacea – a common chronic facial skin condition – is very distressing and increasingly affects young women, although it is usually more severe in men. Conventional drug treatment focuses on treating the secondary symptoms, rather than the flushing, believed to be caused by a disorder of facial blood vessels, which become hypersensitive. Although there isn’t a cure, there are many ways to help manage rosacea symptoms, read on for Liz’s top tips.
What is rosacea?
Rosacea is a chronic relapsing skin condition, which means that symptoms can sometimes flare up badly, while at other times they are less severe. It causes skin to become red, rashy and swollen. The areas most commonly affected are the cheeks, nose, forehead and chin, but some patients may develop more severe symptoms, such as inflammation in the front of the eye (rosacea keratitis) making them sting and feel gritty. Sometimes the skin swells and thickens around the eye (lymphoedema); if this happens around the nose, it’s called rhinopyma, or bulbous nose. (Incidentally, although it’s sometimes called acne rosacea, this condition has nothing to do with acne.)
What causes Rosacea?
Unfortunately, no one knows the underlying cause of rosacea and it is difficult to treat. Some doctors believe that the only effective way of treating the disorder in the blood vessels is to ‘shut them off’ with laser treatment, used in conjunction with lifestyle changes and skin-calming products. But, even if this does work, it is unlikely to be a permanent cure and may need to be repeted one to three years after the first treatment.
Flare-ups of rosacea can have a wide range of triggers, including alcohol, spicy food and hot drinks, food intolerance, sunlight and extreme temperatures (such as those found in saunas), stress, anger or embarrassment and excessive exercising. Research shows that those with rosacea may not produce enough stomach acid (HCI), which helps digestion, and that supplementing the diet with this at mealtimes can improve symptoms. Additionally, stress often interferes with HCI production, and many experience worse symptoms when stressed. One study found that a subgroup who had indigestion after eating fatty foods were deficient in the pancreatic enzyme lipase, which helps to digest fat. When they were given pancreatic enzyme supplements, their indigestion and rosacea improved. Drugs that cause blood vessels to dilate are another risk factor, and a small skin mite (Demodex follicorum) occurs in far greater numbers on the faces of rosacea sufferers and may be an exacerbating factor, stimulating an immune response that results in inflammation. It is also possible that reproductive hormones may be involved. Many women report more flushing episodes and bumps at the mid-month point of their menstrual cycle and during the menopause.
A good quality probiotic will also support beneficial bacteria in the gut, many of which are known to have an effect on the skin and help control inflammation
Rosacea is complicated, so it makes sense to start by identifying individual triggers and avoiding them as much as possible. After that, it’s a case of following an anti-inflammatory regime in much the same way as for acne, including diet, stress management, supplements and soothing topical products.
Essential Fatty Acids are a useful starting point for supplements as they can have an anti-inflammatory effect and may help to balance hormones. In one study, a comprehensive fatty acid supplement containing omega-3, 6 and 9 (Ultimate Beauty Oil, by Viridian) significantly helped some participants. Pycnogenol, an extract from the marine pine bark tree, also has a powerful anti-inflammatory effect and supplements may be helpful for some. A good quality probiotic will also support beneficial bacteria in the gut, many of which are known to have an effect on the skin and help control inflammation.
Topical treatments and creams for rosacea
- Avoid perfumed soaps and moisturisers and don’t scrub your face as this may aggravate the condition. It is best to use a creamy cleanser rather than soap and an unperfumed moisturiser every day if your skin is very dry. Cosmetics and camouflage make-up can help cover up the redness of rosacea – do ask your doctor for a referral if this is something you are interested in.
- Azelaic acid cream appears to be as effective as topical metronidazole (an antibiotic) at reducing papules/pustules and slightly better at reducing skin redness. Best results are seen after four weeks’ continuous use.
- A cream containing MSM, a form of sulphur (which is antibacterial and anti-inflammatory), aloe vera and calendula is very popular with some.
- Pycnogenol can also help soothe the skin’s surface and Pycnogenol Redness Reducing Serum can help support fragile capillaries and potentially strengthen outer layers of the skin, calming the redness of rosacea.
- In addition, topical treatments containing Chrysanthellum indicum, green tea, liquorice and niacinamide, a form of vitamn B3, have all been shown to help rosacea in clinical trials. Using a good mineral-based sunscreen is vital, as UV light and heat will aggravate the condition, as will cold winds. Choose one free from synthetic sunscreens and made with the minerals titanium and/or zinc oxide.
Laser treatment for rosacea
Laser treatment and intense pulsed light treatment (IPL) are when narrow beams of light are aimed at the blood vessels visible on your skin, causing them to shrink. IPL and laser treatment cause minimal scarring to the surrounding area, but you may need to have it up to four times for it to be successful. You will need a referral from a dermatologist and, not usually available on the NHS, it can be expensive.
Oral antibiotics, usually belonging to the tetracycline group are usually used. These include tetracycline, oxtetracycline, doxycycline, lymecycline and minocycline and are sometimes prescribed to be taken at the same time as using topical antibiotics. Another commonly used antibiotic is erythromycin.
Ivermectin cream is a relatively new medicine, and is not available on the NHS everywhere, but it is thought that it is gentler on the skin and more effective than metronidazole. If you are dealing with a severe case of rosacea, an oral antibiotic such as isotretinoin (used in higher doses to treat acne) may be prescribed. Don’t forget to always take a probiotic supplement during and after any course of oral antibiotics to help preserve beneficial gut bacteria and gut health.
Medicines that relax the blood vessels such as clonidine and beta-blockers may also work, as well as some anxiety medications. It is important to see an eye specialist if more severe symptoms occur around the eyes.
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