Archive for the ‘ Rosacea ’ Category

5 Simple Skincare Cheats To Improve Your Rosacea

Red faceYou’re red, you’re bumpy and you’re fed-up. Especially now we’re in the throes of winter. You get off the overheated tube into the stinging, cold wind and then back into a centrally-heated office. Your face is tingling and you know without even looking that your cheeks and nose rival those of Santa.


You’ve tried lots of anti-redness creams but they sting and burn when you put them on, they don’t seem to do much ….and as for green colour-corrective make-up…forget it.


How to get your complexion more compliant? Prescription products are a big part of the story; but I think that the bit that doctors often don’t spend enough time on is the support system. Here are some ways to calm troubled waters with good skincare choices.


  • Cleanse with care.

82% of rosacea sufferers complain of sensitivity to skincare products. This is due to a defect in skin barrier function, a part of the disease often forgotten but practically, this is a huge issue for women. “Everything burns” patients frequently say, when it comes to skincare.

So do use gentle non-foaming cleansers containing synthetic detergents, which are labelled fragrance-free (as opposed to unscented). Pat skin dry – don’t rub.


  • Ditch counter-productive habits.

This means physical exfoliation is to be avoided. Like, totally avoided. I even recommend skipping using a face cloth. Also skip products with questionable benefit that frequently do harm, like astringent toners – avoid anything with alcohol or witch hazel in it. The one exception to the exfoliation rule is the use of salicylic acid, a beta hydroxy acid, which is useful in those with oily skin and also prone to acne blemishes and comedones, as its anti-inflammatory.


  • Moisturise but don’t antagonize.

The right moisturiser will improve skin texture (so often those with rosacea have skin that’s rough to the touch) and boost skin tolerance. I think that moisurising flexibly is a good idea – I talk to patients about good days’ (lighter) and bad days’ ( a little more oomph) moisturiser. Skin is a dynamic organ and it will be oilier in the week before your period and at certain times of year – we should adapt to our environment accordingly. Water-based moisturisers work best and f you’re also prone to acne blemishes (common conditions commonly overlap) stick to non-comedogenic products, from brands like Cetaphil and Avene.


  • Don’t skip on UV protection

Physical sunscreen tends to be better tolerated and less irritating than chemical sunscreens; applying moisturiser beforehand facilitates smooth application without annoying pilling, where little white bits come off…and allow time for it to dry before putting on make-up. I think that it is very much worth investing a little more in this product to find one that’s cosmetically elegant to ensure you apply it properly. Not only is sunlight the commonest rosacea trigger, rosacea plus sunlight is a potent way to degrade your dermis and age prematurely. Brrrrr.


  • Avoid heavy cosmetics that require a Brillo pad to remove.


Keep base light and low risk for irritation (Bioderma and La Roche Posay both do great sensitive skin-friendly products) and use a more high coverage product just where its needed; for this Vichy Dermablend Liquid Foundation works well. Apply with a damp Beauty Blender to gentle build coverage just where its needed.


If there any specific questions relating to rosacea I’ve not answered (it’s a big topic, and one of the most searched for on my blog) drop me a line below.


4 Sobering Skin-related Reasons To Moderate Your Alcohol Intake

Alcohol consumption in women is a topic that keeps cropping up in the press – especially since NICE approved the drug nalmefene for ‘mild alcoholics’ who failed to cut down on drinking 2 glasses a wine a night after a 2 week trial period. Sober October lends itself to a self-imposed trial of abstinence – but it may be worth considering the negative impact alcohol has on the skin in order to harness the extra motivation that beauty benefits deliver. There’s no doubt in my mind that smokers may often find that extra bit of will-power to say no when the ‘carrot’ is probable improvement in acne and wrinkles. So lets consider the possible fall-out from too much booze:

1) Flaming cheeks

Alcohol vasodilates, meaning that blood vessels on the surface of the skin widen, increasing our natural ‘blush’. In certain individuals, this can lead to a debilitating prolonged ‘flush’, causing embarrassment and self-conciousness. This is a sign of alcohol intolerance, as it represents low levels of an enzyme called acetaldehyde dehydrogenase that breaks down one of the alcohol byproducts. Result? Major hangover the next day.

In terms of appearances, the situation is even worse for those with rosacea – alcohol is a known provocateur, with as little as one drink causing problems in as many as 2 out of 3 sufferers. Redness is a hard thing to conceal cosmetically, as many who have tried (and failed) with green-tinged camouflage make-up will attest.

2)Parched pillow face

Yes, alcohol is a diuretic and the accompanying dehydration and disturbance in sleep quality will take its toll on your complexion the morning after. Dry, dull skin is likely to be accompanied by puffiness, especially around the eyes (not a particularly attractive combination), as a consequence of the added salt in many alcoholic beverages like margaritas, beer and white wine.

And the symptoms of a hangover will be much worse if you drink dark spirits like rum and whisky – they contain congeners, chemicals produced during alcohol fermentation that give the drink its flavor.

3) Blemish booster

The sugar in many alcoholic drinks (take a mojito, for instance) causes insulin levels to spike – this creates a pro-inflammatory milieu that can trigger an acne flare.

4) Flaky follicles

Regular guzzling of alcoholic beverages can also drive a number of common dry skin disorders, namely psoriasis and seborrhoeic dermatitis – one of the commonest manifestations of these 2 disorders is a scaly, dry scalp.  As if that wasn’t enough, increased alcohol intake makes you more likely to develop psoriasis in the first place.

