Lots. If you suffer from rosacea, you will have sensitive skin. As a rule, you need to approach skin care with thought & precision. You need to be analytical & patient or sh*t will happen (flare-ups). As a rule, avoid these compounds-

• Tea tree oil, a favourite amongst naturopaths, the contact dermatitis rate is high.
• Retinoids, a favourite amongst dermatologists, the irritant rate is high.
• Vitamin C or L-ascorbic acid. Good formulations have a low pH of <2.5. It can burn & cause irritation.
• AHA including glycolic or lactic acid. The pH can be lower than 2.2. Application will flare up rosacea in most patients.

If in doubt, patch test (see below). Some rosacea patients can tolerate OTC retinoids including retinyl palmitate. Beta hydroxy acids, in low doses of <2%, short contact can be beneficial as it is anti-inflammatory.

Always test patch a product at least one week before full face application. To do a test patch, apply a small amount in front of your ear. Do this as directed but half the application frequency. In most cases it means application every second night. If you do not have any reaction, increase as tolerated to involve your face.

Once you can tolerate every second day application, increase the frequency. If you flare up, back right off, use a bland emollient, then restart when your skin has completely healed. If you think you may have an allergic reaction to a product, a medical dermatologist (not me), can potentially investigate via patch testing. 

Some naturopaths believe that there is an association between rosacea, intestinal overgrowth, guy inflammation & dysbiosis.

Based on this theory, correcting dysbiosis with gut-healing may reduce background inflammation. Some say it can reduce redness, acne, pimples & even swelling associated with rosacea. Naturopaths focus on an elimination diet that addresses triggers (hot food, spicy foods) & focuses on an anti-inflammatory Mediterranean diet.

Firstly, figure out what your triggers are. The best way is to keep a rosacea diary. Next optimise your dietary intake with prebiotic & probiotic foods.

Avoid- refined packaged & processed foods including meat, sugar, refined flour, processed vegetables. Avoid or markedly reduce alcohol.

Eat- prebiotic high fibres foods, at least 25 grams daily. Substitute vegetable oil for olive oil. Supplement with omega 3 fish oil. Supplement with anti-inflammatory herbs like cloves, turmeric, ginger & sage.

Disclaimer: I am a procedural dermatologist. My skill sets are not dietary/naturopathic; however dermatologists acknowledge dietary contribution can be significant in most cases of rosacea. Sorting out your diet can make a difference in some, & in some cases prevent dermatologists from prescribing drugs such as antibiotics & vitamin A derivatives including Accutane. My job is the dude that you see last, I laser.

Some herbal supplements & essential oils can help reduce inflammation. This can reduce rosacea flares. This is the list of the usual essential oils & plant-based extracts normally prescribed for rosacea.

Aloe vera is the go-to plant for skin inflammation. You can either use the sap of the plant, or buy prepacked gel extracts. Contact dermatitis is a rare side effect.

Camomile can be used as a drink (tea) or topically as compresses. Low chance of allergic contact dermatitis.

Green tea: probably has the most medicinal properties & merit. It is a potent antioxidant with scientific data. Drink it, it’s good for you.

Fever few is another plant. It has antioxidant properties as well as very mild sun protection- in theory.

Other botanical extracts include raw honey, ginger, rosemary & thyme. Consider using other naturally derived extracts including azelaic acid & niacinamide topically.

Essential oils like lavender, jasmine, rose, tea tree, thyme etc. have anti-inflammatory and healing properties. Be guided by your naturopath as you will only require 2-3 drops of any essential oil. Your naturopath can guide you as to the application techniques. You can order these oils online & watch a YouTube video on how to use/apply.

As a guide do not apply to broken skin, or if you have compromised skin barrier function. This can increase your chances of allergic reactions / dermatitis. If you develop flare ups, stop immediately & consult your medical dermatologist. I am a procedural dermatologist; in the context of rosacea my work involves lasers.

Hell yeah. Stress can flare up any skin condition including acne, eczema, psoriasis, vitiligo & certainly rosacea.

