Angela Hodgkiss – Angelique Day Spa and Skin Clinic
Rosacea is a disorder of the hair follicle and associated sebaceous glands. It particularly affects aged 30-50 years with a paler complexion, more common in women, although the stage 3 is most common in men. It can be controlled, managed and improved with proper treatment methods, however, there is no specific or long term cure. The first step in determining what treatments will work, is to understand this skin condition and outbreak triggers. Avoiding stress, keeping the skin well moisturised and avoiding anything that dehydrates the skin or that raises core body temperature will assist in keeping it under control, however these things do not cause it but merely aggravate it. It is inflammation of the skin, resulting in facial redness, vacillation of blood vessels, burning and itching, enlarged pores, and swelling and raised papules. The skin feels hot and flushed because the blood is closer to the surface and can resemble orange peel. The blood vessels become damaged by constant dilation so that they remain dilated. Early intervention is key.
There are four stages of rosacea:
1 Erythematolangiectatic rosacea- permanent redness and flushing. Small blood vessels on the surface of the skin and broken capillaries.
2 Papulopustular rosacea- permanent redness with red bumps sometimes even pus filled which last 1-4 days
3 Phymatous rosacea- as previous and with thickened uneven irregular skin particularly on nose.
4 Occular rosacea-red, dry, irritated gritty eyes and eyelids.
What do we know about Rosacea:
Rosacea research and its epidemiological origins have varied opinions but can generally be grouped into one of 3 main causes: Gut issues, inflammatory immune responses and bacteria and mites. These are in fact often all interconnected.
• Helicobacter Pylori bacteria that can be found in the gut and is often found in high levels of Rosacea sufferers. This bacteria is known to stimulate the production of bradykinin protein which can cause blood vessels to expand and lead to rosacea. It is known to cause reflux and stomach ulcers.
• There are genetic links, that interestingly, are all also linked to gut issues such as asthma, eczema, psoriasis, dermatitis, and rheumatoid arthritis.
• Rosacea sufferers have been found to have a much higher level of small intestinal bacterial growth. Eradication of this bacteria induced an almost complete regression of skin lesions and was maintained. (Reference dept of internal medicine, gastroenterology unit, university of geneo, Italy, 2008).
• An overactive immune system has been found trigger a microbial imbalance in the skin, stemming from bacterial overload of parasites and or a leaky gut. In Chinese medicine, rosacea would be considered a liver, lung and colon problem.
• Some reports have shown an increase of specific inflammatory cells, triggering a chain of chemical responses within the skin, including the release of certain enzymes called MMPs, which can cause inflammatory damage resulting in Rosacea.
• Other inflammatory mediators that further exacerbate the symptoms of rosacea are (ROS) and (NO). (ROS) are chemically reactive molecules containing oxygen. ROS are formed as a natural byproduct of the normal metabolism of oxygen and have important roles in cell signaling and maintaining the skins balance. However, during times of environmental stress (e.g UV, smoking, drugs or heat exposure), ROS levels can increase dramatically resulting in damage to cell structures. This is known as oxidative stress and Rosacea sufferers have a reduced capacity to fight it. The role of NO involves vascular changes and is partially responsible for the swelling and redness, worsening with increased sun exposure as an increase of NO has been linked with UVB rays.
• Rosacea sufferers appear to have more receptors that activate the peptide LL-37 which is responsible for the skins defence system. It is basically allergic to this peptide its own body is producing.
• It has also been found that the epidermis of rosacea sufferers had a higher expression of toll-like receptor 2 (TLR 2). This stimulates enhanced serine protease production of keratinocytes. Abnormal levels of this may explain the enhanced inflammatory responses to environment and may be a critical element in the pathogenesis of rosacea.
• Stress is also a contributing factor in that elevated levels of cortisol over a prolonged period suppress the immune system.
• Research also suggests it is the autoimmune response to the bacteria mite (dermodex) that live in high numbers on our skin. The mite invades the capillaries and causes swelling and acne like pustules.
Listening to your own gut and digestive system, eliminating factors one by one, and playing around is key to finding out your own personal triggers.
• According to National Rosacea Society the biggest three triggers are sunlight, heat and environmental factors. They also state 2 out of three people will experience a reaction after drinking alcohol. Red wine is biggest alcohol trigger and 75 % of sufferers reported a reaction after consuming. White wine was around 54% and spirts etc 20-30%.
• Foods: Gluten and yeast, red meat, chicken and liver, chocolate, vanilla, soy sauce, vinegar, eggplant, avocados, spinach, beans and peas, citrus, tomato, bananas, plums, raisins, figs, spicy food, hot drinks, salt, MSG, soft drink, refined sugar, fried food.
• Dairy is a double trigger because it also blocks zinc absorption necessary for healing .
