Where my Rosacea Witches at??

I’ve been wanting to blog about Rosacea for a hot min! And as all of April has been National Rosacea awareness month-well it felt serendipitous!! As a holistic esthetician, I know skin issues are often more complex than they appear, and Rosacea is no exception. So, I believe it's important to shed light on this commonly misunderstood condition. Let's navigate through the intricacies together so you can feel empowered in managing this skin condition!

And away we go!

WHAT IS ROSACEA?

Rosacea is a chronic and common inflammatory skin condition mainly characterized by facial flushing and redness. It affects facial areas such as cheeks, forehead, nose and chin areas(and sometimes the nose & eyes). There are many different internal + external factors which all contribute and can make this skin condition hard to treat. Although not curable, it can absolutely be managed with commitment and care!

According to National Rosacea Society, It's estimated more than 16 million people in the United States have Rosacea. However, actual numbers could be higher, as many with mild symptoms may not seek medical attention or advice. Often they do not realize they have it! Rosacea can develop at any age, but often starts after the age of  30 and becomes more persistent as time goes on. Fair-skinned people of Northern European regions who flush easily are more susceptible to it, although any ethnicity can develop Rosacea. It is more common in women, yet it tends to be more severe in men and there's also evidence it runs in families!

DIAGNOSING ROSACEA:

In the past, doctors categorized Rosacea into four different subtypes based on symptoms: erythematotelangiectatic, papulopustular, phymatous, and ocular. But this approach didn't always work perfectly. Patients could have signs of multiple subtypes at once, or could progress from one and back to another. Now clinicians are using "phenotypes" to diagnose Rosacea. Phenotypes are just observable characteristics that are common to people with Rosacea. To be diagnosed with Rosacea, you must have at least one diagnostic phenotype which are

1. fixed centrofacial erythema which causes persistent redness on the skin

2. phymatous changes that can cause the nose to appear bulbous and enlarged with skin thickening/ swelling.

Rosacea diagnosis can be also made even if none of the above diagnostics are present. Just so long as someone has at least two of the major phenotypes which I have listed below.

🌹Papules and pustules – Dome-shaped papules often appearing in clusters, with or without pustules. Some may also develop nodules. Can sometimes be diagnosed or thought to be “adult acne”. But there will be a lack of comedones most often.

🌹Flushing – Frequent and prolonged flushing is common with rosacea but it is more noticeable in patients with lighter skin. Flushing often occurs as a response to certain triggers such as exposure to sun, emotional stress, alcoholic drinks or spicy food. When a trigger is encountered, flushing begins within seconds or minutes

🌹Telangiectasia – are dilated blood vessels commonly visible in patients with Rosacea. In-depth examination of rosacea patients with darker skin may reveal these changes even if they aren’t immediately visible to the naked eye.

🌹Ocular manifestations – Rosacea can affect the patient’s eyes. Some of the most common signs or symptoms include bloodshot eyes due to blepharoconjunctivitis, eyelid margin redness and telangiectasia, sties, crusty accumulation at the base of eyelashes, sensitivity to light, burning and stinging, sensation of foreign object, and dry eye. Some patients develop corneal injuries that can affect their vision

While not essential for a proper diagnosis it can also present with secondary phenotypes which are - burning or stinging sensations, swelling, and dry skin.

This latest consensus means that we all need (clients and clinicians alike) to start looking at Rosacea from a different perspective. Keeping in mind this inflammatory condition can present itself on a continuum in various forms. This is particularly helpful because it means we can all work together to achieve more accurate diagnoses and create better treatment plans. So lets promise to harness the power of this newfound knowledge to help care for our skin and others with mindfulness!🖤

 FACES OF ROSACEA:

The above are some examples of how Rosacea may present in a client from National Rosacea Society
*it’s important to note in darker skin tones persistent redness may appear purplish or brown instead of red. And though redness may be hard to see - burning, stinging and flushing may still be felt within the skin.

CAUSES OF ROSACEA:

What exactly leads to the development of Rosacea is poorly understood. Rosacea causes are believed to be multifactorial, meaning they likely involve a combination of different factors. Abnormalities in the innate immune + vascular system, genetics, microbials +demodex mites and environmental factors such as UV may all play a role in the pathogenesis of Rosacea. The exact combination and contribution of each factor may vary from person to person, which can make Rosacea quite challenging to treat!

IMMUNE SYSTEM: 

Rosacea witches have an immune response that is overactive and here are some things going on in the skin which make it so.

