if you have facial redness, flushing, skin irritation, and think you may have rosacea - then this is the video you've been waiting for. I'm going to tell you what rosacea is, how it's diagnosed, and most importantly, focus on how to treat it using a combination of lifestyle, over-the-counter, prescription creams and tablets, and also procedures. My name is DrSyed and I'm a board-certified dermatologist living and working in New York.
My channel focuses on scientific skincare content without the marketing BS, so if you're into that kind of thing, if it really gets you going, hey, there's no judgment here, just hit that subscribe button. Let's get into it. Rosacea is a chronic skin condition where your skin is hypersensitive, gets irritated easily, and goes red quickly because there's more superficial blood vessels near the surface.
It's most often triggered by sun exposure, spicy food, cold temperatures, or feeling embarrassed. So this emoji here likely has rosacea, whereas this emoji here, clearly has herpes: stay away from him. Now the redness in rosacea mainly happens on the cheeks and on the nose.
It usually starts at around 30 years old and gets worse with age, but it can happen much earlier. Both men and women, and people of all races, can get rosacea: even though it is under-diagnosed in men because they don't take their skin health seriously, and in people with darker skin tones because it's not as noticeable when they go red. There are four different subtypes of rosacea, but they do overlap so these aren't strict divides.
The first of these is erythematotelangiectatic rosacea, which as the name suggests is where you have redness (the erythemato) and telangectasia (which are the prominent superficial blood vessels). This is the most common type of presentation for rosacea. Next, we have papulopustular, which is much more of an acne rosacea overlap because you notice papules and pustules on the face with a background of redness.
Rhinophymatous rosacea is the third type and this is when you have chronic inflammation on the nose, and over time this makes it get thick and fibrotic. And we can probably all remember seeing someone in our lives with a nose that look like this, usually an older guy, and you probably assumed that he got that in a bar fight. But it was actually rosacea and he is innocent.
And finally, we have ocular rosacea which is rosacea affecting the eyes. This presents with red eyes, irritation and a gritty sensation in the eyes. So if you go red easily and you always feel like you have something in your eye, make sure that rosacea is on your radar.
Rosacea is thought to be caused by a combination of genetics, skin and gut microbiome, and UV exposure. And there's a lot more to say there which is pretty fascinating, but because this video is focusing on treatments, I'm going to leave it at that. So let's talk about treatments, and for those of you familiar with my channel, which is obviously all of you who are subscribed.
Wait, what's that? Only 5% of people watching this are subscribed? You're f*#c%ng with me.
. . 5%?
! Okay, well I love those 5% of you and to the other 95%, I'm so disappointed I don't even know what to say. So those of you familiar with my channel know that I like to approach treatments with lifestyle interventions first, then over the counter options, then prescription creams and tablets, and finally procedures.
So let's start with lifestyle. We already hinted earlier that rosacea gets worse with some well-known triggers such as sun exposure, spicy food, cold temperatures, and embarrassment. So the lifestyle interventions include avoiding those triggers.
So 1) wear sunscreen. And those of you with rosacea need to be EXTRA careful with sunscreen compared to the general public. I recommend that you use a minimum SPF 50 and that you should use physical sunscreens and not chemical sunscreens.
What I mean by that is you should look for products which have zinc and titanium in them, not ones that contain oxybenzone or avobenzone. The reason for that is because people with rosacea have sensitive skin and chemical sunscreens can be more irritating. You should also be reapplying your sunscreen in the afternoon and not just in the morning.
Now I'm not one of those militant dermatologists who tells everyone to reapply sunscreen every two hours. Normally I tell people, hey, do it in the morning and every little helps. But if you have rosacea, genuinely, take some in your bag with you to work and reapply in the afternoon.
So the next step in trigger avoidance is to not eat spicy food. Now if you're brown like I am the idea of avoiding spicy food probably sounds like a fate worse than death itself. And so I would rather shine bright red and eat my biryani.
But if you don't like spicy food anyway then this should be easy. Next, avoiding cold weather, and what you can do is wear a scarf or some kind of ski mask to make sure you don't turn up at work bright red during the winter months. And finally, avoiding social embarrassment, which I think is a great rule of life for basically everyone.
And here are some essential tips for avoiding embarrassment. 1) don't have food in your teeth. 2) don't eat foods that give you gas.
And 3) if you're going to click on TikTok make sure your volume is low, because that autoplay is always going to embarrass you in a quiet room. Okay, so that's advice for the general triggers, but my next piece of lifestyle advice is to help identify your own individual triggers. People with rosacea may have some unique triggers for them such as cosmetics, certain types of foods, or exercise.
If you make a habit of keeping a little diary in your phone every time you feel yourself flushing, you might be able to identify some triggers that you otherwise would have missed. And the final piece of lifestyle advice which I'm obviously a huge expert on is makeup. There are actually some types of makeup that have a green tint and what they do is they cancel out the redness from rosacea to give you more of a baseline look.
