Rosacea: A Holistic Guide
What is Rosacea?
Rosacea is a chronic and persistent skin disorder that is characterized by one or more of the following: facial flushing, telangiectasia (visible small broken capillaries), inflammatory papules and pustules, and thickening of the skin. Many patients with rosacea also report increased sensitivity and frequent burning sensations/ irritation in response to many topical skincare products. There is a genetic component to rosacea, with higher rates reported in people of Northern European/ Scandinavian descent, though people of all ethnicities can be affected.
Onset usually occurs around 30-50 years of age, and is exacerbated by certain lifestyle factors including exposure to extreme temperatures, alcohol, spicy foods, and stress. There are 4 main subtypes of rosacea, each with their own set of characteristics, though they can often be overlap among the subtypes.
4 Subtypes of Rosacea
Erythematotelangiectatic: redness/ ruddiness of the central face; skin sensitivity; visible broken capillaries (telangiectasia); skin flushes easily
Papulopustular: persistent redness of the central face; papules and pustules
Phymatous: thickened skin with prominent pores may affect the nose, chin, forehead, ears, and/or eyelid
Ocular: visible broken capillaries and redness around the eyes; often feels like a foreign body is in the eye
Before rosacea can be treated, it needs to be diagnosed by a qualified health professional. It can often present as or even co-exist with acne, though different approaches are necessary for rosacea and acne.
Topical Approach
I often say that “less is more” when it comes to skincare, and this is especially true when it comes to rosacea. Because skin affected by rosacea is often more sensitive, a simple and discerning protocol of soothing, anti-inflammatory ingredients is necessary. Things like harsh exfoliants, alcohol, and astringents should be avoided, as should all fragrance, most essential oils, and any foaming/ overly stripping cleansers.
Ingredients to Avoid
Foaming cleansers/ antimicrobial soaps
Astringents (alcohol, witch hazel)
Benzoyl peroxide
Chemical sunscreen
Fragrance
Camphor
Menthol
Harsh AHA’s and BHA’s (glycolic acid, salicylic acid, etc.)
Prescription retinoids
Harsh physical exfoliants
The focus should be on keeping the skin barrier intact while avoiding “trapping in” heat. Beneficial ingredients include hydrating products, anti-inflammatories like green tea, zinc, niacinamide (Vitamin B3), and certain soothing botanicals like marshmallow, chamomile, and calendula.
Suggested Skincare Routine
AM:
Spritz face with a hydrating toner like Laurel Chamomile Hydrosol or Hydrating Elixir II
Apply Osmosis Rescue MD to damp skin
Moisturize with Laurel Essential Lipids
Apply Tizo Ultra Zinc
PM:
Cleanse with Laurel Essential Lipids
Spritz face with Laurel Hydrating Elixir II
Apple Osmosis Rescue MD
Moisturize with Laurel Essential Lipids
This particular skincare routine only requires 3 products + a zinc-based SPF. Osmosis Rescue contains a powerful patented anti-inflammatory compound called Trioxalane, which improves the skin barrier and calms inflammation and redness. Laurel’s Essential Lipids is a beautiful multi-purpose product that serves as an oil cleanser, oil serum, and moisturizer. It is free of essential oils, making it suitable for those with skin allergies. You can use a facial roller or Gua Sha stone on your skin after applying your skincare products; the gemstones are cooling for the skin and aid in lymphatic drainage.
Because UV exposure is another trigger for rosacea, it’s important to protect your skin with a mineral, zinc-based SPF. Zinc has the added benefit of being anti-inflammatory, and I’ve been a long time fan of Tizo’s line of zinc-based SPF’s, which come in both tinted and non-tinted versions.
You can also incorporate a weekly mask like the Gentle Mask by Laurel, which contains medicinal roots, flowers, mushrooms, and berries and is rich in mucilage, humectants, and saccharides.
Internal Approach
In ancient medicine systems like TCM and Ayurveda, rosacea is considered an “excess heat” condition, and therefore should be mitigated with foods that are cooling in nature. You’ve probably heard that rosacea patients should avoid “spicy” foods, but it’s important to note that certain spices are warming in nature, while others are cooling. Cinnamon, cloves, and ginger are “warming,” for example, while mint and cilantro are “cooling.”