Rosacea clients have higher levels of a molecule cathelicidin in their skin. Cathelicidin is an antimicrobial peptide (AMP) that acts as first line of defense against skin infections helping to fight off harmful bacteria + pathogens! However in Rosacea skin, there is a dysfunction in cathelicidin expression. Another factor in altered immune response is TLR-2 receptor, a membrane protein and receptor which serves as a "security guard" for the skin, it is hyper-vigilant in Rosacea even when there is no danger. High levels of Stratum Corneum Tryptic Enzyme Serine have also been observed, and inhibitors fail to turn it off All of these factors lead to continuous triggered over- inflammation in the skin. source

VASCULAR SYSTEM:

Rosacea skin shows an increased hyperactivity in vascularity. Blood vessels within skin are overreacting to triggers like heat, exercise, or red wine etc. When this happens, vessels dilate and let more blood flow to these areas. Eventually, this leads to dilated capillaries and diffused redness. There’s an increase in expression of certain markers in skin which contribute to this altered response.

One is a signal protein VEGF (Vascular endothelial growth factor). VEGF helps create new blood vessels in skin. In Rosacea skin we find there is a large increase in expression of this growth factor. Also exposure to UV radiation leads to VEGF production and can be an explanation for why UV affects Rosacea skin so. There are other markers involved with lymphatic vessels and cells lining blood vessels. Meaning there’s an increase in blood and lymph activity within Rosacea skin. These ellular processes contribute to swelling and redness found.source

GENETICS:

Yep you guessed it my witches! There is in fact research now which shows there's a genetic component to Rosacea. Studies have found that up to almost half of people with Rosacea have a family history of the condition! Also two genetic variants in Rosacea have been located in areas of the genome associated with autoimmune disease.

* If I have a client presenting with signs, I will absolutely ask if anyone in their family has been diagnosed with Rosacea. Or just if anyone close to them experiences flushing or redness- as many have never found out they have it. And of course, I myself cannot diagnose but can recommend a dermatologist for you! source

MICROBIALS & DEMODEX MITES:

Demodex mites are microscopic mites that live on human skin and are a totally natural part of the skin's microbiome. totally natural part of our skin as these mites are a part of our microbiome - the community of microorganisms that live within and on the body.

And though they’re found on everyone people with Rosacea tend to have more especially on their face.They have been found in numbers fifteen to eighteen times higher. These mites are also found more densely on papules and pustules in particular.

Studies have also discovered that Staphylococcus epidermidis- a type of bacteria normally found on skin was present in papules and pustules from Rosacea clients compared with none on a normal patient’s skin.

Additionally a bacterium called Bacillus oleronius has been found to triggers an immune response in the skin. Researchers found when B. oleronius was applied to skin of studies subjects it led to activating certain immune cells and release of inflammatory cytokines, which are also thought to play a role in development of Rosacea!

One last thought is that Rosacea skin can be linked to SIBO aka Small Intestinal Bacterial Overgrowth. This is when our small intestine has an excess of bacteria which can cause a compromise of our intestinal barrier leading to issues from digestive to skin disorders. Typically, our large intestine has more bacteria than the small. However with SIBO, the harmony within our gut is disturbed. A small observation found that around half of 63 Rosacea patients studied also had Small Intestinal Bacterial Overgrowth. But the survey showed that in treating SIBO could help with Rosacea symptoms. Almost half of patients who got treatment for SIBO felt their skin showed remarkable improvement! source

ENVIRONMENTAL FACTORS:

Rosacea isn't just about genetic and internal issues however - it is thought external factors can also play a role in causing and aggravating the condition.

All the environmental factors a person is exposed to over their lifetime can play a large role in skin conditions. Factors like smoking, diet, pollution, stress, & UV radiation can all trigger or make the issue worse. Chronic exposure to UV over a lifetime is thought to be possibly most important environmental factor in development of Rosacea. UV radiation produces reactive oxygen species (ROS) which are highly reactive molecules that cause cellular damage and inflammation. Also as we discussed earlier, UV exposure increases the expression of Cathelicidin and VEGF, leading to ongoing inflammation and blood vessel formation. source source 2

FORWARD PATH FOR NAVIGATING ROSACEA:

Now together we have explored quite a bit about Rosacea! How it is diagnosed, what it presents like, and what are thought to be the potential main causes!

This has felt like a proper introduction to what makes Rosacea so unique ! Of course there is indeed more to say about this multifaceted skin condition. Please stay tuned for Part 2 of this blog witches! Where we’ll delve into the world of triggers, treatment plans + product remedies, & of course lifestyle adjustments which all can help to calm and soothe Rosacea skin.

Until next time, please oh please honor your skin, listen to its messages, & stop to smell the roses hehe!

Love your gorgeous faces my witches!

Xo,

Katie