Rosacea is classified as a chronic inflammatory condition, more prevalent in those with fair skin. Several factors may trigger rosacea, with some triggers easy to identify, while others are more obscure, requiring a trial and error approach to determine the aggravating factor and offer appropriate treatments.
Well-documented rosacea triggers include:
- Fluctuations in ambient temperature
- Daylight (UV) exposure, even through glass in winter
- Hot or spicy foods
Even when treated with appropriate skin care, medications and/or procedures, patients may have to avoid rosacea triggers that may activate even well-controlled rosacea.
Contact us to make an appointment to discuss your rosacea at our Melbourne clinic.
- Things we do and don’t know about rosacea
- What to do about early signs of rosacea
- What are symptoms of rosacea besides flushing?
- What does rosacea look like?
- Controlling the flushing of rosacea
- Treating rosacea
- Treating rosacea with laser and light therapies: it works
- Are microbes responsible for rosacea?
- What is the role of H. pylori in rosacea (if any)?
- The role of SIBO (if any) in rosacea
Where rosacea appears
Rosacea usually shows up in the middle section of your face, but it can also appear on the chest area, back, and possibly the scalp.
When we diagnose rosacea, we’re looking for certain key elements, including a redness of the central face that persists, and small visible blood vessels on the nose and cheeks. Rosacea may also present with swollen red bumps, sometimes containing pus, which may be mistaken for acne. Skin usually feels hot and may be tender.
One manifestation of rosacea is known as rhinophyma , and affects the tissue of the nose, making it seem bulbous due to thickened skin. Men are affected more often than women. A disfigured nose can be a source of great distress, however rhinophyma can be improved significantly with treatments at our Melbourne clinic, particularly using laser treatments. A normal nose appearance can usually be restored with a few treatments.
Some people with rosacea get dry, sore, uncomfortable eyes with swollen, red eyelids. Eye symptoms may appear first, prior to any skin symptoms.
How to deal with the flushing of rosacea
Rosacea flushing can be quite intense for the person experiencing it. It can become a force of its own accord, with no immediately obvious treatment strategy for managing it, even avoiding triggers. Sometimes, rosacea can feel completely out of control.
Each of you with rosacea has your own very special set of symptoms that affect you slightly differently to others with rosacea, since the manifestation is determined by your unique biology. Some of you may have unusual or specific triggers or relievers. This is normal for rosacea.
Medication isn’t always very effective for rosacea, though in some people it works very well. Your treatment may also contain laser treatments for blood vessel reduction, but this again will depend on what presentation your rosacea has. There are several options to try.
Avoiding rosacea triggers
Avoiding triggers is the best way we know of to reduce rosacea flare-ups, with some simple changes to diet and lifestyle actually able to have quite a profound change to symptoms. You may be eating something that is setting you off, or being in the sun for too long without a hat on your way to work every day.
Keep a diary over the course of several months to see what patterns you can observe. You can bet there will be some – rosacea doesn’t exist in a vacuum. It is caused by things that you can’t see, but that you can observe the patterns of, making your rosacea less mysterious. Rosacea isn’t so much a skin condition as a body condition. Your skin just presents the symptoms because it is the most obvious to us.
If you are ‘new’ to rosacea, you will need to know about the most common triggers, and start avoiding those first. It will soon become apparent after an ‘elimination diet’ sans triggers to see which your body responds badly to. You may find that some rosacea triggers for others are not triggers for you, and thus you can live more freely. You will soon learn the boundaries.
Most common rosacea triggers:
- Sun/UV light
- Stress (increased cortisol and adrenalin)
- High or low end of the temperature spectrum (too hot, too cold)
- Exercising heavily
- Drinking alcohol
- Taking a hot/too hot bath
- Spicy/hot food
As you can see, these are all things that change the dilating and contracting of your blood vessels in some way to accommodate your temperature or another function.
For example, adrenalin (excreted when things are exciting or stressful) causes an increase in blood pressure; alcohol can cause blood vessels to dilate (widen); and a hot bath has the same but greater effect, widening blood vessels to let heat out. These are predictable occurrences. Understanding a bit about which ingredients in life cause blood vessels to constrict or dilate will become useful information.
Medications we use
Antihistamines or aspirin may be useful in some people to reduce flushing in the short-term, so if you ate something spicy, you could use this medication as a tool in a more immediate fashion, under the guidance of your dermatologist.
