Once again, I have used open source medical articles which I hope will be of help. Some of these articles can get highly technical; for this reason, I do extract what I hope you will find helpful. The full article citation is given at the bottom of this article. It is a lengthy though highly informative read. Italics are mine.
Rosacea has several triggering factors: temperature, emotions (stress and anxiety), food and drink, weather, heavy exercise, and health conditions can have a huge impact on the lives of those who live with this dermatosis. (1) Some of these exacerbating factors, such as hot temperatures, act directly to trigger vasodilatation, while other factors increase skin inflammation by distinct mechanisms. (1)
Although rosacea is not considered life-threatening, it still has profound negative psychological and social effects on the quality of life of patients and presents a high likelihood of depression, social phobia, and anxiety.
Depending on the features, how the Rosacea looks and appears, Rosacea can be classified into four major subgroups: Erythematotelangiectatic Rosacea (ETR - frequent episodes of transient facial erythema (flushing) and nontransient, or persistent, erythema. Papulopustular Rosacea (PPR - features characteristics of both rosacea and acne). Phymatous Rosacea (a rare but severe form of Rosacea that causes the skin to thicken and scar, leading to a bumpy, swollen, and sometimes discoloured appearance), and Ocular Rosacea (inflammation that causes redness, burning and itching of the eyes).
The management of rosacea remains a challenge. Treatment options for rosacea may include skin care, systemic or topical therapies, laser- and light-based therapies, invasive methods (e.g., micro-needling), and several combinations of these options. Currently, the effects of probiotics on rosacea management have been studied, since they are associated with an alteration in the skin microbiome (3).
Skin care plays a vital role in the management of rosacea. (2) Patients should cleanse the skin morning and evening using gentle cleansing products with a neutral or slightly alkaline pH, preferably syndets, to avoid damaging the skin barrier, preparing the skin for the application of an extremely important moisturiser on this sensitive skin. (2)
Dietary adjustments are often recommended to patients with rosacea, since diet may potentiate rosacea symptomatology. Thus, suggestions to avoid “exacerbating” foods and drinks are frequent in clinical practice. Interestingly, countless patients describe rosacea exacerbations with spicy foods or with hot drinks. (4)
Sun exposure is also a triggering factor for rosacea symptoms and is one of the most common factors for flushing.
The other two factors that can worsen rosacea symptoms are alcohol and tobacco.64 On the one hand, alcohol triggers transient flushing, accelerating the diesease’s progression54 and increasing the risk of developing rosacea; on the other hand, the nicotine present in tobacco has an angiogenic action and can trigger rosacea symptoms. (5)
People with rosacea typically complain about “sensitive skin” as a consequence of either impairment in the epithelial barrier function or its exacerbations. Thus, patients are strongly encouraged to use gentle cleansing products without lipids to avoid further skin barrier damage.
When the use of cleansing products requires rinsing, the skin should be carefully rinsed with warm water to ensure that all the cleansing product is removed and subsequently dried using a soft towel. These products should not contain surfactants, such as sodium lauryl sulfate (SLS), as they can irritate the skin. Additionally, those with rosacea should be encouraged to avoid chemical or physical exfoliants and alcohol-based topical products, since they can cause flushing by exerting an abrasive action.
Currently, dry or moist facial wipes can be used alternatively to mild cleansing agents and cleansing creams, and dry wipes must be wetted before use. These cleansing cloths contain a cleansing agent, which is usually a syndet ("synthetic detergent") and the cloth itself allows the skin to be washed. However, if people with rosacea choose these cloths, one should be advised to choose open weave cloths, as cleansing of sensitive skin needs to be less aggressive to prevent facial redness.
Rosacea is a skin condition characterized by a damaged cutaneous barrier that leads to increased trans-epidermal water loss. Therefore, skin hydration plays a key role in creating a favourable environment that promotes the repair of the skin barrier. Moisturisers promote the repair of the skin barrier, as they tend to reproduce the effect performed by sebum and the intercellular lipid compounds of sphingolipids (a class of lipids that are essential for cell membranes and have many biological functions) which occur naturally in the skin.
Due to skin sensibility, in this case one should avoid using moisturisers that contain vegetables and/or animal oil, as this can create a medium ideal for the growth of bacteria. The moisturisers that have shown more efficacy in the prevention of exacerbations are formulations that contain occlusives and humectants; since silicones are inert ingredients with a high moisturizing capacity, formulations containing silicone are often the moisturising products of choice. (6)
Botulinum Toxin has shown promise, but further studies are needed, as it was carried out with a small number of people, in a short follow-up period and without a control group. (7)
It is essential to educate people to avoid triggering factors and to have greater control in the management of the disease. The pathological mechanisms of the disease are not yet fully understood, although it is known that this disease is multifactorial.
This piece is taken from an original article and is not my own work. I have tried to take those elements which may be helpful. Further information may be had from the National Rosacea Society and/ or from reading the full article which is mentioned here:
Paiva-Santos AC, Gonçalves T, Peixoto D, Pires PC, Velsankar K, Jha NK, Chavda VP, Mohammad IS, Cefali LC, Mazzola PG, Mascarenhas-Melo F, Veiga F. Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems. Mol Pharm. 2023 Aug 7;20(8):3804-3828. doi: 10.1021/acs.molpharmaceut.3c00324. Epub 2023 Jul 21. PMID: 37478169; PMCID: PMC10410666.
Article References:
(1) Wilkin J.; Dahl M.; Detmar M.; Drake L.; Feinstein A.; Odom R.; Powell F. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J. Am. Acad. Dermatol 2002, 46 (4), 584–7. 10.1067/mjd.2002.120625.
(2) Kresken J.; Kindl U.; Wigger-Alberti W.; Clanner-Engelshofen B. M.; Reinholz M. Dermocosmetics for Use in Rosacea: Guideline of the Society for Dermopharmacy. Skin Pharmacol Physiol 2018, 31 (3), 147–154. 10.1159/000486688
(3) Thompson K. G.; Rainer B. M.; Kang S.; Chien A. L. The skin microbiota as a link between rosacea and its systemic comorbidities. International Journal of Dermatology 2020, 59 (4), 513–514. 10.1111/ijd.14802.
(4) Yuan X.; Huang X.; Wang B.; Huang Y. X.; Zhang Y. Y.; Tang Y.; Yang J. Y.; Chen Q.; Jian D.; Xie H. F.; Shi W.; Li J. Relationship between rosacea and dietary factors: A multicenter retrospective case-control survey. J. Dermatol 2019, 46 (3), 219–225. 10.1111/1346-8138.14771.
(5) Alinia H.; Tuchayi S. M.; Patel N. U.; Patel N.; Awosika O.; Bahrami N.; Cardwell L. A.; Richardson I.; Huang K. E.; Feldman S. R. Rosacea Triggers: Alcohol and Smoking. Dermatol Clin 2018, 36 (2), 123–126. 10.1016/j.det.2017.11.007.
(6) Baldwin H.; Alexis A.; Andriessen A.; Berson D.; Farris P.; Harper J.; Lain E.; Marchbein S.; Stein Gold L.; Tan J. Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens. JDD 2021, 20 (4), 384. 10.36849/JDD.5861
(7) Zip C. An Update on the Role of Topical Metronidazole in Rosacea. Skin Therapy Lett. 2006, 11 (2), 1–4.
Comments