Rethinking Rosacea

A New Approach to Skincare’s Most Elusive Condition

By Noureddine Mriouah

Rosacea is a common skin concern that affects millions of people worldwide. Largely misunderstood (and often ignored) by the skincare community, rosacea affects all types of skin and usually occurs between the ages of 25 and 50. More common in light-skinned people, it disproportionately affects women, who are two to three times more likely to suffer than men. Symptoms typically appear on the middle of the face (particularly on the cheeks, cheekbones, nose and, to a lesser extent, the forehead and the chin) and can be difficult to treat without a solid understanding of this elusive condition.

Causes

While the origin and pathophysiology of rosacea are not fully understood, there are several assumptions suspecting vascular disorders, abnormal response to thermal stimuli and/or inflammatory reactions. It also seems that both genetic and environmental factors are involved in the pathogenesis of this dermatosis. It is believed that vasomotor instability is the original phenomenon that underlies the disease.

Responding to different stimuli (such as sun exposure, alcohol and tobacco intake, spicy foods, emotional stress, temperature fluctuations, exercise and reactions to low quality cosmetic products), hypersensitive facial capillaries dilate and become more permeable, releasing various proteins, cytokines and inflammatory mediators in the dermis. This initiates an inflammatory reaction, resulting in erythema (a.k.a. Rosacea Diathesis). In the long term, persistent edema, damaged telangiectatic vessels and, in some cases, hyperplasia and fibrosis of different structures of the dermis may appear.

Symptoms

Symptoms of rosacea may include a sensation of dry skin, heat or burning in the face and, in rare cases, pruritus (itching). The primary signs of rosacea are the presence of erythematous papules, pustules, edema and telangiectasia.

There are various degrees of rosacea, which consist of four main stages: flushing or "flush" paroxysmal, Erythematotelangiectatic Rosacea, Papulopustular Rosacea, Phymatous Rosacea, However the progression from one stage to the other is not always systematic.

The flushing paroxysmal stage is characterized by a temporary redness caused by sudden exposure to heat or cold or after alcohol intake. Erythematotelangiectatic Rosacea, on the other hand, is characterized by a permanent redness on the malar areas, especially on the cheeks and the chin; the dilated capillaries lead to the “Classic Couperose”. Papulopustular Rosacea is the real state of rosacea, easily identified by papules and pustules a few millimeters in diameter beneath the erythema, without any associated comedones. Lastly, Phymatous Rosacea appears when the skin thickens progressively, the volume of the nose is increased and diffusely red, and follicular orifices are dilated. Unlike other stages, this later phase primarily affects men.

There is another form of rosacea called Ocular Rosacea, an inflammatory conjunctivitis, causing damage to the edge of the lashes with small blue tones (blepharitis) and damage to the cornea (keratitis). These signs are often ignored and sometimes confused with an ocular allergy.

Rosacea is most often confused with the Acne Vulgaris, which is characterized by the presence of comedones and usually occurs in younger subjects. Rosacea may also be confused with Seborrheic Dermatitis, which can be distinguished by the presence of scales and erythema on the scalp, eyebrows and in the external ear canal. Seborrheic Dermatitis may also include ocular impairment and is treated differently from rosacea.

Treatment

The most popular topical treatments of rosacea are prescription topical creams or gels using 0.75% to 1% of Metronidazole, which different clinical studies have proven to be effective. Other topical treatments used less commonly include Erythromycin, Clindamycin, Sodium Sulfacetamide, Tretinoin and Azelaique Acid. Studies have also demonstrated the effectiveness of anti-inflammatory oral antibiotics, such as Tetracycline, Clarithromycin, Doxycycline and Minocycline, for the treatment of papulopustular rosacea.

For patients who want to avoid prescription drugs for fear of side effects, other options can be good alternative for relieving rosacea. First and foremost are preventive measures, such as avoiding the aforementioned stimuli and by using a daily sunscreen protection cream (SPF 30 or higher). Exposure to ultraviolet rays is the primary factor associated with the appearance of rosacea. In fact, UV rays are directly responsible of generating Reactive Oxygen Species (ROS), causing both oxidative damage and eliciting an amplification of cytokine release, thus perpetuating a vicious cycle resulting in a chronic, systemic, pro-inflammatory state.

It is then highly recommended to use a broad spectrum of topical products formulated with potent anti-inflammatory and antioxidant active ingredients with the objective of inhibiting the key mediator of inflammation and aging processes, such as NF-KB. These actives should also be able to reinforce, protect and boost the antioxidant response system.

Two different classes of anti-inflammatory agents seem to show promising results: COX inhibitors (cyclooxygenase) and 5-LOX inhibitors (5-lypooxygenase). Natural inhibitors used in topical treatments for rosacea include Boswellic acid, found in the Boswellia serrata tree; resveratol, found in grapes; Tamanu Oil, found in nuts from the Polynesian ati tree; and Beta Glucans, derived from plants, bran of cereal grains

To avoid the progression of the temporary erythema to stages of rosacea that are more difficult to treat, it is important to reinforce the skin barrier. There is a reciprocal effect of many chronic inflammatory diseases, such as rosacea, psoriasis, atopic and seborrheic dermatitis, on the disruption of the stratum corneum barrier. However, the barrier can be reinforced by using ingredients designed to stimulate the component of the natural moisture factor (NMF), the production of ceramides and the maintaining of tight junctions—a series of fusion points between plasma membranes of adjacent keratinocytes in the granular layer of the epidermis, which is responsible for ensuring homeostasis of the barrier function.

Finally, no topical anti-rosacea treatment is complete without addressing a major skin issue: maintaining and reinforcing the integrity of the Extra Cellular Matrix (ECM). Using ingredients designed to stimulate the production of collagen and glycoaminoglycans will enhance this key function, ensuring a more thorough treatment with lasting results.

Call today to book your Complimentary Consultation and learn what products and treatments Suede Salon Sp sand Body has to offer to help control your Rosacea: 856-985-0700

Affirm
Antioxidant Firming Serum
$79.00

Benefit Clean
Gentle Clean
$33.00

Clarity Serum
$36.00

Define
Resurfacing Treatment
$77.00

Hydrate +
Daily Moisturizer SPF 17
$46.00

Restore
Colon Cleanse
$34.00

CPR
Skin Recover Serum
$48.00

Delicate Facial  $89

This 60 minute facial is designed to soothe sensitive skin.  Enjoy a thorough cleanse, tone and exfoliation in the most gentlest form.  Includes a face, neck and shoulder massage.  Specific antioxidants and serums are used to calm, soothe, hydrate, protect and heal the most delicate skin.