Alongside gentle skincare, barrier support and daily sun protection, some clients with rosacea may require medical treatment. The treatment selected depends on how the rosacea presents. Persistent redness, visible vessels, inflammatory papules and pustules, scaling and sensitivity do not necessarily require the same approach.
Soolantra — Ivermectin 1% Cream
Soolantra is a prescription topical medicine containing ivermectin 1%. It is used to treat the inflammatory lesions of rosacea, particularly the papules and pustules that can sometimes be mistaken for acne. Ivermectin has both anti-inflammatory and antiparasitic activity. One area of particular interest is Demodex. These microscopic mites naturally live on human skin and are not, by themselves, abnormal. However, increased Demodex density has been associated with some presentations of rosacea. Ivermectin reduces Demodex density while also exerting anti-inflammatory effects. Rosacea is considerably more complex and involves interactions between inflammatory and immune responses, vascular and nerve activity, the skin barrier and other contributing factors. Soolantra requires a prescription and should be used according to the prescribing clinicians instructions.
Azelaic Acid
Azelaic acid is one of the better-established topical ingredients used in rosacea management. It has anti-inflammatory activity and can be particularly useful where inflammatory papules and pustules are present. It may also help improve some of the uneven tone that can remain following inflammation. Different formulations and concentrations are available. Rosacea-prone skin can be highly reactive, and azelaic acid may initially cause tingling, dryness, burning or irritation in some people. This does not mean that stronger or more frequent application will produce a better result. How and when it is introduced should reflect the condition of the skin barrier and the individuals tolerance.
Nizoral — Ketoconazole Shampoo
Nizoral contains ketoconazole, an antifungal medicine. It is important to make the distinction that ketoconazole is not a treatment for rosacea itself. Its relevance arises because rosacea and seborrhoeic dermatitis can coexist. Seborrhoeic dermatitis commonly produces redness, flaking or scaling around the scalp, hairline, eyebrows, sides of the nose and other sebaceous areas. It is associated with the yeast Malassezia. When someone appears to have both rosacea and seborrhoeic dermatitis, treating the seborrhoeic dermatitis appropriately may improve that component of the redness, irritation and scaling. Nizoral is primarily a shampoo preparation. Seek a diagnosis of your skin condition to then determine the best treatment.
Why Correct Assessment Matters
Redness does not automatically mean rosacea and redness in someone who has rosacea is not necessarily being caused entirely by their rosacea.
A client may have overlapping:
- Rosacea
- Seborrhoeic dermatitis
- Impaired skin-barrier function
- Irritant or allergic contact dermatitis
- Acne
- Photodamage
- Vascular redness
This is why assessment comes before treatment. Soolantra may be appropriate for inflammatory rosacea. Azelaic acid may be appropriate for inflammatory rosacea and associated redness. Nizoral may be relevant where seborrhoeic dermatitis is also present. They have different purposes and should not simply be grouped together as rosacea products. The objective is not to use more products. It is to understand what we are treating and why. Skincare trends move quickly. Science doesn’t. Rather than asking what ingredient is fashionable this year, we prefer to ask a different question:
What does this ingredient do, what evidence supports it, and is it appropriate for this particular skin?
Antioxidants
Our skin is continually exposed to environmental stressors, including ultraviolet radiation and pollution, which contribute to oxidative stress. Topical antioxidants can form an important part of a comprehensive photoprotection strategy alongside daily broad-spectrum sunscreen. Vitamin C is one of the best-known topical antioxidants, but formulation matters enormously. The form of vitamin C, concentration, pH, stability and combination with other antioxidants can all influence performance.
Peptides
Peptides are short chains of amino acids. In skincare, different peptides are used for different purposes, including signalling pathways associated with extracellular matrix support and visible signs of ageing. They are an interesting and growing area of formulation science, but not all peptides are interchangeable and the presence of the word peptide on a label does not automatically make a product effective.
Skinceuticals PTiox serum & Cream
Ceramides & barrier lipids
This is an area we talk about frequently. The outermost layer of our skin relies on a carefully organised mixture of lipids, including ceramides, cholesterol and fatty acids, to maintain an effective barrier. When that barrier is compromised, transepidermal water loss can increase and the skin may become dry, tight, irritated or less tolerant of products. Barrier support is particularly important when we are dealing with sensitive, dehydrated or reactive skin.
Skinceuticals Triple lipid 2:4:2
NAD+ and emerging longevity ingredients
NAD+ is essential to cellular metabolism and has attracted enormous interest within longevity research. That interest is now extending into skincare and aesthetics. It is fascinating science, but this is an area where we need to distinguish biological plausibility and emerging research from established clinical outcomes. We will continue watching the evidence.
Bakuchiol
Bakuchiol is a plant-derived ingredient that has attracted interest for its potential effects on visible signs of photoageing. Some research suggests benefits for tone, texture and wrinkles, with potentially different tolerability from retinoids. It should not, however, simply be described as a natural retinol. They are different molecules with different mechanisms.
The Woulfe approach
Ingredients matter. But formulation, concentration, combinations, frequency of use and the condition of your skin barrier matter too. That is why we don’t believe everybody needs the same routine.
HEALTH & WELLBEING
Take a moment to breathe
Breathing is something we do automatically thousands of times every day. But how we breathe can also influence how we feel. During periods of stress or pressure, breathing can become faster and shallower. Deliberately slowing the breath for a few minutes can be a simple way of encouraging relaxation.
Try this
Sit comfortably and relax your shoulders and jaw. Breathe gently through your nose for approximately 4 seconds. Then breathe out slowly and comfortably for approximately 6 seconds. Continue for 3–5 minutes. Don’t force yourself to take unusually deep breaths. The aim is for the breathing to become quiet, slow and comfortable. Slow controlled breathing has been studied for its influence on the autonomic nervous system, which helps regulate functions including heart rate and our physiological response to stress. If counting doesn’t suit you, forget the numbers. Simply concentrate on making the exhalation relaxed and slightly longer than the inhalation. Breathwork doesn’t need to be complicated. Sometimes a few quiet minutes are enough.
If you feel dizzy or uncomfortable, return to your normal breathing.
Products from the article
Sale
P-TIOX Serum + Cream
SkinCeuticals Phyto Corrective PDRN Serum
SkinCeuticals Triple Lipid Restore 2:4:2 - 48ml
Sale
P-TIOX Serum + Cream
SkinCeuticals Phyto Corrective PDRN Serum
SkinCeuticals Triple Lipid Restore 2:4:2 - 48ml
