Rosacea
Rosacea, literally means “red as a rose” in Latin. It can be recognized by a striking red color of the nose, cheeks, forehead and chin. In addition, accompanied by pimples, bumps and thickening of the skin.
Rosacea occurs later in life than pimples, usually between the ages of 30 and 60 and especially in women.
On this page you will find the following information about rosacea:
Dr. Francis Wu on rosacea
Below explains Dr. Francis Wu briefly about the complaints, causes and tips that you don’t often hear.
Rosacea, which literally means “red as a rose” in Latin, is a chronic skin condition associated with periods of worsening and improvement of symptoms. These symptoms include redness, bumps and pus on the face and can last for years. Although rosacea affects all races, fair-skinned people are more likely to be affected. It is a non-contagious skin condition that usually manifests itself between the ages of 30 and 60 and mainly affects women.
Couperose is often confused with rosacea. With couperosis, the blood vessels are dilated and you see red and blue without other symptoms such as swelling, bumps and pus heads. It is possible that couperose is a milder form of rosacea.
The cause of rosacea is not known. Genetics, immune response, microorganisms such as Demodex Folliculorum and Brevis mites and Bacillus oleronius, environmental factors and neurovascular dysregulation are among the known causative factors for the development of rosacea. Moreover, in addition to the known effect of ultraviolet (UV) exposure as a trigger for rosacea, it may also play a role in the onset of the disease.
In rosacea, some factors are known that exacerbate the abnormality in an unknown way. The most important of these are:
Nutrition like
- hot coffee and tea
- alcohol, especially white wine and liqueur
- foods with capsaicin such as cayenne pepper and red pepper
- Cinnamon aldehyde-containing foods:
- cinnamon
- tomatoes
- chocolate
- citrus
- eggplant
- avocado
- vinegar
- banana
- curry
- plums
- raisins
- soy
- spinach
- dairy products
Weather conditions, such as cold or hot weather, ultraviolet light, wind.
Physical exertion or emotions can also give rise to the condition.
Cosmetics, certain irritating substances such as soap, perfume, shaving cream, chemical sunscreen filters, menthol, facial cleansing wipes, peeling products should be avoided.
Drugs such as Corticosteroids, Doxorubicin, Infliximab, Interferon, Nifedipine, Nitroglycerin, Prostaglandin E, and Rifampicin can also enhance rosacea predisposition.
A 2021 study examined the risk of skin cleansing in 999 rosacea patients and 1010 healthy controls. It did not matter what products were used and how long the cleaning procedures took.
It turned out that a high cleaning frequency (more than once a day) and the use of more than 5 different cleaning products per year. Deep cleansing such as overuse of cleansers (more than once a week), oil control, exfoliation, and use of face masks were major risk factors. The conclusion of this study was that excessive cleansing habits were important risk factors for both the onset and progression of rosacea.
Diet plays a crucial role in managing rosacea. Given the complex causes of this condition, it can be challenging to determine which foods influence symptoms. It is essential to understand how different foods interact with rosacea so that specific triggers can be avoided to minimize the impact on the skin.
Alcohol: This is a known trigger for rosacea. Extensive research among 82,737 participants, including 4,945 people with rosacea, showed that higher alcohol consumption was significantly associated with an increased risk of rosacea. White wine and spirits in particular appeared to increase the risk, regardless of whether the participants smoked. Alcohol can produce acetaldehyde and acetone, metabolites that release histamine and cause vasodilation, which can worsen rosacea symptoms.
Spicy foods: Foods containing capsaicin, such as hot peppers, are a particularly common trigger. Capsaicin activates TRPV1 receptors on the skin, leading to vasodilation and an increase in blood flow, resulting in redness and flushing. Research suggests that while spicy foods are not a direct cause of rosacea, they can worsen symptoms.
Cinnamaldehyde-containing foods: Foods such as tomatoes, citrus fruits, and chocolate contain cinnamaldehyde, which can activate TRPA1 receptors and promote vasodilation, which can potentiate erythema and telangiectasia.
Histamine-rich foods: Aged cheese, wine and processed meats can release histamine, which causes vasodilation and increased vascular permeability, leading to swelling and redness. An imbalance between the absorption of histamine and the body’s ability to break it down, known as histamine intolerance, can contribute to rosacea symptoms.
Dairy: Contrary to popular belief, research suggests that dairy products may play a protective role against rosacea, especially in erythema-telangiectatic and papulopustular forms. Dairy may have anti-inflammatory properties and may regulate the gut microbiota. In Asians, dairy may possibly worsen rosacea.
Caffeine: Has a double-sided effect. It may have vasoconstrictive effects, which could theoretically reduce the redness and visibility of blood vessels. However, in some people caffeine can lead to vasodilation after the initial constrictive effect, which can worsen symptoms. Interestingly, research indicates that consuming more than four cups of coffee per day may improve symptoms of rosacea, possibly due to the antioxidants in coffee that provide long-term anti-inflammatory benefits.
High-fat foods: Consider foods, such as fried foods and snacks high in trans fats and saturated fats, can promote chronic inflammation and increase the severity of rosacea. Reducing these foods can help manage the inflammation and symptoms of rosacea.
