Debbie Thomas from the D.Thomas Clinic London joined us in The Ordinary & Deciem Chat Room for a Q&A all about rosacea.
Rosacea is an incredibly interesting topic and skin condition which I think many people have but don’t even realise they have it. If you have a lot of redness, rosy cheeks, flushing, visible blood vessels in your face this could be rosacea along with many other symptoms. It may come and go and certain times and can be set off due to stress, food, drink and many other factors.
If you think there’s a possibility you have rosacea and it’s making you unhappy, go and speak to someone. Try to keep a diary of what you eat, drink, do or use that could possibly have set it off. Everyone’s skin is different so it’s important to really get to know yours and what is making it react.
The Q&A with Debbie Thomas.
How can you tell if you have Rosacea?
Rosacea is normally diagnosed by a Dr (dermatologist) as it is a clinical condition. The symptoms that are most commonly associated with rosacea are being very prone to flushing, developing small broken veins in the areas you flush, the skin can also feel tingly, itchy and uncomfortable, some people will also see spots coming up in the area, these can be small rash-like bumps or bigger more solid painful lumps which don’t seem to have anything in them.
When you have had rosacea for many years you will start to notice the flushing becomes more prominent (stays for longer), all the other symptoms become more evident as well. It is most common on the nose and cheeks but can be on any area of the face. Ladies who have lighter skin tones and are 35-65 seem to be the most susceptible, however it can affect anyone.
Some skin on my nose has turned a slight purplish colour since developing rosacea. I am worried I am going to end up with rhinophyma? Is this inevitable?
No, not at all. It would be texture change that could indicate you’re susceptible to rhinophyma rather than colour, the skin thickens and takes on a waxy feel. It sounds like you have got some slightly larger broken blood vessels in the area which can have a blue rather than red colour. If this is the case it is treatable with lasers with really good success rate. For complete peace of mind if possible it’s always best to get a proper diagnosis from a professional who can look at your skin directly.
Are there any specific facials or treatments I can have that could help?
This is a tricky one as there are lots of things to consider from the severity of the rosacea to the overall skin condition and whether you’re looking for a more traditional approach or the more modern clinical treatments. For my clients I’m all about the high tech, I have to take a combined approach, lasers and IPL give the most consistent results but you need to be cautious not to overdo it, always go to someone who is experienced in working with sensitive and rosacea-prone skin.
I also use peels, LED light therapy and homecare products. When it comes to traditional facials with so many brands and techniques I couldn’t narrow it down in terms of what is good but rather I would say avoid brands that are highly fragranced, very oily or high in alcohol also avoid heat like steaming and abrasive treatments like crystal microdermabrasion or scrubs.
How long should we give products a chance to work for to know if they are going to help?
If you´re not having a bad reaction (allergy, rash), then 6-12 weeks is the minimum time it takes to see benefits from products. It can be a little bit disheartening if you don’t see big changes when you invest in new skincare, but it is important to understand what the function of the product is. Sometimes you don’t get a big wow moment but if the science is sound we know that over time certain ingredients are supporting the skins health, they act as preventatives and protectors.
My cheeks become very red and flushed after certain wines and cava. Would this be classed as rosacea? Or is Rosacea something you have all the time?
Flushing while drinking alcohol (or specific drinks) is definitely a early indicator that you could have mild rosacea. Unless you have it diagnosed by a dermatologist you can never be 100% but most of my clients do talk about the progression of the condition from occasional flushing every time they were exposed to the same trigger for instance every time they had wine or spicy food.
It could take several years but then they normally felt that more things would trigger the reaction. I wouldn’t massively worry but rather just put a few things in place to strengthen the skin and ideally avoid the triggers you already know.
Can I ask are there any skincare provisos re Soolantra. Anything that shouldn’t be used with it? Eg can it used with Azeleic acid?.
I would avoid using a active product at the same time (normally it is applied once daily), if it is an am application I would just follow with light hydrator and SPF. Then in the pm you just have to cautiously try products to see if you have a reaction, I wouldn’t go crazy and use too many products or go aggressive with really strong % but I’m not aware of anything you have to avoid so shouldn’t be a problem.
How do you get rid of the blackheads from your nose, when the skin is sensitive /dry and suppose to avoid any harsh treatment or use hot bath/water to open pores? Does seborrhoeic dermatitis and rosacea related?
Both conditions are inflammatory so definitely some cross over. I would say that niacinamide and azelaic acid could be good options for you as they are anti-inflammatory but should also help with texture and pores.
Does rosacea ever go away or is it just something you permanently have to keep under control?
Rosacea is a chronic inflammatory skin condition. Chronic means long term eg no cure, however as there are lots of factors that can contribute to rosacea flaring up including hormonal there are times I have seen it go dormant for months and for some many years and no recurrence. Managing it takes a 360 approach getting the right skincare is essential but diet and lifestyle always have an impact in some way.
Do you recommend any diet related items to complement treatments? Have read some interesting literature on gut skin connection.
