Your 5-STEP Rosacea Relief Plan

Your 5-STEP Rosacea Relief Plan

 

Rosacea is a chronic inflammatory skin condition that affects approximately 5.5% of the global population.  It is characterised by persistent facial redness, broken capillaries and in some cases may include inflammatory papules and pustules.   These signs are usually seen on the cheeks but can extend to the nose, forehead, and cheeks. Due to the external signs of this condition, it can have profound effects on psychological well-being.

There are four subtypes of rosacea which present with varied features and degrees of severity. (1). The symptoms of each type are as follows:

Type 1: facial redness, flushing and broken capillaries

Type 2: as above with papules and pustules (little lumps that look like pimples)

Type 3: as above with thickening of the skin due to fibrosis – often involves the nose

Type 4: ocular symptoms of redness, dryness, and lid changes – with or without features of types 1 to 3.

Rosacea

Rosacea is considered a chronic and incurable condition that cycles through flares and remissions, however a well-designed treatment plan with individualised strategies can achieve long-term remission.

What causes Rosacea?

Growing evidence links rosacea to systemic chronic inflammation, driven by complex genetic, microbial, immune, and neurovascular interactions. 

Rosacea occurs more commonly in those with specific genetic variants - HLA-DRA and BTNL2 - associated with autoimmune disorders and immune dysregulation. This explains the higher prevalence of rosacea in those with disorders of the gastrointestinal tract such as inflammatory bowel diseases (Crohn’s disease and Ulcerative Colitis), Coeliac disease and small intestinal bacterial overgrowth. (2,3) It has also been linked to autoimmune conditions such as diabetes and rheumatoid arthritis as well as cardiovascular disease and neurological disorders, such as anxiety, depression, migraine, and Parkinson’s disease. (18-22)

Summary figure of rosacea pathophysiology

Pathophysiological changes within the skin

Molecular findings within rosacea-affected areas are complex and involve the activation of the rosacea inflammasome, a multi-protein structure located within cells that initiates an inflammatory response. (15) Affected areas show an increase in innate immune cells such as macrophages, mast cells and neutrophils and higher levels of inflammatory cytokines INFg, IL-6 and IL-17. (4).  These cells are largely regulated by the gut microbiota which explains why an altered composition of the gut microbiota – termed dysbiosis – has been linked to rosacea.(23)

Rosacea is also associated with changes in the skin microbiome as well as a breakdown in the extracellular matrix and a reduction in subcutaneous collagen. These changes appear to be caused by stress and UV radiation. (9,10,16)

In addition, higher levels of neuropeptides, such as substance P and vasoactive peptide, are noted within affected areas of the skin.  These peptides contribute to swelling and dilation of vessels respectively.  This neural involvement may underly exacerbations of rosacea during times of emotional stress (13,14).  

Combined, these pathophysiological features may explain the tri-directional link between the gut, brain and skin – termed the gut-brain-skin axis. (17) 

What are the triggers for Rosacea?

Individuals can often trace the onset of rosacea to certain environmental or dietary triggers (listed below).  It is now known that these triggers initiate the cascade of molecular changes that lead to immune and neurovascular dysregulation within the skin.  Studies show that the pathophysiological changes and symptoms of rosacea can be reduced simply by avoiding certain triggers.  Identification and avoidance of triggers is the foundation of long-term remission.

common rosacea trigger factors

Dietary triggers 

Food has the potential to calm or exacerbate skin symptoms due to naturally occurring components within the food.  Phytonutrients and polyphenols such as curcumin, resveratrol and sulforaphanes are known to reduce inflammation, while food components such as alcohol, capsaicin, cinnamaldehyde, formalin and niacin are associated with the immune and/or neurovascular dysregulation commonly seen in rosacea (see list of foods with these components below).  Packaged foods tend to be fortified with these substances simply because the natural food has been altered or condensed, as is the case for dried spices, sauces, peanut butter, and pate.

The most common dietary triggers are:

  •             Alcohol: wine, beer and spirits (5)
  •             Spicy foods, cayenne, chilli and red capsicum
  •             A high glycaemic diet (6)
  •             Fatty foods (24)

Other foods that have been shown to exacerbate symptoms include (25-27):

  • Dairy products: yoghurt, sour cream, and cheese
  • Hot beverages: tea and coffee
  • Vegetables: eggplant, shitake mushroom and spinach
  • Legumes: lima beans, navy beans and peas
  • Fruit: bananas, avocado, red plums, raisins, figs, tomatoes, and citrus.
  • Meat: turkey, peanut, tuna, liver, and chicken
  • Seafood: shellfish
  • Miscellaneous: noodles, tofu, vanilla, cinnamon, soy sauce, yeast extracts, vinegar, and chocolate

Just a note that many of these foods are associated with histamine intolerance which may be one of the underlying causes of rosacea.  For this reason, it is best to also avoid fermented foods, collagen powders and protein powders. You can find more information on the topic here. 

Environmental/lifestyle triggers:

  •             Exposure to heat or humidity (7)
  •             Exposure to extreme cold (7)
  •             UV radiation (8)
  •             Smoking (11)
  •             Heavy exercise (12)
  •             Emotional stress (13,14)
  •             Medications such as topical and oral steroids
  •             Cosmetic products and treatments – certain ingredients, such as alcohol and fragrances, tend to produce immune reactivity and redness                                                

Biological factors:

  • Gut dysbiosis – which is influenced by diet, antibiotics, environmental toxins and stress. More information here 
  • Small intestinal bacterial overgrowth (3)
  • H.pylori infection – occurs in the stomach and is associated with gastritis (6)
  • Disruptions in the skin microbiome (9,10)

What can be done for rosacea? 