Other: Advocado, Eggplant, Vinegar, Yeast Extract, Soy Sauce, Spinach and Vanilla,
Keeping a food diary is recommended to determine which foods worsen rosacea symptoms. This can help adjust diet to reduce flare-ups.
Previously, rosacea was classified into four different types: erythematous telangiectatic rosacea (redness of the face), papulopustular rosacea (redness with inflammation), fibromatous rosacea (thickening of the skin, known as nasal discharge), and ocular rosacea (affection of the eyes).
In practice, several subtypes can occur simultaneously, such as eye complaints in combination with skin complaints or inflammation of the skin with a thickening of the nose.
The diagnosis of rosacea is made based on clinical symptoms. The diagnosis can be established when at least one diagnostic feature is present and at least two key features are observed.
Diagnostic characteristics: (1 x characteristic)
• Persistent centrofacial erythema (redness in the center of the face)
• phymatous changes (coarsening and thickening of the skin)
Main features: (minimum 2 features)
• papules and pustules
• flushing (hot flashes)
• dilated red blood vessels
• Eye complaints such as grain of sand sensation
Complaints such as burning, stinging, fluid retention, dry skin are not diagnostic criteria in themselves.
There is strong evidence that rosacea is linked to certain conditions throughout the body, what we call systemic conditions.
A recent study examined the systemic conditions associated with rosacea. These conditions vary greatly. Below is a list:
- allergies (airborne and food)
- lung diseases
- intestinal disorders (e.g. Irritable bowel syndrome (IBS), celiac disease)
- hypertension
- hormonal imbalance
- type-1 diabetes mellitus
- cardiovascular disorders
- rheumatism
- anxiety disorders and depression
The more severe and the longer the duration of rosacea, the higher the risk of these conditions.
A genetic survey of more than 73,000 people provides more insight. The researchers found flaws in the chromosomes in 7 different places in the participants with rosacea. These locations are encoding for: IL-13, PSMB9, HERC-OCA2, RS1805007, NRX3-DIO2.
Specifically, this means the following.
- Overexpression of IL-13:
- more asthma, allergic rhinitis, intestinal complaints
- PSMB9:
- rheumatism, heart failure, myocardial infarction, neurodegenerative diseases: parkinson, alzheimer’s, ALS and upregulation of various pro-inflammatory cytokines: IL-8, Nitrite Oxide (NO), TNF-alpha, IL-beta, adhesion molecules, prostaglandins.
- HERC-OCA2 encodes melanin in pigment cells.
In other words: These genes are involved in systemic diseases such as allergies (in the air, such as pollen or dust, and in food) but also intestinal disorders, cardiovascular diseases, neurological disorders, anxiety disorders and depression. Thus, there is a genetic predisposition to rosacea and the development of many systemic diseases.
Genetic predisposition to rosacea and systemic diseases.
While it is still unclear what risks there are for developing systemic disorders and which appear first, these new findings offer a bright spot. New or existing drugs may be used in the fight against rosacea and related conditions.
Also on youtube:Rosacea
Try to avoid triggers in food as much as possible, even if it is sometimes difficult to resist that delicious piece of chocolate in your candy cabinet. One method that can help you with this is a food trigger diary. In addition to certain foods, it is also best not to use rough washcloths and/or cleaning brushes.
In addition, it is also strongly discouraged to use cosmetics with perfume, sodium lauryl sulfate, fruit acids, scrub or glycolic acid.
A mineral sunscreen will give you the least amount of skin irritation, just make sure it contains both titanium dioxide and zinc oxide. This combination provides broad ultraviolet coverage. Titanium dioxide protects you better from uvb rays and zinc oxide covers uva rays better. Read more about UVA and UVB.
A single study showed a beneficial effect of hyaluronic acid serum and reduction of rosacea symptoms. Cream with niacinamide or vitamin B3 also reduces inflammation in the skin in people with a mild to mild form of rosacea.
Tips when you have rosacea
Below you will find tips from Dr. Francis Wu
Tip: avoid certain cosmetic ingredients
Certain skin care routines can exacerbate rosacea, a 2000 study found for both men and women.
Women: fruit acid peels, aggressive toners/cleansers, soap, make-up, perfume, hair sprays
Men: Soap, After shave cologne, shaving lotion, chemical sunscreen.
Tip: Omega-3 supplement against dry eyes
If you suffer from rosacea and dry, burning, itchy irritated eyes, blurred vision and a grain of sand feeling, it may make sense to take an omega-3 supplement.
Research has shown that taking an omega-3 capsule (360 mg EPA/240 mg DHA) twice a day for three months improved dry eyes.
You can possibly combine the supplement with artificial tears for extra relief.
Tip: UV sun protection
Sun exposure was cited as one of the top triggers for rosacea flares by 81 percent of patients in a survey by the National Rosacea Society.
There are two different ultraviolet radiation (UV) that reach the Earth’s surface. Those are UVA and UVB rays.
