April is National Rosacea Awareness Month and I realized I hadn’t written a blog post on this topic yet. Partly because rosacea is such a broad and varied condition. It doesn’t always look the same from one person to the next, which can make it especially confusing. Rosacea has a way of showing up very subtly, starting with a little redness, a bit of flushing with triggers, then you may notice your products sting, your cheeks stay pink, and you're wondering what is going on. I figured it was time we unpack this a bit so welcome to my SkinTalk on rosacea.

I also have a detailed Youtube video on this topic as well that can act as a helpful resource.

What is rosacea and what causes it?

Rosacea is a chronic skin condition that causes redness, broken capillaries, flushing, blushing, and red bumps on the face, typically seen around the nose and cheeks. 

While the exact cause of rosacea isn’t fully understood, there are several factors that contribute to its development. Skin mites known as demodex are microorganisms that live in our pores. They are usually harmless, but studies suggest that an overgrowth of these mites play a role in the development of rosacea. Genetics plays a major role. Dysregulation of the skin’s immune system causes inflammation and other skin changes seen in rosacea. Environmental factors and lifestyle choices such as alcohol, sun, extreme heat or cold temperatures, spicy foods, stress, and certain products can trigger rosacea symptoms and exacerbate the condition.

Who is the most likely to get rosacea? 

Rosacea can affect just about anyone, but we tend to see it most often in people with fair skin, especially between the ages of 30 and 50.  While rosacea affects both men and women, it is definitely more common in women. However, when we see it in men they typically experience more severe symptoms, particularly rhinophyma, a subtype of rosacea that causes thickening of the skin. We usually see this on or around the nose. Rosacea is also seen in those with sensitive or reactive skin. I frequently hear from patients that most products they use cause stinging, burning or irritation so they are very particular about the products they apply to their skin.

When is it time to see a doctor about your rosacea? 

Rosacea gets progressively worse over time so it’s important to treat it longterm to slow down its progression. It's best to see a dermatologist if you experience redness, sensitivity, flushing, or breakouts on the face. 

Should you avoid certain skincare products if you have rosacea? 

Yes, 100%. Here is a list of products I tell my patients to try and avoid:

1. Astringents and Toners: particularly with alcohol or witch hazel as they can cause irritation and worsen symptoms. 

2. Synthetic Fragrances: check your products for fragrance/perfumes because these tend to cause irritation and worsen rosacea. 

3. Exfoliating Scrubs: can cause more broken capillaries and redness in those with sensitive skin or rosacea. 

4. A High Concentration of Vitamin C: this tends to cause flare-ups in rosacea prone skin.  

What products should I use if I have rosacea?

I suggest keeping your regimen simple if you have rosacea as too many products can overwhelm the skin. Micellar water is gentle enough to remove makeup. A gentle cleanser, like Soothe Cleanser that is sulfate free, works best in the morning and at night. Use products with ingredients that target and treat rosacea symptoms such as Azelaic acid right after cleansing. I love Azelaic10 Serum and have seen amazing results with my patients who use it. Lastly, a calming moisturizer and sunscreen to protect your skin barrier. It’s best to choose a mineral based sunscreen with zinc or titanium as opposed to chemical UV blockers. My go to is Intense Recovery Complex at night and Hydratint BB SPF44 during the day, as sun exposure can exacerbate rosacea.

What skincare ingredients are ideal if you have rosacea? 

Here is a list of top ingredients for patients with rosacea:

1. Azelaic Acid: dermatology’s favorite ingredient to treat rosacea as it helps calm inflammation, treats breakouts, and redness in addition to reducing demodex skin mites that contribute to causing rosacea.  

2. Niacinamide: a form of vitamin B3 that helps reduce inflammation and redness, improve the skin barrier function, and decrease the amount of skin oil (sebum) that is produced. Niacinamide (2-5%) is gentle and well-tolerated by most people with rosacea. 

3. Licorice Extract (Glycyrrhizin): has anti-inflammatory and soothing properties, making it beneficial for reducing redness and irritation associated with rosacea. 

4. Sulfur: another dermatology favorite as it helps reduce microorganisms, treat breakouts, and calm redness. It can be found in prescription and over-the-counter products, but the drawback is the noticeable odor. I typically like to use Detox Mask.

5. Other ingredients to look for in your products include allantoin (helps healing), aloe Vera, and cucumber extract. Focus on mineral based sunscreens with Zinc or Titanium.

Rosacea can be highly individual, and what works for one person may not work for another so when you are incorporating these new ingredients into your skincare routine, it's essential to introduce them one at a time and observe how your skin responds. I always say that it is crucial to consult with a dermatologist before starting any new treatment regimen, especially if you're considering prescription-strength ingredients or if your rosacea is moderate to severe. Your dermatologist can provide personalized advice and recommend products that are suited to your skin's specific needs.

What other treatments can help with rosacea?

When it comes to managing rosacea, there are some really effective options beyond just topical treatments. Vascular lasers like the V-beam or broad-band light (BBL) therapy can be great tools as they target broken capillaries, reduce redness and flushing, and can even help minimize those inflammatory bumps some people may see during a flare-up.

Never underestimate the role your diet plays. We’re learning more and more about how our gut microbiome influences the skin. Adding probiotic-rich foods like yogurt, kefir, sauerkraut, or kombucha to your diet may help manage inflammation and, in turn, benefit rosacea.

I often recommend that my patients start incorporating more omega-3-rich foods like salmon, flaxseeds, walnuts, and chia seeds. These healthy fats have anti-inflammatory properties that can make a noticeable difference. Antioxidant-rich fruits and vegetables (think berries, cherries, spinach, carrots, and sweet potatoes) are also good options for calming inflammation and supporting healthy skin from the inside out.

Dr. Azi’s Recommended Products:

Avene Cicalfate+ Restorative Cream: Rich, nourishing skin barrier cream to help restore moisture and support the skin barrier. Formulated with postbiotic extract to promote a healthy microbiome ideal for skin recovery. 

Azelaic10 serum formulated with 10% Azelaic acid in a hydrating serum designed for sensitive skin. The formula doesn’t cause piling or leave residue on the skin like many other Azelaic acid products on the market.  It’s a challenging ingredient to formulate, but my patients really like Azelaic10 Serum.

PROcure Rosacare 

Hyaluronic Hydrogel is formulated with multiple ingredients to treat and calm Rosacea including  allantoin, vitamin E, cucumber extract, and licorice-root extract.  My patients like how this feels on their skin.  It also has chromium color-correcting technology to help mask redness and even out the appearance of the skin.

La Roche posay Toleraine Double Repair

Formulated with ingredients including ceramide-3, niacinamide, glycerin and La Roche-Posay Prebiotic Thermal Water. These ingredients help restore the natural protective barrier and their studies show it provides up to 48-hour hydration. Its lightweight cream texture easily absorbs into the skin making it suitable for all skin types, including oily, acne prone, and sensitive. 

AziMD Skincare Intense Recovery Complex

This product is ideal for redness-prone skin as it combines 4 Essential Ceramide Complexes to strengthen the skin barrier, Glycerin for hydration, Vitamin E for antioxidant protection, and Allantoin to reduce inflammation and irritation. Additionally, Phytosphingosine enhances barrier function, while Cactus and Yeast Extracts soothe and reduce irritation caused by active ingredients.