by the Alurx Medical & Expert Council
Rosacea is best thought of as overly sensitive skin. The skin flushes easily in response to heat, stress, spicy foods, and a variety of other triggers. It’s best to think of rosacea as a 'reactive' skin condition. The skin reacts to a trigger to result in dilation of the blood vessels and result in an increased sensitivity of the skin overall. Because of this, rosacea causes can vary. Since rosacea is a chronic condition, early diagnosis and treatments can control the symptoms. Ultimately it is best managed by avoiding triggers, especially when the holidays are around the corner.
1. Avoiding the diet triggers
When it comes to rosacea, the key is avoidance of foods, such as high histamine foods, that result in flushing as a result of dilating our blood vessels. They include: alcohol (wine and spirits), shellfish, canned foods, smoked meats, legumes, fermented foods (like cheese), some fruits like strawberries, tomatoes, papaya and red plums. Identifying triggers for rosacea can be difficult. Sometimes the initial flushing is missed as people are more often bothered by breakouts that can follow a few days later. There can be a delay in seeing the breakouts that make it tougher to tie back to specific foods. I advise to track the worst days for rosacea flares for a month, and identify the triggers with your physician before proceeding with an elimination diet.
2. Adopt a “prebiotic diet”
There are also some studies that have linked a higher prevalence of GI disorders and bacterial overgrowth in our gut to flaring rosacea. Hence, a diet high in fiber may actually help reduce flares and reduce inflammation. This is referred to as a “prebiotic” diet rich in fiber that is not processed until it gets to the colon. Probiotics are the “good” bacteria for your colon. Prebiotic foods feed or support probiotics. Prebiotic fibers include: onions, raw garlic, bananas, endives, asparagus, whole grains.
If your rosacea is flaring early in the week but settles down through the week, focus on your weekend habits. If you start the week out great but your skin spirals out of control during the week, take a good look at your routine habits during the week. Consider how excess coffee or caffeine, lunch at work or wine at dinner may play a role. Sometimes the issue is less dietary and more stress-related. This is worth keeping in mind if your flares are isolated to just a few days a month on your calendar but show no other signs of consistency. In that case, relieving stress through daily exercise, better sleep habits or meditation can be helpful.
3. Get an early diagnosis
Early diagnosis and treatment are key to controlling the progression of this chronic disease and avoid the potential for scarring. Differentiating between acne and rosacea is also essential to find a treatment plan that works. I routinely have patients of color that have seen numerous other doctors and had their diagnoses missed simply because their skin type did not show the classic “rosy cheeks” because it's not as apparent. As a dermatologist of color, I encourage our resident physicians to ask more questions so that they can accurately make a diagnosis.
Most of my rosacea patients misinterpret the ‘breakouts’ they get as acne and resort to OTC acne products. The breakouts from rosacea are different, however, and can often worsen with the use of traditional acne products. This is followed by the skin starting to swell or thicken and taking on an “orange-peel” appearance with widened patulous pores. If it continues, then the skin can become even thicker and result in “phymatous” changes. This is the classic “WC Fields”nose but can also occur on the chin, cheeks, or forehead.
4. Less is more: treatment options
Rosacea is best managed by calming the skin down- not exfoliating. It’s important to use anti-inflammatory ingredients, hydrating ingredients, and avoid products with fragrance and preservatives. Many cases that have already reached the ‘pimple’ stage will need oral antibiotics to resolve. In terms of treatment options, the early disease can be managed with over-the-counter topicals containing azelaic acid or redness-reducing products. More persistent flushing can be managed with prescription topicals. Most of these function as anti-inflammatories. Choosing the right one can at times be a bit of a trial and error game of determining which ingredient works best for you.
For many patients with rosacea,"less is more". Avoid overdoing it with a skin care regimen and start to limit your product choices to only what is needed. Simple cleanser, a moisturizer such as Wrinkle Smoothing Hydrating Cream, and a nighttime cream to protect and/or repair the skin overnight.