So there you have it – beaucoup booze can make turn you into a spotty, ruddy, flaky, crispy-skinned person. So how to drink safe and preserve your looks at the same time? Aim for moderate drinking, ensure you have 2 nights off a week to give your body time to recover and choose your beverage with care. Skip sugary mixers + dark liquors, try to eat at the same time as drinking and alternate an alcoholic beverage with a glass of water – your skin will say thank-you.

Extinguishing the Fire of Rosacea (the most-searched tag on my blog)

Rosacea is probably one of the commonest and most annoying conditions-it can render the sufferer beetroot red at a moment’s notice, and usually when least convenient. Unpredictable and terribly self-conscious making.

Treatment works best on the spotty papulo-pustular type; treating the flushing, fixed redness and broken capillaries is harder. But the key to developing better treatments is a more detailed understanding of the processes behind the disease, and how current therapies modify it. I think we can now safely say we we’re closer to understanding this capricious condition.

The key to understanding rosacea is to appreciate how the skin senses the environment, in it’s bid to keep our insides safe. The innate immune system is a primitive-but-useful part of this protective mechanism that serves as a warning system, which responds to dangers in the environment. Like the sun. But in rosacea, this system is hyperactive and over-anxious.

Think of it like a fire-alarm-designed to ‘go off’ when there is a significant hazard. Like the oven has caught fire. Instead, it goes off when the kettle boils. The premature alarm generates pro-inflammatory changes, which are disproportionately strong. This leads to leaking from capillaries, weakening of capillary walls leading to inflammation and visible surface blood vessels. And, through the release of nerve-stimulating peptides, can cause burning, stinging and sensitivity. And all of this is compounded by sun exposure, with the associated damage to elastin and collagen fibres that can further weaken blood vessels and strength of the skin’s scaffolding.

Finally, if this goes on unchecked, the chronic, ongoing inflammation can recruit white cells and overwhelm lymphatic vessels, leading to fibrosis and distortion of facial features, like the nose.

Much of this process is due to genetics with environmental triggers. People are probably bored of hearing about sun protection, but I think the above explanation makes it clear that first-line therapy for rosacea sufferers is to know your environmental triggers and use daily sun protection. I find patients tolerate a well-formulated sunscreen with broad-spectrum filters-I like both Obagi and Skinceuticals sunscreens for this reason, as they really are compatible with daily wear.

The treatments that I think work best have been shown to influence the innate immune system-oral tetracyclines turn down the over-active response pathways generated by the alarm going off, as do effective topical agents like azelaic acid.

In the future we will have better treatments to target the premature alarm bell itself-receptors called Toll-like receptors. We think azelaic acid may well do this too. And we will also be better able to target the family of response molecules called cathelicidins which have a specific action on the blood vessels themselves.

A complex disease with complex mechanisms-but I think we’re getting thereJ

The Red Face of Rosacea

One of the commonest inflammatory disorders, it spares no-one, from famous comedians (WC Fields) to world-leaders (see left), frequently chronic…..and is the cause of tremendous distress and embarrassment on a day-to-day basis. It’s commonest in those between 30 and 6o and typically affects us light-skinned Celts. It can be surprisingly tricky to eliminate altogether, but with a few simple tips, should become a lot easier to handle.

The earliest signs are often subtle-a tendency to a prolonged blush after a hot drink or spicy food; this may then progress to the erythemo-telangectatic phase, with fixed central facial redness, typically on the nose and cheeks that doesn’t go away. Acne-like lesions with red spots and white-headed pustules may be superimposed upon this-but what is distinct about rosacea as opposed to ordinary acne, is the absence of blocked pores or comedones. Also the inflammatory spots themselves are often dome-shaped, rather than ‘pointy’ (if that doesn’t sound daft!), which is what you typically see with whiteheads in acne.The sebaceous glands of the nose and chin may over-grow, resulting in a condition called rhinophyma-but this is more common in men. Finally, a symptom that is often overlooked is that of dry,gritty, red eyes, which may be part of the disorder-ocular rosacea. It can affect as many as 1 in2 patients so is an important aspect of the condition.

The exact cause of rosacea is unknown but we know genetics are important, and the trigger may well be immunological, possibly due to over-production of a protein involved in protecting us against bacteria called cathelicidins. Topical steroid use on the face (for conditions like eczema) can also trigger rosacea, and given that redness is also a feature of this condition, can make diagnosis challenging.

I think one of the most important aspects of managing rosacea is knowing what to avoid and using the right type of skincare, something busy physicians often forget to discuss. Know your dietary triggers, be very cautious about sun exposure and take care with environmental extremes of temperature like saunas. Certain ingredients like alcohol will often sting, due to a defect in the barrier function of skin afflicted by rosacea; similarly, oil-free, water-based cosmetics and sunscreens are better tolerated. Cetaphil Gentle  Cleanser and Moisturising Lotion (which are non-comedogenic) are generally well-tolerated and soothing. I also find patients like Avene and Eucerin’s anti-redness ranges.

Medically, oral anti-inflammatory agents like Efracea (which is a low-dose of Doxyxcycline, avoiding its anti-bacterial effect) and Finacea (15% azelaic acid) tend to be effective at managing the ‘spotty’ aspect of the disease. Treatment is usually needed for 8-12 weeks, sometimes longer. Finally, for persistent redness and broken capillaries, light sources like IPL are invaluable (and really the only sucessful option for this aspect of the disease).

As with most inflammatory skin problems affecting the face, unpredictability is one of the most vexing aspects of this condition-so know your triggers, avoid irritants like aggressive scrubs and astringents, use gentle skincare/broad-spectrum sun protection and medicate when needed….life should get a little less testing.