I’m not a nutritionist so I won’t go in to huge detail. But in short yes I do think diet matters and gut health is very important. In terms of what to eat more of its green veg all the way as they tend to be most anti-inflammatory I also love turmeric for the same reason, drink water and avoid (reduce) foods that cause inflammation and mucus build up in the body, these tend to be animal-based foods, sugars and for many gluten.
I have always blushed easily, and with exercise my face goes almost plum purple and I have a Burning feeling for hours after, is this a form of Rosecea?
It does sound very likely that you do have rosacea. You have several of the common symptoms.
Are there some preventative things you can do if you don’t suffer, to ensure you don’t get Rosacea in later years?
Some people never get it, so if you think you may be genetically predisposed but don’t have current symptoms it is about weighing up what skin concerns you do have with maintaining healthy skin. SPF is key regardless of skin concern but the DNA damage from UV rays definitely weakens skin making it more prone to inflammatory conditions.
A good antioxidant for the same reason, it helps protect against the weakening oxidative stress from the sun, pollution etc, then peptides are strengthening and repairing. Avoid things that make you flush or go red for prolonged periods (saunas, steam rooms, got yoga etc).
Is Rosacea more common in men? I know more men with it than women. Could that mean there is a hormonal link?
Strangely enough it’s the other way round. However women tend to get/start with milder versions which are often not diagnosed. Whereas men tend to get the more severe so more obvious form.
What is the difference between rosacea and couperose?
Couperose is the term to describe the skin when there are also textural changes like enlarged pores, it also appears more oily or waxy than a traditional rosacea skin.
Can you have rosacea at a younger age, I’ve read that it typically appears after 30?
Yes, rosacea can affect any age it is just much more common over the age of 35
I’m 28 and have had redness on my cheeks, the sides of my nose, between my brows and under my mouth since my teens. It flares up from temperature changes (sauna, hot shower etc), alcohol and stress.
My first bit of advice which is annoying (sorry) but you need to try a steer clear of the things that flare your skin up. This is a progressive condition and the more often it flares up the quicker it progresses, this is because the intense flushing you get is inflammation and inflammation weakens the skin (just a little each time).
It is possible your reaction to the azelaic acid is because your skin is too compromised at the moment so better to calm and restore. Lipids and anti-inflammatory products will help. You could also look at a milder azelaic acid product to start. I would consider an antioxidant and niacinamide as well. It is hard with these types of akin conditions because everyone needs something a little different. You also have the option of prescription medication or creams from a Dermatologist.
Are acids and retinol a no no with rosacea?
Not at all but you do need to be more cautious and slowly add them in. Also start with milder formulations So you can test your skins tolerance. There will be cases where the skin is too compromised (sensitive and weakened), then you may have to spend time repairing and calming the skin before considering any stronger actives.
Would you have any suggestions for treatment of rosacea following Chemo treatment. My face is a constant red blotchy colour and I have no idea where to start with it, besides the rosacea it is in very good condition.
Firstly I hope you now have the all-clear. So things to look at is firstly are the blotches permanent (always there) if you press them do they fade (blanch) then come back quickly. If this is the case it would be that you have a matting of tiny broken veins the only way to treat these would be with laser or IPL (normally not an issue but check with your Dr re timeings). If it is the more traditional rosacea symptoms then start with a calming product like niods MG, use ceramide based products but not too rich, cerave do a simple cleanser and moisturising lotion.
Ceramides repair the barrier function of the skin which is the uppermost layer that protects the deeper living layers. When your barrier is not working well more irritants can get in and good things like moisture evaporate out. Peptides are also a good addition as the help strengthen the skin overall and I recommend everyone use an antioxidant like vitamin C which also protects and strengthen. Some people can find vitamin C irritating so you can use another antioxidant if you need to. There are also prescription medications available from a dermatologist that can help, these can normally be used alongside you existing regime.
I was just given a prescription for Finacea. Any suggestions for other skincare products to use with this? How long do I need to use the Finacea until I can try to layer other actives too?
Hi, so you are basically using prescription strength Azelaic acid. So to start I would be looking to add in some protective and restorative ingredients like lipids (found in niod MG) if you skin is tolerating the Finacea well then I would start adding other products in within 2-4 weeks. My client’s play around with there regime until it suits their needs. Eg they may only use Finacea at night so they can use antioxidant, niacinamide and SPF during the day.
The most important factor is to be constant with your products, if you feel like the rosacea gets under control don’t jump ship with products (or your main ingredients). However you could look at reducing Finacea to every second or third night giving you the opportunity to use another product on those nights. Then if you get a flare-up you simply increase the Finacea again.
Can I use metronidazole (for rosacea) with other skincare products (like niacinamide, glycolic acid, retinol, vitamin c suspension) for other skin concerns (ageing, acne scarring, textural issues)?
Thank you! yes you can but don’t throw everything on at once though serums can go on first, wait 10-15 mins then apply Metronidazole. It is a antibacterial so shouldn’t interfere with other products. In the am make sure to apply SPF.