[Updated] Understanding rosacea: causes, symptoms, skincare and treatments

Despite so much happening with the #skinpositvity movement, more needs to be done to show “real” skin on social media – especially when it comes to inflammatory conditions like adult acne and rosacea.

Rosacea is a long-term inflammatory skin condition which usually occurs on the face and affects one in 10 people in the UK, according to research from Bupa, with most in the 30-to-50-year-old age group, or who have fair skin. 

The flare-ups that come with the condition are tough to conceal and can be as mentally hard for clients to manage as they are physically, which is why more needs to be done to normalise rosacea in the media, as well as helping clients to manage the symptoms correctly. 

We quizzed top facialist Kate Kerr, owner of Kate Kerr London, on why rosacea occurs in the skin, covering the common symptoms and “triggers” that can exacerbate the issue, and the ways you can effectively treat the condition in your beauty salon or spa. 

What is rosacea?

“Rosacea is an inflammatory skin condition that generally affects the middle section of the face (known as the butterfly shape) – the forehead, nose, cheeks, above the lips and on the chin. It can also thicken the skin tissue and often when people think of rosacea they think about the bulbous nose,” says Kerr.  

“It is generally categorised into stages with redness, persistent redness, flushing, tingling and burning – especially on the cheek area; broken capillaries and enlarged pores. You can also get papules and pustules but these are a bit different to acne spots, protruding above the surface in a more dome-like shape. They also tend to last longer than acne breakouts.” 

What causes rosacea?

Kerr says that the causes of rosacea are not 100% certain, with some experts thinking it is a 50/50 split between genetics and environmental factors. “What we know is that it is a much more common condition in fair skin and in skin that naturally blushes, even from a very young age,” she explains.  

“I treat a huge number of rosacea clients in clinic and when I ask somebody if anybody in the family has had it, generally they tell me that either mum or dad suffers with it. Some clients don’t even realise it might be a genetic thing, so I ask them: does your mum or dad’s skin flush? Have you noticed skin thickening on their nose? You need to ask your clients these key questions.”

Broken capillaries

What are the common symptoms of rosacea?

Persistent redness is one of the best known symptoms of rosacea and it commonly appears across the cheek area, but that’s not all, as Kerr explains. “Rosacea is an oily skin condition which is what people don’t tend to realise. They just think of it as being sensitive skin but often you’ll find that people who have it will have suffered with acne in their teenage years,” she says. 

“Rosacea is activated by oil and this causes a lot of inflammation – you see a lot of vascularity in the skin, and it often starts with flushing, redness, and/or persistent redness and tingling in the cheeks. Broken capillaries are also a common symptom, which you might see in the corner of the client’s nose or across the cheeks. Those are the first couple of stages, then you start to get the papules and pustules.” 

However, the symptoms will vary from client to client and you need to be aware of that when treating customers in salon. “Experts tend to talk about the stages with rosacea – stages one to four (pre-rosacea, mild rosacea, moderate rosacea and severe rosacea) – but I don’t think stages is the correct term because clients don’t necessarily start at stage one and progress to stage four,” explains Kerr.

“You may have a customer suffering with symptoms in stage one and two, who then progress further in those two stages more severely, or another client who might just have stage one and three and have it super mild.”

What are the most common triggers of rosacea?

Certain drinks have been noted as top influencers of rosacea breakouts, "such as red wine, beer, gin and vodka," says Chanele Rosa, aesthetic specialist at Candela Medical, while spicy food can also be a culprit. According to a study by the National Rosacea Society, spices and hot food worsened the symptoms of rosacea in up to 75% of adults suffering with the condition. 

Although exercise is good for the body, it can increase the likelihood of a flare-up, as Rosa explains. "Cardio in general is known to be the most aggrevating due to the increase in the body's demand for oxygen, which results in higher respiration and heart rates.

She adds: "Increased heart rate and respiration causes flushing from increased blood flow to the skin. The key is to modify the workout to minimise the effects on rosacea, while still maintaining the cardiovascular and respiratory benefits – [advise clients to] exercise in off-peak hours when the sun is low and the temperature is cool, and make sure they stay hydrated."