There are four main categories of dietary triggers that should be avoided in rosacea skin: cinnemaldehyde containing foods, capsaican-related foods, alcohol, and heated beverages.
Foods to Avoid
Foods containing cinnemaldehyde: cinnamon, citrus, tomatoes, chocolate
Hot beverages: stick to room temperature drinks
Cayenne, red pepper, hot sauces
Alcohol, especially red wine
Coffee
High histamine foods: aged cheeses, processed meats, most nuts
Foods to Include
Probiotic rich foods including sauerkraut, kimchi, and miso; high-quality yogurt and kefir if dairy is tolerated
Prebiotic rich foods including vegetables, legumes, and whole grains
Healthy fats high in Omega 3’s including salmon, sardines, olive oil, walnuts, etc.
Berries
Melons
Leafy greens
Seeds including flax, pumpkin, and sunflower
Supplements to Include
Pre/probiotic: My top choice is SEED probiotic because it’s designed to survive the intestinal tract and make it to the colon, is formulated with both probiotics and prebiotics, both of which are paramount to a healthy gut flora, and includes specific strains that benefit the skin.
Vitamin B3/ Niacinamide: Improves barrier function and reduces redness and inflammation.
Selenium: Modulates vascular function which can help address telangiectasia. 2-4 Brazil nuts per day will fulfill your daily selenium requirements.
Other Correlating Factors
Like everything else, the pathogenesis of rosacea does not happen in a vacuum. There are many other factors to consider, and the full manifestation of rosacea symptoms is usually a perfect storm of genetics, diet, and lifestyle factors.
Demodex Mites
There is a direct correlation between rosacea and an increased amount of demodex mites on the skin (their population is about 50% denser in rosacea skin), which raises a bit of a “what came first, the chicken or the egg?” question. There is some anecdotal evidence that the topical use of probiotics can help restore balance to the skin’s microflora, thus helping control the amount of demodex mites.
In my opinion, the misuse/ overuse of certain topical ingredients can, over time, damage the skin’s microbiome and create an unhealthy balance of bacteria. This creates the perfect environment for more malevolent species to populate. Marie Veronique, who I have long admired in the esthetics industry, has a line of microbiome-friendly products which work to help restore this balance. Her Pre + Probiotic Daily Mist helps introduce more of the “good guys” to the skin to help crowd out the “bad guys.” She is also an advocate of cleansing with yogurt, and we love a resourceful queen.
The Gut Health Connection
There is a very real connection between the gut microbiome and the skin that is now referred to as the “Gut-Skin Axis.” Rosacea in particular has been linked to both small intestinal bacterial overgrowth (SIBO) and H. pylori infection. Signs of H. pylori infection can include redness under and around the nose and gastritis. While the conventional course of treatment for H. Pylori involves antibiotics, I encourage everyone to be more discerning in their usage of antibiotics (I am not a doctor, as a disclaimer).
Sulfurophane (a compound found in broccoli sprouts) and EGCG (a polyphenol found in green tea) are two examples of dietary inhibitors of H. pylori. Probiotics have also been shown to help eradicate colonies of H. pylori, specifically the Bifidobacterium strains.
If SIBO is the underlying cause of rosacea, adopting a low-FODMAP diet is the best course of action, in addition to everything discussed above. Working with a functional health practitioner can help you get to the root of the problem, and can provide you with a results-oriented course of action.
Stress Management
One of the biggest triggers of rosacea is emotional stress; in fact, a study by the National Rosacea Society identified emotional stress as the second most common trigger, behind UV exposure. This is why it’s so important to prioritize stress management techniques. The goal is not to eradicate all sources of stress, but rather to shift your response to life’s daily stressors. Some mindfulness techniques to explore could include breath-work, yoga, gentle forms of exercise (intense exercise is another trigger of rosacea), and meditation.
I am also a fan of adaptogens like holy basil, ashwagandha, and astragalus (among many others) to modulate the stress response. Establishing boundaries with friends, family, and co-workers, and taking time for self-reflection are all important components to maintaining emotional health. The field of psychodermatology is something that fascinates me, as it looks at the holistic mind-body-soul package and how they all interplay.
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