What are the different stages of rosacea?

Flushes, or heat, and intermittent redness are early signs, they appear in young people.
The later appearance of telangiectasias ( dilation of small blood vessels) is characteristic of rosacea—they are located near the surface of the skin. This vascular abnormality is characterized by redness on the cheeks, nose, forehead, and chin. As the disease progresses, this redness can become permanent and be accompanied by dilated vessels, a condition called couperose.

These rednesses are more or less associated with spots whose red color attracts the eye, with or without pus. These lesions can be temporary or permanent (papulopustular form). At an advanced stage, we can see infiltrated red plaques (phymatous form).

Another form, rhinophyma, a granulomatous hypertrophy of the nose, is rarer and affects almost exclusively older men. Ocular rosacea with manifestations similar to those of conjunctivitis (sand in the eyes, redness) may also be associated with the above symptoms.

To establish the diagnosis, either the phymatous form or persistent erythema is required. Otherwise, other signs must be present to suggest the diagnosis: tightness, burning, pain, itching, which are secondary signs. Also, hormonal changes (pregnancy, menopause, taking corticosteroid creams, nasal sprays, or tablets) can be triggers. 

Please note that rosacea should not be confused with acne, which does not have this vascular component.

Rosacea is always accompanied by flushing, that feeling of heat, and couperose, that is, the dilation of blood vessels. Moreover, acne in adults is located more on the chin and mandibles, while rosacea is more on the cheeks, nose, and forehead. 

What are the triggers of rosacea?

Although the central facial area has the particularity of being rich in sebaceous glands, with a dense vascular and neurological network, often populated by demodex (skin mites), the physiology remains unclear. Indeed, in addition to genetic factors, the pathogenic effects of demodex are noted. They can mechanically block the hair follicle and the sebaceous duct generating inflammation, but also trigger an immunological reaction. The potential pathogenic role of the associated bacterial flora (streptococcus and staphylococcus) should not be neglected either, explaining certain relationships with acne.

It's important to consider triggers such as heat or cold, exercise, UV rays, spicy foods, and alcohol. In the case of rosacea, these factors trigger the release of vasoactive neuropeptides relayed by sensory nerves, which perpetuates the dysregulation that causes the symptoms. 

Skin and intestine: if the link with Helicobacter pylori (the agent of gastric ulcers) is not established, intestinal dysbiosis will have to be corrected, in particular irritable bowel syndromes. SIBO (small intestinal bacterial overgrowth) is a chronic imbalance of the intestinal flora, which results, among other things, in bloating and abnormal gas production, abdominal pain, alternating diarrhea and constipation. If these symptoms appear, I recommend that you consult a micronutritionist to analyze your intestinal flora, perform specific tests to identify SIBO and adapt your diet.

What treatments would you recommend?

First of all, you will need to act on the triggering factors, adopt strict sun protection, avoid heat or cold, spicy foods, alcohol if possible, and learn to manage your stress.

Certain plants can affect microcirculation: horse chestnut, red vine, sweet clover, ginko, biloba, yarrow. I recommend taking them as a herbal tea or dietary supplement. Also balance minerals: selenium, copper, manganese, and antioxidants. Diet should follow the seasons: in spring and autumn, fruits and vegetables change, which has a beneficial purifying effect.

1 Clean:

Cleansing should be gentle and non-irritating. In the evening, perform a double cleanse with the Cleansing Oil and then the Mango & Avocado Soap . Finish rinsing by spraying a mist of very pure, low-mineral spring water. It neutralizes limescale and chlorine in tap water.
In the morning, in the shower, cleanse your skin with Mango & Avocado Soap . It is suitable for the face and body.

2 Hydrate:

Moisturizing for skin types that are often dry and sensitive: apply the fragrance-free Sensitive Skin Moisturizing Cream morning and evening to minimize any reaction. Its fine, enveloping formula deeply moisturizes, soothes redness and strengthens the skin barrier.
If hyper seborrhea (acne) is associated, apply Combination Skin Moisturizing Cream instead.

3 Protect:

When you are outdoors, sun or not, apply our SPF50+ Sun Cream . Designed like a BB cream, it masks redness while regulating microcirculation.

4 Treat:

Then the treatment will be adapted to the symptoms:

For transient flushes and redness, we can offer MIRVASO, a cream based on brimonidine which will be applied when their arrival is particularly feared, as well as beta-blockers. 

Vascular lasers can be useful in the early stages, they relieve flushing and improve aesthetics by eliminating redness. These laser sessions are important because by acting on the vascular component at the origin of skin inflammation, they prevent the transition to chronicity. In painful cases, lidocaine gel or even antidepressants can be used. 

To treat red spots (rosacea), in moderate forms local treatments may be recommended, based on ivermectin metronidazole (erythromycin (2%), clindamycin.

Dr. Sylvie Peres: I prescribe them in the form of a compounded preparation to avoid excipients. toxic and irritant sources of maintenance of the pathology.

Ocular rosacea: Apply warm water mist compresses and massage gently to drain sebum. You can also apply copper sulfate water and our restorative, regenerating, soothing, and antioxidant Eye Contour Cream . It also contains active ingredients that improve microcirculation and combat edema.

In severe cases, oral treatments will be necessary: ​​tetracyclines, metronidazole, clarithromycin, and azithromycin, or even oral ivermectin if the Demodex infestation is significant.

Combining these treatments often results in a cure, if not a reduction in recurrences. We hope these tips will help you regain healthy skin.