How to better live with rosacea?

Although it is an incurable chronic skin disease, there are several types of treatments available to alleviate symptoms and thus improve quality of life, depending on the form of rosacea in question. The metronidazole, azelaic acid in topical application or doxycycline in oral form are the most frequently prescribed. For more severe forms of rosacea, treatments involving mechanical destruction, the use of lasers or recourse to cryosurgery are possible.

As such, consider consulting a dermatologist as soon as you notice the first symptoms to make a diagnosis of rosacea, discuss your feelings and implement a treatment plan tailored to your situation. Early treatment can prevent symptoms from worsening. The doctor may also prescribe soothing and repairing care in parallel to alleviate symptoms and improve the skin's appearance.

Similarly, regular visits to a dermatologist can also help manage rosacea, by providing personalised advice and adjusting treatments as necessary.

The identification of triggering factors and understanding their impact on the disease incidence are paramount. By knowing them, the patient can gradually rectify their lifestyle habits to move towards a more balanced management of the disease and their daily life. It's not necessarily about stopping all habits indefinitely, but rather about modifying certain behaviours to limit their impact.

Common triggers for rosacea flare-ups include sun exposure, temperature, stress, spicy food, intense physical exercise, alcohol consumption, and certain skincare products.

Diet's role in the pathogenesis of rosacea is significant. Adopting a balanced diet, including the consumption of certain types of foods, can be beneficial and alleviate the symptoms of rosacea.

A study by SHEN conducted in 2023 assessed the role of diet on rosacea, and more specifically the relationship between adherence to a Mediterranean-style diet (consumption of whole grain products, vegetables, legumes, fish, olive oil, and nuts to be favoured, due to their omega-3 content) and the risk of incident rosacea. This study took place from January 2018 to December 2021 on a prospective cohort. Several skin examinations were carried out and a Mediterranean Diet Score (MDS) was generated.

Out of 83 patients suffering from rosacea, the MDS was associated with a reduction in the risk of rosacea among the patients. Adopting the Mediterranean diet helps to lower the production of inflammatory cytokines and aids in reducing skin inflammation.

Stress can exacerbate rosacea. Indeed, it is responsible for the activation of the NALP3, TLR-2, and TRPV1 pathways, thus inducing an increase in inflammation accompanied by a vasodilation of the blood vessels. However, this latter will lead to a strengthening of the symptoms of rosacea with more intense redness manifesting in the form of flare-ups.

In order to minimise discomfort as much as possible, it is recommended to engage in activities that promote mental and physical relaxation such as yoga, meditation or even Schultz's autogenic training, in your daily routine. Autogenic training, developed by psychiatrist Johannes SCHULTZ, is a relaxation method based on the use of self-concentration techniques. Furthermore, it is important to maintain a good sleep pattern. Indeed, lack of sleep is also a significant stress factor for the body.

Alcohol is one of the triggers of rosacea. Its consumption will induce an increased release of catecholamines which cause dilation of the blood vessels. Furthermore, inflammation will increase and cause the intensification of erythema. In order to preserve your health and avoid harmful effects, it is preferable to limit your alcohol consumption to two or three glasses per week .

The effects of smoking on rosacea are somewhat more abstract, and the scientific data on this subject is still somewhat unclear. Overall, tobacco remains a harmful element, due to the numerous toxic compounds it contains. The nicotine found in tobacco could particularly contribute to the development of the disease. Moreover, the degradation of elastin and collagen fibres contributes to the damage of the skin barrier.

As with many inflammatory diseases, sun exposure, through the UV radiation it emits, is one of the most common triggers of rosacea flare-ups. UV rays induce the formation of free radicals which lead to an oxidation process resulting in the deterioration of skin tissues. This process occurs as a result of the stimulation of NALP3, TLR-2 and TRPV-4 activation pathways, which amplifies inflammation and the release of pro-inflammatory cytokines.

To reduce rosacea flare-ups caused by the sun, it is recommended to apply a broad-spectrum sunscreen (UVA/UVB) providing a SPF of 30 or more daily to ensure optimal protection, regardless of the season or weather, to wear sun-protective clothing (hat and sunglasses with UV protection), to seek shade as much as possible and limit direct sun exposure.

