Rosacea is associated with chronic inflammation. 

The 4 main subtypes of this condition:

1. Flushing and Broken Blood Vessels
If your face frequently flushes red for more than about ten minutes after exercise, drinking alcohol, being outdoors in warm weather, or other common triggers, you may have what’s called erythematotelangiectatic rosacea (ETR). This type of rosacea is characterized by facial flushing and broken blood vessels, which are likely caused by years of dilating and constricting.

2. Papulopustular or Acne-Like Rosacea
Flushing and redness can also be present with papulopustular rosacea, but papules or acne-like bumps will also appear on top of redness. Some evidence suggests that this subtype could be associated with allergy-like responses within your body’s immune system. Other studies have shown an association with the microbiota (bacteria) in the gut. Additional research is still needed to uncover the exact cause of rosacea.

3. Phymatous Rosacea
Rosacea subtype 3 is characterized by thick, red skin that usually develops on the nose, but can also affect your chin, ears, forehead, and eyelids. Although rosacea, in general, is more common in fair-skinned women than in men, phymatous rosacea is most commonly seen in men.

Sun protection, trigger avoidance, and medical-grade treatment are the best ways to manage phymatous rosacea. As with other subtypes, catching it early on is crucial for minimizing symptoms.

4. Ocular Rosacea
Many people who struggle with red, burning, stinging, or uncomfortable eyes do not realize that they could have ocular rosacea. In many cases, this type of rosacea occurs in conjunction with subtype 1 — facial redness, flushing, and broken blood vessels. Sometimes, ocular rosacea develops before symptoms appear on your skin.

The 4 types of rosacea can be categorized into 2 basic complexion types.

These 2 categories will help you to determine the best skin care routine for your skin type.

1. Sensitive Type - erythematotelangiectatic rosacea. Subtype 1 rosacea.

2. Tolerant Type - papulopustular rosacea.  Subtype 2 rosacea.

The different features between these 2 rosacea skin types are the following:

Erythematotelangiectatic rosacea (Type 1)

• The skin is very sensitive and easily irritated by normal to harsh products, environmental climates, etc.
• Skin flushing and blushing often sting.
• The skin is fine textured with scale and roughness to the touch and visible fine broken capillaries.
• Red pimples are often small.
• These changes may be very dramatic or quite subtle.

Click here for the DermExcel Treatment pack for Rosacea Type 1

Papulopustular rosacea (Type 2)

• This is the more classic type of rosacea with skin that may be sebaceous, oily, red, thick and swollen.
• Large pores are often present.
• Pimples are often large and very red.
• Broken capillaries are visible.
• Skin is often not sensitive (It may however also feel sensitive - especially if you have a tendency towards accompanied dermatitis).
• Flushing may or may not sting.

Click here for the DermExcel Treatment pack for Rosacea Type 2

Rosacea with Seborrheic Dermatitis

People who have rosacea often have facial seborrheic dermatitis (aka dandruff) too. Both rosacea and seborrhea cause sensitive red facial skin, and both respond to some of the same treatments.

Here is how to tell if you have seborrheic dermatitis along with your rosacea:

Rosacea often involves the “apples” of the cheeks, mid-forehead, chin, and nose.

Seborrheic dermatitis of the face often involves the furrows of the face and hairy areas. It causes redness and a flakey scale in the eyebrows, the furrow along the sides and crease of the nose and along the sides of the chin. Facial seborrhea may be accompanied by dandruff (redness and/or dry scaly flakes) on your scalp.

Best Skin Health Treatment plan for rosacea:

1. CLEANSE
2. CORRECT
3. HYDRATE
4. PROTECT

1. CLEANSE 

Use a medicated pH-balanced cleanser that is free from harsh surfactants and fragrance. Medicated cleansers are a simple way to deliver treating ingredients to the skin. 

Avoid physical exfoliation and toners. 

For excessive facial scale and engorged/clogged pores: Gently use a lukewarm wet facecloth to soften and remove the scales. Wait until the skin’s sensitivity and signs of rosacea are controlled before removing the scales and peeling skin. An active flare-up of rosacea may not tolerate even gentle exfoliation and scrubbing.

DermExcel recommendation: Medi-Zinc Cleanser with 2% pyrithione zinc that also addresses seborrheic dermatitis.

2. CORRECT

Control redness, inflammation, and microbial overgrowth with effective anti-inflammatory and anti-microbial products. 

Proven effective active ingredients include: Zinc pyrithione, Zinc PCA, Vitamin K, Argan, Niacinamide, Salicylic acid, 4-Ethoxybenzaldehyde.

DermExcel recommendations: Acne Repair serum, DermRepair and Daily Acne peel.

3. HYDRATE

The barrier strength of rosacea-prone skin is weakened. Help it heal by keeping your skin optimally hydrated.

Use hydrators free from fragrance and potential irritants like certain plant extracts. Proven active ingredients include argan, jojoba, glycerin, hyaluronic acid, panthenol, and ceramides.

DermExcel recommendations: DermRepair & DermNourish

4. PROTECT

Protect your vulnerable skin with Sunscreen SPF 50 every day. 

DermExcel recommendations: DermDefence SPF50

Active Ingredients in the treatment of Rosacea:

Niacinamide:

Niacinamide, Vitamin B3 is a powerful ingredient to help stabilize rosacea-prone skin. Not only does it increase our natural Ceramide levels which strengthen the skin natural barrier layer and reduce sensitivity, but it’s also a powerful anti-inflammatory and boosts the immunity of the skin.

