Since Jina has stimulated a conversation about rosacea, we thought we would do a quick post on the subject. Maybe we will do a part two about management. But Dr George thinks he may be onto something new.
Not all redness is rosacea, and not all rosacea is the same.
Rosacea starts with redness, caused by excessive blood congesting within sensitive tissues of the face. Redness can be accompanies by itching, burning, and stinging. These are signs of inflammation. It starts out being intermittent, but then stays longer each episode, until some residual redness is present all the time. There are many “triggers” to redness (see below). As the condition progresses, inflammation increases, and papules (bumps) and pustules (bumps with pus) can appear, sometimes persisting for weeks. Facial pores become larger and prominent, and with solar exposure skin becomes yellowed, leathered (elastosis) and more prone to be wrinkled. Eventually the problem spreads from the face to also include neck, chest, and scalp regions. Visible spider veins (telangiectasia) can appear. Some go on to further stages including excessive inflammatory lesions, swollen nose, scars, and deformities.
Flushing, Blushing & Redness
Rosacea sufferers have more facial blood vessels than the average person and their blood vessels are abnormally constricted due to swelling and inflammation. There are various factors that cause rosacea facial vessels to dilate or contract. But not all persons who easily blush, have flushing and redness, or who responder to triggers like cold have rosacea. Some people genetically have more blood vessels, but they don’t become inflamed and constricted. The only way to tell the difference is by observing over time whether it progresses to lumps and bumps rosacea.
Sensitive Skin
Many people have sensitive skin, and will get redness, itching, stinging and swelling (inflammation) from coming into contact with an allergen (makeup, lotion, dust,, etc.). It usually subsides quickly once the offending substance is removed.
Nervous Blushing & Redness
Embarrassment and social anxiety are familiar feelings, but some people feel these more than others. Personality traits such as shyness may predominate. Blushing, in earlier times, was assumed to be a positive thing in women, evidence of their sensitivity and purity. It is possible to speculate that many with rosacea were getting credit for undeserved wholesomeness.
Redness of this type is caused by nervous connections from emotional centers of the brain which stimulates the sympathetic nervous system. Any activation of these nerves causes ‘constriction of our body blood vessels’ except in the ‘facial blush/flush areas, where dilation occurs. Adrenaline release can also be involved, in situations of fear, anxiety, or fright. It’s part of our ‘fight or flight” reaction in response to danger. Chronic stress and anxiety can lead to prolonged facial redness.
Exercise & Redness
Exercise opens blood vessels in many parts of the body, especially the face and neck, to helps us maintain a normal body temperature when faced with heat production from activity. Lactic acid may accumulate, further stimulating vascular dilatation. This is normal, but can be annoying for persons who do have rosacea.
Smoking & Redness
Nicotine is a vascular dilator. It also depletes the skin of key nutrients, interferes with collagen formation, accelerates the cross linkage of collagen and the hardening of elastin in the dermis, and creates an abundance of free radicals which can then damage capillaries. Smoking, which robs the skin of oxygen, is a potent initiator of telangiectasis.
Cold Weather Blushing & Redness
Redness may result from coming in from the cold into a warm room. When outside in cold weather the distal parts (feet, hands, ears, and nose) get less blood flow than the rest of the body, to maintain body temperature. Upon returning indoors, the higher temperature quickly warms the facial skin and extremities while the cardiovascular system is still in a moderately high exercise mode. The familiar stinging sensation upon rewarming (nose, ears fingers, toes) reflects that rapid change. This is made worse by dryness, as the skin becomes less pliable, and less able to accommodate the sudden increase in blood flow. Cold weather blushing is exaggerated in people suffering from rosacea. They may get more redness, and the redness last longer.
Redness of the Eyes
Many rosacea sufferers have ocular rosacea with symptoms of redness or flushing of the eyes. Any of the above “redness triggers” may be involved. It is often mistaken for eye infections or allergies, with inappropriate medication given, which actually exacerbates the problem if it is true ocular rosacea.
Alcohol & Redness
Alcohol causes the blood vessels to dilate causing redness. The hops in beer, and some of the resins in red wines, can also be vasodilators.
