Precision skin care is required if you have rosacea & sensitive skin. You can not afford to ‘have a go’ at things, or rosacea flares will occur. Your key ingredients are-

• Niacinamide or vitamin B3. This is anti-inflammatory & can help reduce flares.
• Hyaluronic acid is a natural substance that is great as a moisturizer & humectant.
• Azelaic acid is produced by yeasts & found in grains. It reduces inflammation.
• Antioxidants including green tea & tocopherol are usually well tolerated.

  

Generally, the acids, apart from azelaic & very low strength salicylic acid. Rosacea falls under the umbrella of sensitive skin. You have to be very careful when adding new skincare ingredients. Be guided by your skincare expert.

Potential flares: Glycolic acid, lactic acid, ascorbic acids, retinoic acids.

Compatible products: azelaic acid, niacinamide, hyaluronic acid, resveratrol, tocopherol, retinyl palmitate. Low strength salicylic acid wash can be tolerated by most.

Very slowly with thought & understanding of your skin’s threshold. Everyone’s skin has a unique threshold, exceed this an sh*t will happen. With rosacea the threshold is markedly reduced. 

Start with every second or third nightly application. Perform a test patch in front of your ear (one inch square). If you have no irritation after a week, apply to larger areas. After another week, increase.

If you have a rosacea flare up, stop immediately. Record this in your diary, use or modulate as tolerated. Understand how to salvage your skin if irritation occurs.

In short, the one you are most likely to use. UV is the number one flare factor in rosacea, reported in over 80% of patients. Physical sunscreens including zinc & titanium dioxide are best tolerated for patients with sensitive skin. La Roche Posay makes cosmetically elegant, high factor, cost-effective hybrid sunscreens

My suggestion, try before you buy. The proper way to use SPF is to apply twice a day. One 50 ml bottle should last you 2-3.5 weeks. Hats, umbrellas & window tints are useful.

Absolutely. The best way to figure out any dietary flare ups is to keep a rosacea diary. As a general rule (not absolute as flare ups are as individual as you are);

• Avoid- refined packaged & processed foods including meat, sugar, refined flour, processed vegetables. Avoid or markedly reduce alcohol. Hot drinks can also flare up in some cases.
• 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.

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

If you are naturally inclined, see a naturopath as they can discuss methods of addressing gut inflammation & correct dysbiosis with gut-healing. Naturopaths focus on an elimination diet that addresses triggers & focuses on an anti-inflammatory Mediterranean diet.

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.

Dermatologists endorse mineral makeup, essentially paraben free & talc free. There are many brands on the market. Try before you buy. For makeup advice, see my staff at The Formulated.

Frequently blamed as a flare factor, alcohol may pertain to your rosacea trigger. In most cases it is red wine over white. Record this down in your rosacea diary to correlate intake & flare.

Even the smallest modification counts. It all adds up. For example, using the correct makeup may give a 1% improvement, changing your cleanser another 1%, niacinamide 1%, better SPF 1%, proper face washing 1%, quick tepid showers may give you 3% (bonus), & so on. As a single lifestyle change one percent is not seen, but all everything up, you may get 20-60%.

You have got to find the correct combination for your pattern of rosacea. If you want more information, I suggest going to rosacea.org to understand more.

Heat. It is common to have long hot showers with lots of steam, especially in winter. It feels good, I understand. This is probably one of the most common flare factors in patients. Showering more than 3 minutes is a luxury that rosacea patients cannot afford. Tips are-

• Tepid showers ( I am not asking for cold showers)
• 2-3 minutes (This will allow time to clean every nook & cranny)
• Soap substitutes, & oatmeal shampoo – conditioner (most contain sodium lauryl sulphate)
• Pat your face dry, do not rub.
• Consider cooling your face after showers to reduce rebound redness.

One quarter of rosacea patients will have ocular rosacea or eye signs. This includes dry eyes, itchy & runny eyes as well as eye irritation including conjunctivitis. For an accurate management plan, consult your ophthalmologist. Tips include-

• Anti-inflammatory tablets including tetracyclines, doxy & minocycline.
• Short course topicals such as prednisone eye drops.
• Eye baths with saline – salt water.
• Drops & ointments including Refresh Eye range
• IPL, BBL & vascular lasers
• Sunglasses & eye protection

This is difficult as physiologically elevated heart rate will flare up rosacea in up to 80% of cases. The flipside is that exercise is good for you, & releases endorphins that can reduce stress levels, in turn reducing rosacea flare ups. It’s a compromise. Here are some tips that may or may not work;

1. Keep exercise to short bursts of say 7-15 minutes. This is called interval training. This allows time for your body to cool off.
2. Ice application during your rest periods, especially if you are at the gym.
3. Keep ambient humidity low. If possible, training with air conditioning.
4. Remember lots of SPF if you are exercising outside. Use a sticky zinc based waterproof sunscreen.
5. Cool drinks & water spray can help keep you cool & hydrated.

   

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. Spicy foods, including chilli, curry, and wasabi can potentially flare up rosacea.

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.

Any specific food related questions should be directed to your dietician.

By far, lasers & light-based procedures are the most effective. Chemicals including peels & skincare active can flare up rosacea. Avoid glycolic, lactic, mandelic & retinoic acids. Some patients can tolerate retinol or retinyl palmitate.

The most effective anti-aging procedures are laser based & should always combine a vascular laser. Options include.

• Thulium 1927 Clear & Brilliant + V BEAM
• Fraxel 1927 + V BEAM
• LaseMD +V BEAM
• IPL-BBL
• Laser Genesis
• Tixel + Botox +/- V BEAM

For simple rejuvenation work, consult my nurses, alternatively book an appointment with myself.

These group of injectables are placed under your skin to stimulate collagen. They stimulate collagen without the generation of heat, hence they do not flare up rosacea prone skin.

Biostimulants are an ideal solution for anti-aging in rosacea patients. 2-4 sessions are required for optimal outcomes.

More on biostimulators for Anti-aging. 

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.

Lots. Stress, either physical, emotional or mental can flare up any dermatological condition including acne, psoriasis & rosacea. I am the wrong person to provide suggestions to controlling stress, so I won’t even try. Consult-

• Your GP
• A psychologist
• A psychiatrist
• Some who does alternative stuff like yoga, acupuncture, meditation

Vascular lasers are employed to treat rosacea. In Brisbane I use: VBeam Prima, Perfecta, DermaV, as well as IPL and BBL.

In Sydney I use ExcelV laser.