Sun exposure is also a common factor because "the ultraviolet rays from the sun is recorded as a trigger for [the condition] because of the severe-exposed skin that rosacea causes," says Rosa. "Those with fair skin are more likely to experience sun damage, and signs of sun damage can be found on rosacea skin tests." Cold weather, such as bitter winter winds, can also trigger the symptoms, so get your clients to cover their face with a scarf to avoid irritationg the blood vessels as well as applying sunscreen. 

How can I treat rosacea in my beauty salon?

“Rosacea is a condition that generally does progress – it can go into remission or disappear at times, but it will come back. Unless you’re treating it, it tends to get worse. As a therapist, you want to prevent the progression because it’s much harder to claw it back when rosacea has progressed to the later stages,” explains Kerr. 

“With rosacea, the key thing is to make sure your client has a really strong barrier function, so work to strengthen it to prevent transdermal water loss (the evaporation of moisture from the skin), which will help with hydration and make the client’s skin glow more.”

Kerr also advises working to inhibit oil production, which will help to minimise inflammation. “I want rosacea clients to have a really healthy skin cycle, so I get them on a regime which is going to do all these things. I often get them on a retinol to regulate all of the above, helping to thicken and strengthen the skin.  

“Then I look at things in 12 weeks’ time, which is two skin cycles, assessing: do we need to go any further with treatment? Do we need to step it up a gear? Or do we need to do a referral to a dermatologist or a GP? For example, say I’ve corrected the papules and pustules but the client has still got some underlying redness and broken capillaries, then I would look (after two skin cycles) at using more advanced treatments like lasers, lights or IPL.”

What ingredients are best to use on rosacea clients?

“Salicylic acid will help control oil production but you also want clients to exfoliate, which a lot of people with an inflammatory skin condition are quite frightened of doing. When you speed up cell turnover, you speed up cell function too, so when people aren’t exfoliating, they’re accumulating dead cells on the surface which leads to dull skin,” explains Kerr.  

“However, anything can get in when you exfoliate, which makes the skin more on edge – the inflammatory systems within the skin are on high alert, so the client’s complexion will become more easily inflamed. Strengthen that barrier and follow it with application of lots of antioxidants and sun protection, as the sun is a big trigger for rosacea. Clients also need to look at their diet and alcohol intake as all of these things are triggers for the condition.” 

Rosacea before and after

What treatments should I avoid using on rosacea clients?

“I would be very careful with exfoliation, especially microdermabrasion,” says Kerr. “A lot of advanced treatments are actually very beneficial for rosacea as long as the skin is strong, resilient and prepped. You need to make sure the skin is calm and functioning beautifully first and foremost, then you can boost it further with peels or microneedling, which can help with healthy cell turnover and to refine the skin’s texture.” 

When should you refer rosacea clients to a GP or medical practitioner?

“It depends on the severity of the rosacea. I also take into account their emotions as well as the physical symptoms. For example, If you have a client who just has some redness, flushing, and a few broken capillaries and spots, then I can treat that in clinic, but if the client has got thickening of the skin tissue, lots of breakouts which happen repetitively and really enlarged pores, then this is more long-term damage that we’d like to prevent, so I would recommend a referral to a GP,” says Kerr.  

“I also give clients the opportunity to choose the best course of action for them: I say, ‘we can refer you now; or we can try and treat you in clinic and then refer you if we don’t see the results we want; or we can do both – I can refer you to a GP and treat you in clinic as I know how rosacea medications work, so I will be able to treat you safely alongside any prescribed medication.”  

Working in partnership with a medical professional could be the perfect combination for some clients, providing the best of both worlds. “Often, when clients see medical professionals for these sorts of things, they are just treating the disease and the symptoms of the disease, they’re not looking at the overall skin health, which is where our expertise as facialists come in,” explains Kerr.

“The skin is our body’s biggest organ, so we need to check it is functioning well, and that every cell type within it is functioning right, so the client has skin that looks beautiful and is less likely to have disease. I believe in the three-prong treatment approach – clinical, medical and skincare. Find out about the medical treatment of rosacea so you can work alongside a GP to help complement what they’re doing.”

Do you want to know how to treat hyperpigmentation and scarring caused by acne