Although these recommendations can help to minimize flushing, still the best thought is “not to drink any type of alcohol”. Even though alcohol sedates, it can prevent a good night sleep as the alcohol stimulates the brain when the brain has its normal pH of 7.4 altered to an acidic range of 7.2; in addition, when the brain pH is lowered to 6.9, the social life ends forever as intoxication is excessive, rosacea terminates, and the sleeper does not awaken “ever”. This would be a very “sad social rosacea diet plan” or a lack of good planning and control.
Foods, Supplements, Medications & Redness
Many medications, supplements, and foods can cause flushing and therefore worsen rosacea symptoms. Niacin, as an example, is a very potent vasodilator. But there are many others. Many antibiotics, including those prescribed for rosacea, can cause skin to flush. Foods, and certain spices in particular, can cause flushing (we will gather a list for you).
The Sun and Redness.
I guess this is an obvious one. What is less obvious is the underlying connection between solar stress “free radical generation), and the progression of rosacea from earlier to later stages. Photoageing is a large contributor.
Hi drjohn,
Thank you for following thru with blog. I love barefaced truth but have would have thought you go with truthinscience. Anyway, look forward to your report on collagen and elastin. Don’t get it when I read about applying those on your skin. I have read that it’s far better to ingest collagen and carnisone. then there are sites that say that gastric juices don’t allow for any absorption. Also, I like Marta and many others on this site suffer from constant rosasea My constant redness stems from spending most of my life on Australian beaches. I now live in Toronto, Canada and the extreme in climate has worn my skin out. At 50 don’t have any major wrinkles to be concerned over but sure wish for some comfort in that there is something to help this flushing.
Regards
Jina, welcome! A fellow Canadian with Aussie connections. In regards to collagen and elastin, these are huge molecules that cannot be absorbed by skin. Just as an example, molecules under 500 daltons in size are easily absorbed, those between 500 and 10,000 generally need some help (carriers). Collagen is on the order of 100,000 to 500,000 daltons. Of course, scientists have been pointing this out for decades, and it hasn’t stopped companies from putting out products claiming collagen (generally from hides of animals) helps your wrinkles (L’oreal, shame on you). And you are right, it won;t be absorbed orally. Like any large protein it gets broken down into amino acids and small peptides. Here’s the bottom line — the way to get more collagen in your skin is to get the fibroblasts there to make more. But they have to be convinced it is needed. More on that soon — this is just a “teaser”. I think you mean carnosine, it is a dipeptide, and can be absorbed by skin. More on that later too.
On the whole Rosacea issue, we need to bring Dr. George into the discussion. We are just completing a clinical trial (stem cell cytokines related) and have seen some results that speak to the redness issue.
Hi, Jina.
This is Dr. George. You and I are in good company with Bill Clinton, Mariah Carey, even J.P. Morgan. We all suffer (or used to in the case of Mr. Morgan) from the angst and embarrassment of acne rosacea. There are millions of us; some estimates say one in ten women and slightly fewer men. You already know this condition is not physically debilitating. Nonetheless, it can make recluses of some individuals for whom florid red flare-ups are simply too much to cope with in social settings. One day your skin is “quiet” and “calm” and the next day florid red patches make it embarrassing to leave the house.
Sadly, no one has figured out exactly what causes the condition although there are a number of postulates ranging from increased leaking and numbers of superficial blood vessels, UV damage to connective tissue, microbial infestation, and genetic predisposition, among others.
For most people, rosacea becomes a decades-long condition that waxes and wanes at varying intervals. Finding an effective treatment can be frustrating. First line defenses include oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics like metronidazole (Metrogel). Centrally acting alpha-2 and beta blockers have been tried. Antihistamines are of not proved benefit. Vascular laser treatments can reduce the redness by destroying superficial vessels through heating, and carbon dioxide laser treatment can be used to vaporize the excess tissue associated with rhinophyma. The not so good news is there is no cure, only management.
Bias Warning – Dr. John mentioned we will disclose any BFT bias. Mine follows.