Managing stress effectively can reduce rosacea flare ups as it reduces triggers & skin inflammation. The best person to discuss ways to manage stress is a psychologist, psychiatrist or naturopath.

Disclaimer: My job is laser work for recalcitrant rosacea. I am generally the last person you see if all other avenues fail, this includes management of stress, trigger factors, diet & conventional therapy.

Botulinum toxin type A (BTX A) is a naturally occurring product, from clostridium bacteria. BTX A works on the acetylcholine receptors to reduce muscle contraction. It also is a modulator of inflammation. By reducing muscle contraction in blood vessel walls, it reduces intermittent spasms of capillaries & can be useful to treat redness, flushing, & blushing.

BTX also markedly reduces the population of demodex mites on the skin. Demodex infestation is one of the causes of rosacea. BTX only lasts 3-6 months, & cost between $690 to $990, depending on the extent of treatment. This is one of my last line therapies if the laser fails. 

Yup, allergies can make your condition worse. Essentially, there are two allergies to be considered. Firstly, a food allergy or intolerance, an example is the ubiquitous gluten that is blamed for everything including acne, psoriasis & rosacea. If you would like to find out if gluten is a culprit, see a dietician, do a gluten elimination diet, record your outcomes in your rosacea diary.

Secondly, allergic contact dermatitis. Rosacea patients have a compromised skin barrier, this can lead to an increase in both irritant & allergic dermatitis.  This can be due to common chemicals such as fragrance, propylene glycol, sodium lauryl sulphate, preservatives, alcohol, & the dearth of essential oils that you may have used. This type of allergy is best managed by a medical dermatologist (not me). They can arrange specialised testing called patch testing & can extend the battery of tests to include your own topicals.

UV is a trigger in over 80% of cases. The best sunscreen is the one that does not irritate your skin & is cosmetically elegant. Some rosacea patients do not tolerate chemicals. Other rosacea patients don’t like the idea of applying chemicals on the skin. If this is the case, you can consider elemental metals as these are organically sourced from the periodic table of chemistry, namely zinc & titanium dioxide.

As a guide, physical sunscreens are better tolerated than chemical sunscreens. Try before you buy. Invisible Zinc is a favourite amongst dermatologists.

A flare-up diary can assist in identifying potential triggers. Try to write down all flare-ups quickly, recording what you did before the flare up happened. For example, record your diet, skin care application, sun exposure, stress levels that day. You must keep a diary to have any hope of establishing a blueprint for your skin.

The National Rosacea Society recommends a Rosacea Diary Booklet, which you can download on their website. This helps you learn what all kinds of triggers aggravate rosacea and gives you a journal to write them down in.

If you really want to go all natural, dermatologists are the last people to see. We prescribe drugs including long term antibiotics as well as vitamin A tablets called isotretinoin or Roaccutane. The flipside is that our prescription patterns are calculated bearing in mind a risk benefit ratio. At any given time if you feel like stopping your medication, go ahead.

If you are after natural treatments, a combination of vitamin B3 or niacinamide topically, coupled with natural light or light amplification by stimulated emission of radiation (lasers) may temporarily suppress your rosacea. I cannot cure your condition, perhaps a naturopath can.

Disclaimer: I am a procedural dermatologist; this means my work is laser-based (in the context of rosacea). If you see me for laser work, I may give you a prescription for anti-inflammatory medications short term. You have the option of filling out the prescription. I am not here to convince you to trial conventional medications, however by giving you a prescription, I have fulfilled my duty of care.

Lasers can help reduce the signs & symptoms of rosacea. They work via two main pathways. Firstly, they can target redness, including broken capillaries & veins. Secondly, they can reduce skin inflammation. Most patients require 2-4 sessions to control their rosacea. In summary-

Types of lasers I use: V Beam vascular laser, Prima, Perfecta, LP Nd Yag, IPL, BBL.

Recovery: 1-3 days, mild swelling in most.

Treatment time: 5-10 minutes.

Pain level: well tolerated as the laser has in-built cooling.

Cost: $370 – $690 with partial Medicare rebates in most cases.