Reference:

Draelos ZD, Ertel K, Berge C. Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea. Cutis. 2005;76(2):135‐141.

4-Ethoxybenzaldehyde:

A prototypic anti-inflammatory agent that has been trialed in Rosacea. It was found to significantly reduce the erythema compared to placebo applied topically. 

Reference:

Draelos ZD, Fuller BB. Efficacy of 1% 4-ethoxybenzaldehyde in reducing facial erythema. J Dermatol Surgery 2005; 31:881-5.

Retinoids:

Photodamage plays a role in the pathogenesis of Rosacea, and therefore the anti-photo damage action of retinoid as well as the anti-inflammatory action is useful in the treatment of Rosacea.

Reference:

Kligman AM. Topical tretinoin for rosacea: a preliminary report. J Dermatol Treat 1993; 4:41-73.

Vienne MP, Ochando N, Barrel MT. Retinaldehyde alleviates rosacea. Dermatology 1999; 199:53-6

Zinc Pyrithione:

Zinc Pyrithione is effective in significantly reducing the redness, flushing, and inflammation associated with the chronic, incurable adult acne-like skin condition of facial Rosacea, and with skin erythema, in general.

Reference:

Gupta M, Mahajan VK, Mehta KS, Chauhan PS. Zinc therapy in dermatology: a review. Dermatol Res Pract. 2014;2014:709152. doi:10.1155/2014/709152

Salicylic acid:

Salicylic acid has an antimicrobic activity which also stimulates fibroblasts, inducing an improvement of the vascular component of rosacea.

Reference:

Salicylic acid peeling in the treatment of rosacea1 - Journal of the American Academy of Dermatology

Lifestyle Changes to Manage Rosacea

The steps that you can take to help manage your rosacea are mostly focused on reducing flare-ups. A number of factors can cause your rosacea symptoms to flare up. However, these factors vary among people with rosacea. It is unlikely that every trigger will cause you to have a flare-up.

Common triggers include:

• Emotional stress
• Sun exposure
• Hot weather
• Alcohol or caffeine
• Very hot or spicy foods
• Exercise
• Wind
• Hot baths
• Cold, windy weather
• Hot drinks
• Scrubbing, rubbing or massaging the face
• Irritating cosmetics, other toiletries, and skincare products

The steps you can take to help reduce your risk of a flare-up and to manage your symptoms when they occur include the following:

• Reduce stress.
• Protect yourself from certain weather conditions.
• Watch what you eat and drink.
• Exercise in moderation.
• Be gentle with your skin.
• Talk to your doctor or dermatologist.
• You can also take steps to manage the emotional effects of rosacea.

Reduce Stress
You can reduce stress by taking care of yourself. This means eating a healthy diet, getting plenty of sleep, exercising regularly, and having enough time for rest and recreation. A variety of relaxation techniques can also help you to cope more effectively with stress. Examples include meditation, deep breathing, yoga, and biofeedback.

Protect Yourself From Certain Weather Conditions
Sun, hot weather, humidity, cold, and wind can trigger rosacea flare-ups in many people.

The following tips can help you to protect yourself:

• Sun exposure - Stay out of the sun between 10 AM and 2 PM during the summer. Wear a gentle, non-irritating sunscreen with at least an SPF (sun protection factor) of 15 or higher all year long.
• Heat, humidity - Try not to overexert yourself during a flare-up of rosacea. If possible, stay in a cool, air-conditioned environment. Keep your face cool with a cold cloth. Sip cold drinks or chew on some ice.
• Cold or windy weather - Limit your time outdoors. Cover up with ski masks or scarfs. Use a moisturizer with SPF on your face daily to protect it from the drying effects of cold and wind.

Watch what you drink and eat

Keep track of foods and beverages that cause your symptoms to flare up. If you notice that your rosacea gets worse after eating certain foods, avoid them, or make some modifications. Some people with rosacea find that they have to reduce their intake of caffeine and alcohol or avoid it completely. Hot spices such as white and black pepper, red pepper, paprika, and cayenne can cause a problem for some people. It may also help to reduce the temperature of hot beverages such as coffee, tea, and hot chocolate.

Exercise in Moderation
Intense exercise can cause a flare-up of rosacea symptoms in some people. This may be the result of increased blood flow to the face or overheating. Therefore, make every effort to stay as cool as possible during exercise. Avoid heavy exercise and try shorter, more frequent workouts. Exercise during cooler parts of the day like early morning or early evening. When you exercise inside, make sure that you have proper ventilation such as open windows, fans, or air conditioning. Wear clothing that “breathes,” and keep a cool, wet cloth around your neck during hot weather. Also, keep a spray bottle with cool water for your face.

Reducing the Emotional Impact of Rosacea
Rosacea changes the appearance of your skin. You may feel embarrassed and self-conscious as a result of these changes. It is quite normal to feel this way, but you can help turn this situation around by taking a few steps. First, get the medical treatment you need to keep your rosacea under control. Second, make the lifestyle changes you need to reduce flare-ups. Lastly, you can apply makeup to hide blemishes, tiny blood vessels, and redness. Green-tinted pre-foundations are recommended to mask redness and can be covered with a skin-tone foundation. Powders are not recommended.

References

Rosacea: Tips for managing. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea#tips. Accessed December 22, 2017.