On July 1st, I discontinued my doxycycline / Metrogel regimen for treating my own rosacea and started using the human stem cell derived skin care system developed by our team of scientists. Over the next two to three weeks my rosacea dramatically improved and has not flared up again since. The 48 person clinical trial of our product commenced two months later and has generated similar improvements in subjects with rosacea. Redness and flushing has dramatically improved in two trial subject, both women, who have had rosacea for years. They, too, discontinued their treatment regimens when they started using our product. Other trial subjects with ruddy, reddish complexions also experienced notable improvement in their skin tone. We will report our findings on rosacea improvement as we expand our user population in the months ahead. Certain ones of the naturally occurring cytokines in our product appear to be responsible. We’re happy about that, especially me.
Dr. George
Hi Drgeorge,
Congratulations on your formulation and your personnal improvement of rosacea. Glad to say mine is not of the acne type my cheeks today are burning and quite red when I come out of the cold into a warm place. I get temporary relief from spraying chamomile hydrasol. I find no moisturizer can help in winter, they all seem to irritate my skin and oils just make me break out eventually. Luckilly I had a great summer and no skin issues but once Canadian cold sets in I tend to suffer:(. I did have ipl last October 5 treatments and I thought that was the reason I had flawless skin this summer. But as soon as October in Toronto set in my redness started up again. I would not mind putting my hand up for a Canadian trial. An excellent formulation would have to weather these conditions. I don’t know should I get more ipl treatments? I don’t know if these lasers will do damage in the long run and how many can a person have.
Hi drjohn,
Use to suffer from breakouts until I came to Canada some 10 years ago. Then I went from oily to uber sensitive and dehydrated skin. There is no aircon/central heating in Sydney homes (think Florida weather). Estheticians and beauty consultants mostly pointed out that I had mild rosacea in Canada. If you think I am a good subject to help your hypothesis, and my redness, sign me up. When do I begin?
Drjohn,
Could the constant redness from many of the above mentioned factors contribute to less wrinkled skin because of the blood and nutrients reaching the skin layers for a longer period? Isn’t that what a lot of cosmetic companies try to achieve when they produce products claiming to stimulate the skin.
That would be poetic justice. But I think not, certainly not if constant. If it is inflammation related (like rosacea) then it is likely to lead to more, not less wrinkling at the end of the day. Blood and nutrients are not really the limiting factor for skin health in normal people, so more is not better. But, if you are truly just a rosy cheeked blusher…. well then maybe. Must be something in the fact that “blush” is the finishing touch for many women applying makeup . maybe something Darwinian there. Survival of the reddest? . Of course, baboon bottoms blush too … but you need to be another baboon to get the message.
Drgeorge
Looking forward to product. My days are described as good skin days and sore skin days with the cold windy days upon us now. Hope ingredients are TIA friendly as most on site that are described as being irritants are pretty spot on with my skin.
Drsgeorge/John
Have been thinking for a while about purchasing a LED light for face. Have read a few sites as how it assists ATP in your cells. The red lights assists in rejuvenation and/or green light in reducing hyper pigmentation and redness. Dont know if you science guys have read any scientific papers. Trying to make up my mind and justify my limited spending money on such a product. Would appreciate your feedback. Did see a derma doctor on tv recommend it to a psoriasis patient as not a cure but a tool to assist in the symptoms.
Jina: when talking about light therapy it’s important to know wavelength, intensity, and duration. I can say that Low level light therapy (LLLT) is generally going to be safe, if not overused. The precise mechanism of action is not clear. I’m betting it is affecting cytokine patterns. Maybe mitochondrial origin (I’ll check with our colleague who is a leading expert on mitochondrial energy metabolism — the ATP angle). It’s effectiveness has been studies in acne (red & blue good results) actinic keratoses (red), and would healing (blue). If it is good for wound healing, it is probably going to prove helpful for damage from chemicals, environment, and photoaging. I will paste below a recent abstract from the September issues of the medical journal Healing.
Injury. 2011 Sep;42(9):917-21.
Light therapy by blue LED improves wound healing in an excision model in rats.
Adamskaya N, Dungel P, Mittermayr R, Hartinger J, Feichtinger G, Wassermann K, Redl H, van Griensven M.
Abstract
BACKGROUND:
Low level light therapy (LLLT) is an attractive alternative to enhance wound healing. So far most studies are performed with red or infrared irradiation. However, we recently showed that blue light (470 nm) can significantly influence biological systems, improving perfusion by release of nitric oxide from nitrosyl complexes with haemoglobin in a skin flap model in rats. Here, we compared the effects of blue and red low level light by light-emitting diodes (LEDs) on in vivo wound healing in an excision wound model in rats.