It is suggested to increasingly turn towards solar care products based on mineral filters (zinc oxide and titanium dioxide) and without artificial fragrance.

It is recommended that skin prone to rosacea should cleanse the face with a gentle cleanser designed for sensitive skin, soap-free and with a pH of 5.5 at a frequency of once to twice a day only.

As inflammation impairs the barrier function, skin prone to rosacea becomes particularly sensitive and dry. Indeed, the skin barrier suffers damage, increasing water loss and making it less capable of fulfilling its protective function. This dysfunction can cause significant discomfort for the patient, accompanied by intense feelings of tightness.

Thedaily use of a non-greasy cream with occlusive and moisturising functions is necessary to counteract the harmful effects caused by inflammation. It should preferably contain emollients (ceramides, vegetable oils, squalane, niacinamide), humectants (hyaluronic acid, glycerine, allantoin), occlusives (butters, waxes, silicones, etc.), as well as anti-inflammatory agents (azelaic acid, bisabolol, etc.) in order to best restore the epidermal barrier, while reducing the accompanying sensations of tingling or burning.

If you are using medications to treat rosacea, first apply your topical treatment, then follow up with a moisturiser that is gentle on rosacea.

Skin prone to rosacea is particularly sensitive and can react strongly to certain components found in cosmetic products. These reactions often manifest as feelings of irritation, itching, and the appearance of red patches.

They are advised to choose gentle and non-irritating formulas, free from synthetic fragrance, alcohol, menthol, camphor, sodium lauryl sulfate or other potentially harsh ingredients.

Before applying any treatment to the face, always remember to test the products beforehand.

In theory, rosacea makes the skin more sensitive and prone to irritation. However, it is a highly individual condition. Consequently, while for some people exfoliation may be "beneficial" for their rosacea, it can conversely worsen it for others.

However, in the case of active redness or a flare-up of rosacea, it is preferable to avoid exfoliation until the skin has calmed down.

retinoids , AHAs (glycolic acid, lactic acid, etc.) and BHAs (salicylic acid, etc.) due to their potential to irritate sensitive skin.

Similarly, the use of accessories (exfoliating glove, konjac sponge, dry brush, exfoliating strap, etc.) and grainy mechanical scrubs can be abrasive and irritating. However, gentle exfoliants such as poly-hydroxy acids (PHA) may be suitable for sensitive skin prone to rosacea. They are much less irritating.

Be gentle with your skin and avoid over-exfoliating. Those suffering from rosacea should exfoliate less frequently than those who do not. Once a week, or even less frequently, may be sufficient. Of course, this can vary depending on individual tolerance.

If redness becomes too bothersome on a daily basis, the use of makeup can be beneficial. Once again, it is crucial to select gentle and non-irritating products. For instance, when it comes to foundations, it is advisable to use liquid cosmetics or medical foundations, which provide coverage without being occlusive. Care should be taken to avoid thick and greasy textures, as they can clog the pores on the skin's surface and lead to an exacerbation of inflammation and symptoms.

Furthermore, the application of a green anti-redness concealer can be beneficial and allow to neutralise the red colour of the skin, while maintaining a natural effect. Green and red are known as complementary colours, they cancel each other out when combined. The green concealer can be used in various ways depending on the extent of the redness.

Living with rosacea can pose a psychological challenge as the visible and disturbing symptoms often lead to self-consciousness in patients. Addressing the psychological aspect of the disease can have a real impact on the progression of the disease and, most importantly, on the quality of life of the patients.

This care can be provided through a psychological support from the patient's surroundings or by a specialist, the joining of a support group or a online community. These groups are spaces where individuals share their experiences and tips for better managing the disease. This allows the patient to obtain advice and emotional support regarding the experience they are going through. These discussion groups can be recommended by the doctor or easily found on social networks and on the internet.

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• YIN D. & al. Association between rosacea and smoking: A systematic review and meta-analysis. Dermatologic Therapy (2021).

• REINHOLZ M. & al. Dietary patterns in acne and rosacea patients—A controlled study and comprehensive analysis. Multidisciplinary Digital Publishing Institute (2023).

• VEIGA F. & al. Topical treatment and care for rosacea: From traditional methods to new drug delivery systems. Molecular Pharmaceutics (2023).