The International Society of Dermatology has over the recent years changed its stance on the underlying causes of rosacea and its course, recognizing the significant role of Bacillus oleronius microorganism for the aetiology of the condition alongside the previously established association with Demodex mite infestation. Also, the classification of rosacea skin lesions has been altered, with distinct presentations of the disease now replacing what was formerly referred to as its subsequent stages. Please note that the notion of skin prone to distended and broken capillaries or skin with vascular problems present in cosmetology, has now been aligned with a broader perspective, and  may be referred to as erythematotelangiectatic rosacea subtype. Unfortunately, rosacea remains a condition whose aetiology is not yet fully understood.

The direct underlying cause for the skin lesions, however, is increased blood flow to the blood vessels of the face (flushing), or the so-called vasomotor neurosis. The afflicted person’s capillaries are characterized by oversensitivity to external and internal triggers.

MAJOR TRIGGERS INCLUDE:

• UV radiation: overexposure to sunlight, solarium visits
• high temperature: hot baths, sauna
• weather conditions such as wind, frost, high humidity, temperature shifts
• ingested foods, such as hot beverages, spicy foods, alcohol
• topical agents: corticosteroids
• beauty products containing alcohol, acetone, menthol
• stress
• infections with Helicobacter pylori and infestation with Demodex folliculorum and the accompanying Bacillus oleronius

THERE ARE 5 BASIC ROSACEA SUBTYPES:

1. Erythematotelangiectatic rosacea: a passing or chronic erythema or flushing of the face, oftentimes accompanied by telangiectasias, as well as a swelling, stinging or burning sensation felt in the affected region. This is the most prevalent rosacea type, one that beauticians most commonly diagnose in their beauty salons.
2. Papulopustular rosacea: chronically reddened central portion of the face with temporarily occurring papules and pustules.
3. Phymatous rosacea: the skin is thickened and shows irregular surface nodularities, most typically involving the nose (rhinophyma), but also the chin, forehead, cheeks and ears. Frequently, folliculitis (the inflammation of hair follicles) is found in the involved areas.
4. Ocular rosacea is the type most challenging in terms of diagnosis. Patients frequently consult an ophthalmologist due to chronic blepharitis, conjunctivitis and keratitis, which manifest with tearfulness (increased eye watering), redness, stinging and itching, photophobia, and a “gritty” sensation. Also a dysfunction (obstruction) or inflammation of meibomian glands, manifesting with recurring lipogranulomas (chalazions) and styes due to a Staphylococcus infection, is characteristic of rosacea.
5. Granulomatous rosacea, exceptionally rare.

Before adequate therapy is initiated, the clinical picture must be thoroughly considered by a trained professional.

Management of each rosacea subtype requires carefully matched skincare and strict elimination of the triggering factors.

Care of rosacea prone skin

IF YOU HAVE ROSACEA,

TAKE STRICT CARE TO:

• Protect the skin against UV radiation (skin care formulas with SPF 50+, containing physical filters, such as zinc oxide, titanium dioxide, etc).
• Avoid certain foods, such as alcohol, hot spices, coffee, strong tea, and hot drinks, and limit your salt intake.
• Work on keeping your emotions under control.
• Give up hormone therapy.
• Get treatment for a Helicobacter pylori infection.

BUT ALSO AVOID:

• granular and gommage peels, using a sponge or a washing cloth for face-washing, harsh towels
• skin care products containing alcohol or menthol
• warming face masks, peel-off masks
• microdermabrasion
• the facial steamer
• TCA acid
• massage causing increased blood flow in the face area

The gold standard in both daily and beauty salon-based skin care are formulations with azelaic acid that has been proven effective in management of every rosacea subtype. It has anti-inflammatory and antibacterial qualities, and impedes colonization with Demodex folliculorum. The care of rosacea affected skin must be based on carefully selected beauty products paired with a comprehensive lifestyle upgrade including your diet and even the ways of spending spare time. As harsh as it may sound, adhering to such recommendations guarantees that you will notice an improved skin appearance, as well as prevent the condition afflicting you from exacerbating in the future.

A HANDFUL OF DAILY SKIN CARE TIPS IF YOU HAVE ROSACEA:

• Wash your face with lukewarm water and liquid cleanser formulations based on synthetic detergents, not alkaline soaps.
• Select carefully the skin care products you use, remember they should invariably be “sensitive” or hypoallergic formulas
• Use dermo-cosmetics improving the condition of your capillaries.

Many people who have rosacea suffer huge insecurities. If you are also struggling with the issue, you may want to seek the combined assistance of several different specialists, including a cosmetologist, an endocrinologist, a gastroenterologist, sometimes a psychologist or even psychiatrist to ensure successful management of your condition. Their joint effort is bound to help you get back on track. Also, do not forget to use cosmetics formulated specially for your skin problem in your daily home-based care. If you carefully follow this care plan step by step, you are sure to get your desired effects, and see visible improvement of your skin’s appearance. This definitely is something worth working for.