Managing the Challenge of Rosacea by Christine Heathman - Dermascope (July 2010)
by Christine Healthman
The course of rosacea is prolonged. Recurrences are common and difficult. Rosacea is a skin in trauma and out of balance. When tissue repairs itself, it requires more amino acids for cell proliferation. Peptides are organic chemical compounds composed of one or more basic amino acid groups and one or more acidic carboxyl groups. Select a peptide product that contains palmitoyl-pentapeptide-3 and other peptides with a low molecular weight in the amino acid chain. Peptides are non-irritating and more stable than vitamin C and Retinol. Not only do peptides have the capability to reduce the inflammation associated with rosacea; they reduce the aging factors that compound rosacea sufferers linked with photo-damaged skin. Peptides must be an integral step in treating rosacea skin.
Carbohydrates constitute the main source of energy for all body functions and are required for the metabolism of other nutrients. This is why balanced nutrition is necessary, incorporating non-inflammatory foods augmented with antioxidant supplements help with rosacea skin detoxification.
Treatment of rosacea requires patience from the client and a thorough understanding of the histology, anatomy, and physiology of this disorder in relationship to the skin by the skin care professional. Rosacea is currently incurable; however it is a great skin challenge to treat because much can be done to relieve its signs and symptoms. An important goal for clinical treatment is to limit progression to the more severe, end-stage manifestations of the disease.
It is established that rosacea clients can have sensitive skin and misled that this hyper-reactive condition could be affected by topical agents such as cleansers and AHAs. This hypersensitivity link has not been convincingly demonstrated, nor is it proven. For example, rosacea patients are not especially prone to stinging after an application of 10 percent Lactic Acid. Clinical studies of this disease in relationship to these acids are reassuring because rosacea can readily accommodate irritating agents. Because rosacea is photodermatosis, it is absolutely imperative that a rosacea compatible SPF 30+ and protective makeup such as a camouflage base is part of the daily treatment program to protect against the environment. Selection of sun protection for rosacea must be a formula that does not increase inflammation. Know your skin care company and be sure they provide an SPF product for rosacea. Not all SPF products are rosacea compatible and many sun protection products will irritate the condition and hold heat in the skin causing more redness.
Rosacea is often a difficult, stubborn, humiliating disease to treat if not properly understood. It is a challenge for the creative skin care therapist. Great therapeutic triumph comes when using AHAs in the clinical environment for rosacea. Many topical acne agents include retinoids that may be too irritating to the rosacea skin type and could aggravate the telangiectasiac component. AHAs have not been shown to promote angiogenesis and therefore may be a more effective keratolytic agent for rosacea. In addition, these actives have been substantiated to possess antioxidant and anti-inflammatory impact on rosacea.
The properties of AHAs may help account for the decrease in erythema and telangiectasias in thicker skin, masking some of the superficial vascular plexus, and may also account for the ability of sensitive skin to tolerate the AHAs. AHAs may also provide an alternative to topical steroids for mild inflammation as the steroids may actually worsen rosacea and thin sensitive facial skin, further aggravating the telangiectasiac component.
AHAs have also been shown to improve cutaneous atrophy due to potent topical steroids by increasing epidermal thickness and dermal components. With their unique affect on corneocyte cohesion, AHAs may prevent the attachment of the demodex mite in the follicle, exhibiting clinical effects similar to that of sulfur. Thus, AHAs applied daily and through chemical peeling may improve the erythema and papular component of rosacea, providing additional treatment alternatives for this recalcitrant condition. It is believed that use of a low pH AHA can deplete bacterial nutrients, resulting in decreased numbers of pathogens. In addition, enhancement of ground substance (Hyaluronic Acid, glycosaminoglycans, elastic fibers, and collagen) in the dermis by AHAs could also potentially make telangiectasia less noticeable. AHAs also increase the internal hydration residents by stimulating the lamellar bodies of the cell. This action helps compensate for any lipid imbalance and increases the barrier repair function of the skin.