Medication is useful in some people to treat the small bumps/pimples of rosacea. We might also use beta-blockers or clonidine for stress-related flushing, caused by your autonomic nervous system.
How your autonomic nervous system causes flushing
Your autonomic nervous system – your unconscious nervous system – can cause flushing that is completely out of your control. This tends to be the ambient temperature (too hot, too cold), exercise, or after a hot drink, but it can also be set off when you’re nervous or stressed – or even really excited.
Getting too hot and what to do about flushing
These rosacea triggers are all you getting ‘too hot’, or your body needing to offload some heat, which it does by opening up your blood vessels wider, to allow more blood through, to provide more surface area for the heat to be transferred out of your blood (body) to your skin, through your blood vessels. Once the heat leaves your skin, your body becomes cooler, and your autonomic nervous system is happy again. Rosacea flush over.
What you can do then to help your autonomic nervous system get back into temperate balance is cool yourself down – you can use a fan, wet towel, or drink cold water. Anything that reduces your temperature back to a normal temperature can be used to control flushing caused by your autonomic nervous system’s temperature control system.
Getting stressed and what to do about flushing
Stress – a surge of adrenalin and cortisol into your blood – is a sure-fire way to get a flush episode of rosacea, but we don’t always get to control our stress levels as much as we might like. If you are a nervous or anxious person, or operating in a high-stress environment, you may be getting a lot of stress-hormone-related rosacea flushing. In this case, you may benefit greatly from stress management techniques. You can’t stop the stress, but you can control your response to it.
Managing your stress response could include many elements, for example mindfulness and deliberate relaxation techniques, using ‘rewiring’ behavioural techniques like neurolinguistic programming (NLP), taking medication, or a collection of many of these tools. Having an out-of-control stress response is damaging to many systems, so taking a closer look at what your brain and body is reacting to, and modifying your response as much as you can, is a useful rosacea management technique.
How we treat rosacea at our Melbourne clinic
Treating rosacea takes a combined approach in most people. We cannot cure your rosacea, but we can help you manage the symptoms.
Your rosacea will be assessed based on your specific symptoms and triggers, and your treatment may include some of the following:
- Topical antibiotics (clindamycin, erythromycin, metronidazole)
- Glycolic peels/preparations
- Gels to constrict blood vessels in rosacea-prone areas
- Vascular laser treatments
- Systemic (oral) antibiotics (tetracycline, macrolides, erythromycin, roxithromycin, azithromycin, clarithromycin, metronidazole)
- Isotretinoin (usually used if antibiotics have failed)
Trigger avoidance will be high on the list of things to learn about, including general measures to keep your skin cool, stay out of the sun, and avoid any known triggers of yours.
Rosacea and microbes
Some rosacea has been associated with small intestinal bacterial overgrowth (SIBO), some small mites, and Helicobacter pylori infection of the gut, so if your rosacea is in conjunction with intestinal disruptions of any kind, mention this to your doctor and ask their advice, particularly if your rosacea outbreak has coincided with digestive issues.
Again, rosacea doesn’t exist in a vacuum, and while we can’t always see what’s causing it, something is. Figuring out what that thing is isn’t always easy to do – and sometimes we’ll never know, but it’s worth trying to figure out.
How vascular lasers work to reduce visible blood vessels and redness
A vascular laser works by zapping the blood vessels closer to the skin. There is some evidence that damaged blood vessels release chemicals that cause rosacea to appear and progress over time. Treating the blood vessels by getting rid of them completely (don’t worry, you still have loads more!) means that we can really reduce some symptoms of rosacea.
Laser treatments can also complement other treatments, but without the side effects often present with topical treatments. Multiple treatments will likely be required.
The laser we use to treat rosacea in our Melbourne clinic
We use the Cutera laser with the Excel V and Genesis components. This laser is considered one of the best in the world for treating facial redness, targeting visible blood vessels, and the blood vessels that are deeper into the skin, while also treating general redness. Other lasers may struggle to get as good results for rosacea.
Repeated treatments may be necessary every few years, but this will depend heavily on your specific type of rosacea presentation.
How laser works to treat rosacea – Melbourne clinic
Vascular rosacea tends to respond well to laser and light therapies. Heat from the laser beam hits the capillaries that leads to general redness, and destroys them. The body then reabsorbs the dead cells during its regular ‘garbage collection’, and the cells disappear. Effects are immediate, but also improve over the coming weeks as the cells are reabsorbed.
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