• Environment: hot weather, saunas, hot baths, UV, strong winds, cold, humidity, pollution, smoking, exercise (as it raises core temperature)
• Drugs: steroids, vasodilators
• Other: flushing, menopause, caffeine withdrawal, dehydrated skin, hereditary, stress, over active immune system, digestive disorders including irritable bowel, vitamin A and Vitamin C deficiency.
• Cosmetics: witch hazel and alcohol, mineral oils, lanolin, acetone, eucalyptus, chemical sunscreen, soap based products, menthol, peppermint, over use of lipids. The American academy of dermatology link fragrance as causing more contact dermatosis than any other ingredient.
Rosacea and Sensitive skin has the tendency to overreact so it’s important to treat carefully and slowly. These skin types need non-irritating products at first to calm and repair skin health and to restore the dysfunctional barrier. Later active ingredients are necessary to remodel the damaged skin in a way that promotes healing. Rosacea reflects two coexisting conditions; an increase in skin’s blood supply, attempting to repair itself and thinning from the excessive inflammation, resulting in visible capillaries. If other skin conditions are present, (eg ageing or pigmentation) rosacea and its associated inflammation must always be treated first.
At Angelique Day Spa and Clinic we prefer DMK treatments because it addresses the skin as a whole system, revising the multiple dysfunctions that contribute to Rosacea, not just calming what we see on the surface like other brands. Our skin revision treatments will address the three main causes referred to above, by: killing the bacteria and mite, reducing inflammation and swelling, re-establishing skin barrier and defence lines, enhancing function and immune system of the skin, improving lymphatic drainage, circulation and strengthening capillaries. By encouraging restoration of the barrier we will have a healthier skin that is able to hold water, have a better defence system and thus less likely to inflame.
We do not recommend IPL whilst internal disorders are still present as new vessels will ultimately return as they branch out again seeking oxygen. But once the disorder is under control, IPL can be a very effective way of treating the capillaries and redness left behind. Effective IPL often takes approximately 4 treatments , spaced apart every 2 weeks.
Red LED therapy
Many rosacea sufferers find that treatment with all-red LED provides relief from their rosacea symptoms. Studies have shown that red and near-infrared, yellow and green, from LED lamps and also from low-level lasers, have an anti-inflammatory effect. Studies have shown that LED technology inhibits enzymes that break down collagen, also minimising the increased symptoms of inflammation.
Collagen Induction Therapy (CIT needling)
The weakened blood vessels associated with Rosacea can be treated with the use of needling. It will stimulate the epidermal growth factors and increase the density of the epidermis which lessens the appearance of of vessels and overall redness. It will also strengthen collagen in vessel walls and the connective tissue that supports the vessels. Not recommended until the inflammation is under control.
At Angelique we understand Rosacea and have a number of products that will specifically calm the disease, tailored to your specific condition.
• Milk Cleansers that are non soap based, antioxidant and hydrophilic
• Salicylic cleansers to reduce inflammation, detoxify cells, reduce pore size and slow down shedding into follicles thus reducing compaction
• Combination of EFA based oils and mists to repair the skins natural moisturizing factor (NMF) and reduce inflammation.
• AHAs to heal papules and promote healthy blood vessel growth. They have anti-oxidant and anti-inflammatory properties.
• Red vein relief to reduce inflammation, flush out clogged capillaries, repair vein walls and long term damage caused by internal heat
• Barrier creams to seal and prevent water loss
• Serums to attract the Langerham cells which are our skins natural defence system. Their role is to engulf any foreign bacteria or invasion to the skin. Langerhams are the number one essential cell in skins immune system to initiate repair and are often malfunctioning in rosacea suffers.
• Moisturizers to sedate the skin and reduce redness and heat. Help improve circulation and oxygenate blood flow and strengthen weak capillaries.
• Physical sunscreens with titanium dioxide or zinc oxide. These will irritate skin less than chemical sunscreens which are absorbed by the body and skin thus increasing the potential for skin irritation and exacerbation of rosacea.
• Sulphur masques to retard bacterial infection and the activity of the demodex
• Cooling and healing masques to sooth
• Supplements with evening primrose and omegas to rebuild barrier and repair TEWL. Think fire under the skin and water will put it out. When the barrier is compromised bacteria levels can elevate.
• Supplements for gut health with pro and pre biotics to eliminate unhealthy bacteria contributing to the inflammation and to support the healthy bacteria to restore gut function. The wet oily look of rosacea is not due to loss of oil but fast Trans epidermal water loss. When the acid mantle and ceramides are compromised they lose water which again aggravates rosacea. Therefore EFA and restoration of acid mantle is vital in treatment.
• Vitamin A is our cells supreme regulator and corrects all skin disorders and maintains skin health.
• Vitamin C is required for the formation of connective tissue in between skin cells.