Acne sulfur masks and resorcinol up to four percent are additional effective topical to retard the onset of bacteria and the activity of the demodex mite that resides in the follicle. These should be applied at least once a day, preferably in the evening before 10 p.m. in conjunction with a complete skin care circadian balanced program.
Nutrition plays a key role in treatment. Avoidance of foods such as chocolate, nuts, cheese, soft drinks, iodized salt, seafood, alcohol, spices, and hot drinks is imperative.
When treating rosacea, it is important to detoxify and nourish the connective tissue from within. Cleansing and replenishing is central to the ayurvedic medical principals of health by cleansing the body of toxins before you begin treating the condition. Always ensure the client is using a supplement manufactured for this purpose and that the ingredients include detoxifying complex of water balanced nutrients, cleansing herbs, and fiber blends. In addition, the acne skin formulas must contain anti-inflammatory ingredients that treat the rosacea skin from within with healing zinc, blood purifiers, in addition to vitamins A and C for healthy tissue recovery.
Rosacea also responds favorably to topical applied nutrients including vitamin C and other water and lipid soluble vitamins such as E and A. These ingredients are known for their radical scavenger abilities and with twice daily use, these powerful anti-inflammatories can drastically reduce the facial erythema that accompanies rosacea’s chronic redness in as little as 48 hours. They can also be effective moisturizers since dryness of the skin can further irritate and redden the rosacea skin condition.
The skin’s own functions should be naturally supported and rebuilt by using proven substances that correspond to its own natural chemistry:
The Lymphatic structure is recognized as the body’s second circulatory system and are small, blind-ended afferent capillaries lined by a single layer of epithelium that run parallel to the vascular network. The smallest lymphatic vessels begin in the upper dermis and drain lymphatic fluid from this region, emptying into a superficial plexus, which in turn flows through interconnecting vessels into deeper plexuses located between the dermis and the subcutaneous fat and then on to the central lymphatic system. Lymphatic treatment boosts the immune power of the skin and this healing massage can reduce erythema and promote healthy skin activity by cleansing the skin’s connective tissues of nasty waste by-products and remove the toxins exacerbating a rosacea condition.
There are rosacea factors that can be controlled by your client and the number one step to success is educating them to what these irritants are and understanding what impact they have when managing the disease. The following is a list of foods, drugs, environmental conditions, and other factors a rosacea sufferer should be aware of:
Rosacea Food Irritants
Women treated with the green tea extract cream had a 70 percent improvement in rosacea compared with women treated with a placebo, says Tanweer Syed, MD, PhD, an Associate Professor of Dermatology at the University of San Francisco, Calif. This study was presented at the American Academy of Dermatology meeting in New Orleans.
Medical treatments are part of the life of many rosacea sufferers, and your client may have already been on one or more of the following agents. It is the responsibility of the aesthetician to familiarize themselves with these medications.
Oral Medicine—several agents can be used to treat rosacea. Erythromycin and tetracycline are the main oral antibiotics used. Other antibiotics that can be used are doxycycline, flagyl (metronidazole), and minocycline. Some people only need to take antibiotics for flare-ups, while others have to take antibiotics every day to suppress symptoms. The antibiotics help more with the red bumps and acne-like lesions on the face, yet they don’t help as much with the redness and blood vessels. Isotretinoin (Accutane) has been used for stubborn rosacea but can have severe side effects.
Topical Medicine—several topical agents can be also be used to treat rosacea. The most commonly used agent is Metrogel (metronidazole). Another topical agent is sulfacetamide and sulfur lotion that can be found in a flesh-colored formulation to help hide some of the redness.
Surgery—the enlarged nose cannot be reversed with medicine. Cryosurgery, laser surgery, and electrosurgical therapy have been used for this with variable effectiveness. Electro surgery and laser therapy are useful for the blood vessels.
In conclusion, the treatment of rosacea can be challenging, but highly rewarding. The skilled aesthetician should avoid the conventional therapy and establish a protocol that includes both clinical remedies and home care skin products that are reassessed periodically. Completing this program for treatment must also include nutritional dos and don’ts, approved herbal supplements, and an SPF 30+ specifically for rosacea augmented with camouflage makeup protection.
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