We spoke to skin experts and rosacea sufferers for everything you need to know...
When you have rosacea, controlling skin flare-ups and concealing redness may feel like a never-ending battle. And it may be more common than you think as, according to the NHS, an estimated one in 10 people in the UK have the skin condition.
So what causes it and, more importantly for those struggling, can it be treated? We spoke to skin experts and people with rosacea to get the lowdown, from potential triggers to how it can be managed on a day-to-day basis.
What is rosacea?
‘Rosy cheeks and warm, flushed skin are some of the tell-tale signs that you might have rosacea,’ says Dr Kemi Fabusiwa, aka Dr Fab, founder of the Joyful Skin clinic. ‘Rosacea is a chronic, inflammatory skin condition that is characterised by hypersensitive skin, red rosy cheeks, pimples and pustules.
‘Individuals who have rosacea will first start to experience flushing and widespread redness across their cheeks, nose and chin, but as the condition progresses people start to notice dilated blood vessels, pustules and blemishes,’ she adds. ‘Over time, if the condition is left unmanaged, it can result in thickened skin, damage to the eyes and a mishapen, bulbous nose.’
Although rosacea is frequently seen in individuals with white skin – ‘the flushing, redness and dilated blood vessels are immediately noticeable and can affect one’s self-confidence’ – Dr Fab stresses that cases in people of colour are by no means rare.
‘The central redness that is normally easy to spot may go unnoticed in darker skin, especially if the individual also suffers from hyperpigmentation. For this reason, rosacea is often misdiagnosed,’ she explains. ‘Dark-skinned individuals should look out for warmth and flushing, especially after certain triggers, as well as a burning or stinging sensation after applying certain products.
‘The best way to assess whether a darker-skinned person has rosacea is to properly visualise the skin under adequate lighting and try to assess if there is any underlying redness.’
What causes rosacea?
‘We don’t know the exact cause of rosacea, but we do know is that there are several things that can increase your risk of having it,’ says Dr Fab. ‘Those who are most at risk are fair-skinned women between the ages of 20 and 50, but actually anybody can have it. Risk factors for rosacea that you can control include alcohol, spicy foods, UV radiation from the sun and your levels of stress.’
‘There are many potential contributing factors [of rosacea]; an impaired skin barrier can allow irritants to enter the skin, causing inflammation, and free radical damage can also play a part in intensifying inflammation,’ explains Daniel Isaacs, Director of Research at Medik8. ‘That’s why we advise those with rosacea to implement daily sun protection as well as anti-pollution skincare in their regimes.
‘Abnormalities in blood flow through facial blood vessels can cause flushing and persistent redness, and having a family member with rosacea may also make you more prone to developing the condition. Rosacea has also been linked to certain bacteria found in the gut, which may play a role in developing it.’
How to treat rosacea
‘As with most skin conditions, prevention is better than cure,’ says Dr Fab. ‘Your skin is hypersensitive and so it is important to know which triggers are causing your skin to react and avoid them as much as possible.
‘It is also important to protect your skin’s defensive moisture barrier. You can do this by avoiding irritating soaps and instead switch to calming cleansers – why not try Cetaphil’s Gentle Skin Cleanser (£9.50, Boots).
It’s also important to avoid harsh exfoliators and scrubs that are irritating skin that is already hypersensitive. This is particularly important for those with dark skin, as damage to the skin’s barrier also makes you more likely to suffer from hyperpigmentation.
‘Avoid the sun like the plague and wear SPF every day, remembering to reapply it after two hours. Consider trying La Roche-Posay’s Rosaliac range, which is often recommended by dermatologists and is a line dedicated just for those with rosacea.
‘If your rosacea starts to have an impact on your self-confidence and you’re not able to manage it on your own, then it may be time to see your doctor. It is after all a medical condition that can be managed with active agents such benzoyl peroxide and retinols or even antibiotics and if it starts to affect your eyes and nose then it’s definitely time to get a referral to your dermatologist. This is to prevent the the severe, longer-term complications of rosacea.’