Rosacea is a chronic condition however with appropriate management you can achieve symptomatic relief and long-term remission. 

Mild and infrequent flares may improve with simple measures such as supporting a healthy gut microbiome, avoiding triggers and modifiying your skin care routine.  

In some cases, your GP may recommend prescription topicals such as Metronidazole gel or Ivermectin paste.

Other active ingredients that have been found to improve or reduce rosacea symptoms:

  •      To protect the epidermis: niacinamide, colloidal oatmeal, panthenol,   allantoin
  •      To reduce inflammation: azelaic acid, zinc, feverfew, Glycyrrhiza inflata             (liquorice root), Gingko biloba, aloe vera         
  •      To reduce UV-induced damage: vitamin C, Green tea (Camellia sinesis)     

Here’s your 5-Step Plan to Rosacea Relief

Step 1. Obtain a diagnosis and exclude other causes

See your doctor for a definitive diagnosis.  Assessing for other conditions such as autoimmune diseases or neurological disorders is essential.  When a diagnosis is made, your doctor may prescribe topical and/or oral medications. For severe or chronic rosacea, you may be referred to a dermatologist for a more targeted management plan that may include oral and topical treatments, laser devices or intense-pulsed light therapies and surgery. 

Step 2. Avoid dietary triggers

Avoidance of triggers form the basis of long-term remission so it’s important to identify what  triggers your symptoms.

Diet influences the composition of the gut microbiome and therefore plays a key role in immune regulation and general health.  A Mediterranean diet has been shown to rapidly improve gut microbial composition and reduce systemic chronic inflammation, so this is the diet of choice for optimal health. Enjoy a clean and varied diet of green and colourful vegetables, healthy fats (such as olive oil and flaxseeds) and fish (for omega 3). Small amounts of fruit, nuts and seeds can be added if well tolerated. More information here

In addition, it is important to avoid:

  • Alcohol
  • Caffeine
  • Spicy food
  • Processed foods
  • Refined sugar and foods with a high glycaemic index
  • Hot food and drinks

If this does not improve your symptoms, you may want to try avoiding the other foods in the list under “Dietary Triggers”, as well as foods that are commonly associated with  histamine intolerance 

Step 3. Identify and manage environmental triggers

Identify and manage the environmental triggers for your symptoms:

  • Avoid extremes of temperature – keep your environment at room temperature, avoid saunas, hot baths etc
  • Avoid direct sunlight during the middle of the day.
  • Avoid excessive exercise
  • Implement daily stress-management techniques such as breathing protocols or meditation (free on youtube)

Step 4. Simplify your skin care routine 

Individuals with rosacea have a more alkaline pH in the skin and tend to react to topical creams, therefore modifying your skin care routine is important. 

  • Avoid skin care products with fragrances, alcohols, colours, or essential oils
  • Avoid touching your face during the day
  • Avoid tonics, scrubs, facials, face masks, peels or any treatments that cause redness or flushing

Minimise your daily skin care routine (product examples below):

In the morning:

  1. Cleanse with a soap-free cleanser  - Avene Antirougers Clean* or AnteAGE® Cleanser****
  2. Apply prescription or active topicals then wait 10 minutes - Rosacea Day and Night Cream** or AZClear*** or AnteAGE® Serum & Accelerator****
  3. Apply a barrier mineral sunscreen with titanium dioxide or zinc-oxide - Avene SPF 50+ Face Emulsion*
 At night:
  1. Cleanse with a soap-free cleanser (Avene Antirougers Clean*) or AnteAGE® Cleanser****
  2. Apply prescription or active topicals – wait 10 minutes (Rosacea Day and Night Cream**) or AnteAGE® MD Serum & Accelerator****
  3. Apply a moisturiser designed for sensitive skin. (Avene XeraCalm AD*) 

*The Avene range of products are developed for sensitive skin and some are spefically designed for rosacea.  You can purchase these from Chemist Warehouse without prescription.

**The Rosacea Day and Night Cream is a prescription formulation that contains 1% zinc, 3-10% niacinamide, 5% vitamin C, azelaic acid. To order email office@bioaesthetics.com.au 

 ***AZClear contains 20% azelaic acid and can be purchased without prescription from any pharmacy.

****AnteAGE® MD products and AnteAGE® Pro products can be purchased on www.bioaesthetics.com.au 

Step 5.  Heal from within

supplement powders

The only supplements that have been shown to reduce symptoms of rosacea are zinc sulphate and omega-3 fatty acids (28, 29).  However, due to the tri-directional link between gut, brain and skin health, it may be beneficial to include supplements that help support and manage each system. 

These supplements include:

  •      For skin health: zinc and omega-3 fatty acids 
  •      For gut microbial composition: prebiotics – inulin, pectin and fructo-
  •      oligosaccharides (FOS) .
  •      To improve gut wall integrity: glutamine, glycine, proline.
  •      To reduce inflammation and improve immune function: vitamin C, zinc,
  •      curcumin, quercetin, green tea extract and omega-3 fatty acids.       
  •      For brain health: omega-3 fatty acids and magnesium threonate *          

Our Recommendations

Zinzino Balance Oil for omega-3 and essential fatty acids order here

BiomeMD Bowel Formula is a prescription formulation in powder form that contains inulin, pectin, FOS, glutamine, glycine, proline, Curcumin,quercetin and green tea extract. To order email office@bioaesthetics.com.au

Immune Support is a prescription formulation in powder form and contains Zinc, Vitamin C, niacinamide, vitamin D, Magnesium, quercetin and B-group vitamins. To order email office@bioaesthetics.com.au

*You can purchase Magnesium L-threonate and most of the vitamins and nutrients listed above from iherb.com.au.  We recommend the “NOW foods” range.  

 

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