METHODS:
Circular excision wounds were surgically created on the dorsum of each rat. Excisions on either the left or right side were illuminated post-OP and on five consecutive days for 10 min by LED at 470 nm or 630 nm with an intensity of 50 mW/cm(2),while protecting the contralateral side from exposure. In the control group, neither side was illuminated. On day 7 post-OP, we analysed planimetric and histological parameters, as well as expression of keratin-1, keratin-10 and keratin-17 on mRNA level.
RESULTS:
Illumination substantially influenced wound healing. Blue light significantly decreased wound size on day 7, which correlated with enhanced epithelialisation. Light also affected mRNA expression. Both wavelengths decreased keratin-1 mRNA on day 7 post-OP, while keratin-10 mRNA level was elevated in both light treated group compared to control. Keratin-17 mRNA was also elevated in the red light group, but was unchanged in the blue light group.
CONCLUSION:
In contrast to previous studies, we showed that also blue light significantly influences wound healing. Furthermore, our data suggest that light therapy can play an important role in normotrophic wound healing by affecting keratin expression. Illumination would provide an easily applicable, safe and cost-effective treatment of surface wounds.
Thanks for this. Excellent. Cheers and best wishes for all success.
I have been curious about this for some time. Thank you. This is a very unusual site- I have never seen another one like it. High quality, engaging, but you aren’t selling anything. You give scientific references so its not just your opinion. Impressive.
I occasionally suffer with my eyes (minor ocular rosacea) – but the eye drops do work. I only ever got rosacea on my cheeks and across my nose. I have used the Somaluxe Redness Repair for 7 months both morning and night and I am delighted to say this stuff has completely cleared all symptoms. I use dove soap bar in the morning to wash my face and I apply the Somaluxe Redness Repair once and again before bed. I highly recommend this product and it sounds dramatic to say but its given me my confidence and life back.
Hi DrJohn
I was of the understanding that I had sensitive skin until a formal diagnosis by a dermatologist when I was 48, I’ve basically been a “rosacean” for most of my adult life with flareups due to exercise, heat, red wine, spicy food – pretty much everything pleasurable in life!
From around 34 years of age, my face became increasingly riddled with pimples/pustules and I tried every product I could afford to help but it got worse. I was ashamed of the broken capilliaries across my cheeks and that the skin on my nose was starting to thicken because people started to hint that I had a drinking problem. I would joke that my complexion was so depressing it was making me drink!
New research (and a successful trial of a new product by Galderma called SooLantra) brought to light that the cause of some P&P rosacea was due to a skin mite called the demodex mite. The product was not available in Australia at that point so my dermatologist recommended using a scabies cream called Lyclear twice a day to break the mite’s mating/egg cycle (it contained formaldehyde and after a few months was irritating my skin) and then I started using a lotion called Quellada which has seen incredible results (at a fraction of the price of SooLantra!) and after a year of essentially using an insecticide, my skin recovered.
In hingsight, everyone has demodex mite on their skin however sometimes the balance can get out of whack and looking back, I recalled a time in my early 30’s when I got chicken pox and was very sick with a 6 month recovery period. In that time, the demodex mite got the upper hand. They loved my sebum rich areas (around the nasolabial flaps and my chin) and the more they fed and bred, the more sebum was being produced by my skin as a reaction and the area of reaction increased to cover my cheeks and into my forehead. (It’s fascinating to me now but at the time it was devastating to deal with.)
Since I was able to return the demodex back to balance (you never really eradicate them), I have had 6 sessions of IPL and my complexion is better than ever! I kept a photographic blog of my journey in the hope that my outcome could help others.
In short, I am hoping that anyone reading here with similar rosacea symptoms (p&p), will consider asking their dermatologist to do a skin scraping for demodex mites.
I still do a once weekly application of the scabies lotion to keep the balance in check and occasionally see a pustule around my nasolabial area but it’s nothing compared to how it used to me.
Thank you for your excellent site. I’ve just turned 50 and am finding my skin is thinning and have been researching using microneedling as a way of increasing my depleted collegen levels. Your information about Hyaluron Acid has been valuable!
Thank you Drs John and George.
Cheers
Kate