Medik8’s Daniel adds: ‘Antibiotics are sometimes prescribed, as their anti-inflammatory properties can help to take down redness. Specific skincare is often prescribed to rosacea patients, usually containing metronidazole, azelaic acid or vitamin A.
‘Some dermatologists will refer you for light-therapy, which uses laser pulses to remove visible blood vessels and reduce excess redness, but long term therapy is often required due to the chronic inflammatory nature of the condition. Treatments and their duration should be tailored towards each individual with the help of an experienced dermatologist.’
Lex Gillies was diagnosed with rosacea when she was 21. She blogs about skincare and nail art as Talonted Lex and is a rosacea ambassador for the British Skin Foundation. ‘Over time, I have identified most of my triggers and learned to remove them or minimise them as much as possible – which is often easier said than done!’ she says.
‘My main trigger is definitely stress, and although I’ve made some changes to reduce my stress levels – including leaving a very intense job – some stress is unavoidable.
‘My other triggers are common ones,’ she adds, ‘extremes of temperature – hot showers, the hair dryer – the sun, air conditioning, alcohol, hot drinks, and certain skincare ingredients. It was a long process to isolate what makes my skin unhappy, and was hard to accept such a drastic change in lifestyle.
‘At times it felt insurmountable, but I’ve found a great balance with my rosacea. If I want a huge plate of cheese or a glass of wine after a bad day, I’ll weigh up that need against how my skin will react; sometimes it’s worth it, sometimes it’s not. But once you know your skin better, it gives you the control to choose how you deal with it.’
Rosacea and diet
With many medical conditions, not just rosacea, patients may try to manage the symptoms through their diet – dairy and acne being a prime example. ‘Rosacea patients are advised to closely assess and identify lifestyle and environmental factors that could exacerbate redness, says Daniel. ‘In terms of diet, it is best to avoid spicy foods, hot drinks and alcohol, which can naturally cause flushing.’
‘Diet has been a big change for me,’ says Lex. ‘I’ve mostly removed dairy from my diet as it has an instant effect on my skin. I’m gluten intolerant (along with a few other foods), and that intolerance often triggered my rosacea, so by removing these ingredients I’ve improved my skin.
Best skincare for rosacea
‘Skincare routines can aggravate or soothe redness-prone skin. Using a soap-free, pH balanced cleanser helps to keep the skin’s protective barrier intact so as not to irritate the skin. Occlusive moisturisers [those that block the skin’s water loss] can also help to restore this protective barrier to enhance the skin’s defences against the environment.
‘High SPF sunscreens are also advised as the sun can aggravate the condition. It is also good to avoid irritating ingredients such as menthol, camphor, strong fragrances and sodium lauryl sulfate.’
When it comes to specific brands and products, Lex has her favourites that prove to be very effective. ‘Brands that I tend to go back to regularly are Avène and La Roche-Posay – the French really know their sensitive skincare!’ she says. ‘In particular, Avène’s Tolérance Extrême range and La Roche-Posay’s Toleriane range are wonderfully gentle, but really work.’
The important thing to remember is that a diagnosis isn’t the end of the world. ‘At 21, it was very difficult to hear that I had an incurable skin condition and that if I was “serious about treating it” I should give up alcohol, make-up, hair straighteners, sugar, junk food…’ says Lex.
‘I had a very unsympathetic GP who made me feel very vain and stupid for worrying about my skin – but the psychological effects of my rosacea have altered every part of my life, from my relationships to career and self-esteem.
‘One of the main reasons I talk about it so openly is to raise awareness of the condition; I hope that, by increasing public awareness, the act of showing my bare face to the world won’t be seen as “brave” anymore – that I’ll just be another face in the crowd.’
Best make-up for rosacea
‘Rosacea is something I’ve weirdly come to love, because it has connected me with so many women!,’ Rose Gallagher of Mixed Gems Beauty tells us. ‘By day, a distracting patter of redness in my skin that can drive me mad and make me feel self conscious.
‘But by night, it is something that leads me to have long and interesting conversations with other people that have rosacea, who have fallen into my Instagram DMs and are amazed that I’ve had the balls to show my face make-up free.