UVA rays are present with relatively equal intensity during all daylight hours throughout the year, and can penetrate clouds and glass. These UVA rays make up the largest part of the ultraviolet radiation, so more than UVB.
UVA rays are not felt on the skin. These rays cause free radical formation in the dermis, which destroys your collagen and elastic fibers.
3 x UV(A) – Asymptomatic (doesn’t feel it), Always present, Aging of the skin
UVB rays
UVB penetrates into the superficial epidermis and is responsible for our vitamin D production. So for a slow and longer lasting tan. Too much UVB causes redness, sunburn and eventually also skin aging and skin cancer. Unlike UVA, UVB does not penetrate glass. UVB radiation can be up to 1000x stronger than UVA rays.
Advice: Mineral sunscreen with both zinc oxide and titanium dioxide (SPF30) and also day cream with UVA filter. Especially UVA sun rays play a prominent role in the Netherlands. It turns out that UVA and visible light amplify each other and cause redness on fair-skinned people.
Tip: red rosacea face
Redness, flushes and burst blood vessels can also be cosmetically annoying in addition to burning.
What are the tips for this:
- Camouflage or with anti-redness green cream. The green dye in the cream masks the redness.
- Vascular laser treatment, with a special laser the vessels are burned closed. My tip is to do a small test spot first to see how your skin reacts to this and have the treatment take place in the autumn or winter period.
- There is a gel on the market that reduces redness and flushes. Mirvaso gel is not reimbursed and can only be obtained with a doctor’s prescription. The active substance is brimonidine and works within 30 minutes by reversibly constricting the blood vessels.
Tip: skin care ingredients suitable for rosacea
Choosing skin care products with specific ingredients can help relieve and soothe rosacea symptoms:
Here is a summary of cosmetic ingredients in skin care (review on this)
- Ginkgo biloba
- Aloe vera
- allantoin, from wheat
- feverfew (motherwort)
- Glycyrrhiza inflata (licorice root)
- Green tea
- Silybum marianum (Silymarin) – mariadistel
- Chrysanthemum indicum
- Quassia amara extract (bitterwood or Surinamese quassia)
- Kinetine
- Ectoine
- Niacinamide (vitamin B3)
Azelaic acid is also frequently publications mentioned for the treatment of rosacea. Dr. Wu’s experience: it is a good alternative for the treatment of rosacea. But in people with tinted skin, it is poorly tolerated and causes more skin irritations such as redness, burning and pigmentation.
Advice: first apply to a small piece of skin once a day to assess how you react to it.
Iconic Elements Award winning Spotreducer contains Niacinamide & Ectoine.
The best products for your skin with rosacea
Choosing the right skin care products is important for people with rosacea, as this skin condition is associated with sensitivity and redness that can be worsened by certain ingredients. Choose products that help soothe and protect the skin without damaging the barrier. Look for products that contain anti-inflammatory and moisturizing ingredients, and avoid harsh ingredients like alcohol, retinol, fruit acids and other irritants. A gentle approach with specific, targeted skin care can help manage rosacea symptoms and improve skin condition.
1. Calming Cream: This cream contains marshmallow root and avena sativa (oats), ingredients known for their soothing and anti-inflammatory properties. Another key element, ectoine, helps protect the skin from environmental stressors and promotes hydration, which is crucial for the disrupted skin barrier often seen in rosacea.
2. Spotreducer cream: Enriched with niacinamide and ectoine, this cream not only provides benefits for reducing hyperpigmentation but also helps soothe redness and irritation. Niacinamide is known for its anti-inflammatory properties, making it an excellent choice for addressing rosacea symptoms such as redness and uneven skin tone.
3. Cleansing Milk Step 1: This mild cleanser, free of alcohol, has been specifically developed to gently cleanse the skin without removing essential oils. Avoiding alcohol in skin care products is important for rosacea sufferers, as alcohol can dry out and further irritate the skin, worsening symptoms.
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Frequently asked questions about rosacea
Experts don't yet know the exact cause of rosacea, but there's no evidence that it's contagious. You cannot pass on rosacea to other people by touching them, through towels, shared make-up items or shared cosmetics, skin care products.
Both acne and rosacea cause redness, bumps, and pimples on the face. The redness of acne is usually just around the pimple, while the redness for rosacea usually covers a large area. Acne also has more blackheads and clogged pores than rosacea. With rosacea, there is often an area without redness around the eyes.
However, a recent study of 82,737 American women found that alcohol increases the risk of rosacea. The researchers investigated whether it made a difference what the women drank. The biggest culprits appeared to be white wine and liquor.
More than 5 glasses of white wine per week gives an increased risk of 49% in women!
Researchers have found that one to three drinks per month increases the risk of developing rosacea by 14 percent. Drinking five or more glasses of white wine a week increases the risk by 49 percent. Red wine and beer seem to be a safe alternative.
In men, it has not been studied.
The temptation is great to squeeze a pustule or to scrub away a pustule area. Squeezing a pustule can cause not only some of the contents to come out, but also inadvertently push some of it in deeper. This can lead to more inflammation and even scarring.
Exfoliating on rosacea skin can lead to more skin irritation and burning.
