Subtypes of Rosacea
Erythematotelangiectatic Rosacea (ETR)
This is the most common form of rosacea, typically presenting with persistent redness, visible blood vessels (telangiectasia), and a tendency to flush or blush easily.
Papulopustular Rosacea
Often mistaken for acne, this subtype involves redness accompanied by acne-like breakouts. It is characterised by papules and pustules, which can lead to swelling and a burning or stinging sensation on the skin. Some experts believe that an overproliferation of the Demodex mite may exacerbate this condition. The Demodex mite is a tiny, parasitic organism that naturally lives on human skin.
Phymatous Rosacea
This less common subtype is marked by thickening of the skin, most frequently on the nose (rhinophyma), but it can also affect the chin, forehead, cheeks, and ears. It is often seen in more advanced cases and involves a bumpy texture and enlarged pores.
Ocular Rosacea
Affecting the eyes, this subtype presents with dryness, irritation, redness, and swollen eyelids, potentially leading to serious complications such as corneal damage if left untreated.
Causes of Rosacea
The exact cause of rosacea remains unknown, but it is believed to be a combination of genetic and environmental factors. Potential triggers include sun exposure, extreme temperatures, spicy foods, alcohol, stress, and certain skincare products. These triggers may provoke inflammation, leading to the characteristic symptoms of rosacea. Additionally, the presence of Demodex mites on the skin and abnormalities in the immune system are thought to play a role in some cases.
Treatment Approaches
Erythematotelangiectatic and papulopustular are the most likely types of rosacea that practitioners may encounter. Since rosacea is a chronic condition, the focus is more on managing symptoms than curing it entirely.
Phymatous and Ocular Rosacea require dermatologist care due to their severity and potential complications.
I generally focus on only treating ETR, and then only in mild cases. I find that Intense Pulsed Light (IPL) can help considerably to reduce redness, specifically using a 560 nm filter. To offer this treatment, you would need to ensure that your IPL machine is medically registered and that suitable insurance is in place. Furthermore, I recommend my clients use gentle, anti-inflammatory topicals containing ingredients such as niacinamide, azelaic acid, or ceramides to help reduce redness and calm inflammation, and to avoid any known triggers such as those mentioned above.
If they live in a hard water area and their tap water is unfiltered, I suggest they use mineral water on the face as much as possible because hard water, with a pH of 7.5 to 8.5, is slightly alkaline. This alkalinity can disrupt the skin’s natural acidic barrier, leading to irritation and potentially worsening rosacea symptoms. Mineral water, with its more neutral pH, is gentler on the skin and helps maintain its balance and hydration.
For more severe cases of ETR or papulopustular rosacea, I suggest seeking a consultation with a dermatologist or an online service like Dermatica to obtain a prescription cream tailored to the individual’s needs. Typically, the cream will contain Ivermectin 1%, which is an anti-inflammatory and anti-parasitic treatment that targets the Demodex mites, which are often associated with rosacea. It helps reduce inflammation and the pustules commonly seen in this subtype of rosacea. It will also probably contain Metronidazole 0.75%, which works by stopping bacterial growth and reducing inflammation, helping to control the redness and bumps associated with papulopustular rosacea.
Treatments to Avoid
While microneedling can improve skin texture and promote rejuvenation, it involves creating micro-injuries to the skin, which could exacerbate inflammation and redness in rosacea-prone skin. Similarly, skin boosters, although hydrating, might cause temporary redness or irritation, potentially worsening rosacea symptoms.
Chemical peels are generally not recommended for individuals with rosacea, particularly in moderate to severe cases, due to the sensitive nature of rosacea-prone skin. The acids used in peels can strip away the skin’s natural barrier, making it more susceptible to irritation and flare-ups. In very mild cases of rosacea, where the skin is not overly reactive, a gentle peel using milder acids like lactic or mandelic acid might be considered, but only with caution, starting with a low concentration and a patch test.
Conclusion
Rosacea requires a nuanced approach to treatment, with a focus on gentle, non-invasive therapies tailored to the specific subtype. While some treatments like microneedling, skin boosters, and chemical peels might be effective for other skin conditions, in my opinion, they are generally not suitable for rosacea due to the risk of exacerbating symptoms.