‘Rosacea is definitely an emotive skin condition for me, and it impacts the way I see myself. But, I really enjoy delving into skincare and make-up, and find huge enjoyment in sourcing the best remedies in both. My friend Talonted Lex [above] has the most incredible blog about her rosacea experience that I would really encourage you to check out, complete with downloadable assets like checklists and diaries that will help you to track and manage your rosacea symptoms.’
‘I became the UK and Ireland brand ambassador for IT Cosmetics simply because I didn’t shut up about how well this covered my rosacea… True story! Don’t be deceived by the name; this CC Cream offers a full spectrum of skincare, SPF 50 (crucial for rosacea prone skin) and a completely full coverage finish. What I love about this is that it still looks dewy even though it covers so well, so you don’t look like you’re wearing lots of make-up, you just look like you have clear skin.’
‘Speaking of cream textures, this Becca illuminator is ideal for textured skin. If you’ve had a bumpy rosacea breakout, a liquid will sit gently over any texture as opposed to a powder, which may cling in places. This one is my favourite for unparalleled glow that doesn’t look or feel heavy on the skin, but really catches the light in real life and in photos.’
‘Hush is a peachy cream that simply gives a well lit complexion in one sweep. Press this into the cheekbones, temples, bridge of nose and forehead to add radiance to the skin and detract from any redness. It is my belief that everyone looks infinitely more radiant in Hush. Ultimately a highlighter, I feel like you can use this a little bit of everywhere to achieve a fresh skin look.’
‘Not strictly a make-up item, but this mist from La Roche Posay will not only seal make-up in place, it will help to calm and soothe irritated skin. I use this before make-up, throughout my skincare routine, and to seal in a full face for the day. While you’re there, LRP are home to some of the simplest rosacea skincare heroes. Everything is simple, gentle and fuss-free.’
Expert tips for dealing with rosacea
Facialist and rosacea sufferer Lisa Franklin has spent years researching the condition, and has come up with five tips to help manage flare ups:
- Rose quartz facial tools, such as a roller or a Gua Sha, are ideal for skin conditions such as rosacea because they’re so cooling on the skin. They regulate the skin and help instantly calm any redness. For an extra cool hit, try popping them in the fridge for 15 minutes before you use it.
- Look for nutrients in your diet that help strengthen the immune system and guard against inflammation. I love rosemary – it’s high in carnosolic acid, which helps combat free radicals (one of the main causes of DNA damage) and reduce rosacea flare ups
- Maybe the most difficult one, but avoid touching your face too much. Cleanse with warm or tepid water and use cleansers and concealers developed for sensitive skin
- Don’t forget your – you will need products that help limit exposure and protect against UV during a flare up. The fragile capillaries of rosacea sufferers can be easily damaged by UV, resulting in thread veins and reddened skin. Products rich in Vitamin B3 will also help protect from infrared, which has the same effect as UV rays.
- The first product I created to help with my own rosacea was my Lisa Franklin Pro Effect Luminescent Base. It’s a mattifying serum that also primes skin for make-up. It contains both rose quartz and rosemary leaf extract to soothe, alongside diamond particles that reduce the appearance of redness and frankincense that reduces inflammation.
Clinically proven to improve the appearance of irritated skin. While it won't cure your rosacea, it will help alleviate redness and inflammation.
This is an intensive treatment that nourishes and hydrates the skin. There are only seven ingredients in the formula, so it's really simple and can be used every day. Pop it on as soon as you get home from work.
Not only does this offer relief from ultra sensitive skin, but it also evens out your skin tone and masks the redness.
Developed with rosacea-prone skin in mind, this day cream conceals redness, reduces symptoms over time and protects against UVA and UVB rays.
As Lisa Franklin mentioned, a rose quartz facial roller with cool hot and irritated skin, as well as stimulating lympathic drainage and increasing micro-circulation.
This hypoallergenic line is ideal of rosacea sufferers. It's fragrance free and contains soothing ingredients.