I know that Clinique has a Redness Solutions line which seems to be pretty popular, although I have no association with them. So next up for rosacea treatments is over-the-counter options, and before I talk about which over-the-counter products you should use, it's more important even for me to clarify which ones you SHOULDN'T use if you have rosacea. As I said before, people with rosacea have sensitive skin, and therefore they need to avoid any ingredients that have an irritating potential.
These include things like physical exfoliants, those microbead scrubs, or even chemical exfoliants with things like glycolic acids, salicylic acid, or lactic acid. Also benzoyl peroxide and certain types of vitamin C can be extremely irritating, and finally, chemical sunscreens and retinoid products. Now that may come as a shock to you because I basically mentioned every popular skincare ingredient on the whole of social media.
But keep in mind that even if those ingredients can have amazing effects for other people, if you have rosacea and sensitive skin, they're likely going to do more harm than good for you. So even when it comes to my favorite type of ingredients which are retinoids, I would advise you not to use one unless it's been specifically formulated for sensitive skin. Okay, so what over-the-counter products should you use?
1) is moisturizers, and that's because maintaining a solid skin barrier which is nice and hydrated is going to have an anti-inflammatory effect on your skin. If you're able to use a moisturizer which is specifically hypoallergenic from a brand like Vanicream, that is even better for you. Next, gentle hydrating cleansers, and if you have rosacea you should only really be using a hydrating cleanser and not a foaming one or a medicated one.
A few examples of hydrating cleansers should be linked below my video, but basically look for anything that doesn't foam. As I mentioned earlier, physical sunscreens with zinc and titanium are what you want to go for. Now when it comes to active ingredients, azelaic acid really is your best friend if you have rosacea because it's anti-inflammatory and reduces redness.
The higher concentrations of azelaic acid are prescription only, but I've linked some over-the-counter options below the video. And finally, sulfur-based products. Now this can be a cream, a cleanser, or even a mask.
Sulfur is known to be a great anti-inflammatory option for rosacea, but there are surprisingly few sulfur containing options in the US at least. If you do happen to find some good over-the-counter sulfur options, comment below so we can all benefit. But one thing I do want to warn you all about is that sulfur containing products smell like rotten eggs.
Now, let's move on to prescription creams and I'm going to kick things off with metronidazole. This is one of the first line options for rosacea but I'll be honest, I think it's pretty trash. I will personally only ever prescribe metronidazole if somebody's insurance plan insists that they try and fail it first, but from my experience, it doesn't tend to do a lot.
Next, azelaic acid, and that is at 15-20% concentrations which are prescription only here in the US. The most popular formulation is something called Finacea which is an azelaic acid foam. Okay so as I mentioned azelaic acid has a proven benefit when it comes to anti-inflammation, anti-redness, anti-pigmentation, it's suitable for sensitive skin, and you can even use it if you're pregnant, so this really is a superstar, powerhouse ingredient in the world of skincare.
Next, we ivermectin cream, and you may remember that word "ivermectin" from when Joe Rogan took it and all of the news talked about it as a 'horse dewormer'. But why would an anti-parasitic cream help for rosacea? Well, it's thought that the Demodex mite which horrifyingly lives on all of our skin, may exist in higher concentrations in those people people who have rosacea.
So ivermectin cream, which is really effective at killing mites, therefore reduces the amount of Demodex and reduces the inflammation in rosacea sufferers. From my experience, ivermectin cream is probably the best of all prescription creams when it comes to results for rosacea. Next up we have Oxymetazoline, which is prescribed as Rhofade in the U.
S. The way this works is it stimulates the constriction of those superficial blood vessels in our skin, and therefore reduces redness in those people who have rosacea. It's only a short-term reversible effect and so this isn't a cure for rosacea, but it's great if you're going to some kind of event and you want to reduce the redness on your face.
Now although there's no over-the-counter rosacea cream that has oxymetazoline in it, it happens to be the main active ingredient in a nasal decongestant spray known as Afrin. So if you were to take Afrin nasal spray and put two pumps into your favorite moisturizer and apply it to your face, you've basically got a bootleg Rhofade. So try it out and see what you think, if you want, this isn't medical advice, don't sue me.
Next, we're onto tablet medications and stay with me we are almost there. These are usually reserved for people who have very severe rosacea resistant to all those other treatments, or if the rosacea is affecting the nose in that Rhinophymatous form I was telling you about, then we jump straight to tablet medications. Oral doxycycline, which is an antibiotic and anti-inflammatory tablet, is one of my favorite treatments for rosacea.
At high doses it's only safe to use oral doxycycline for around two to three months, but there is a low dose extended release version known as 'Oracea' which is actually safe to use for much longer. Other antibiotic tablets like erythromycin or metronidazole are also sometimes used, but in my opinion doxycycline is the best. And finally low-dose oral isotretinoin, also known as Accutane, can be a great treatment for times when nothing else is working.
And finally, let's wrap up with procedures. And primarily these are just vascular lasers. The most commonly used ones are IPL and V-beam laser, and what these do is they literally just explode the superficial blood vessels in your skin, and after a little bit of bruising for a few days, those blood vessels just disappear.
The results from these vascular laser treatments are really amazing, and most people only ever need one or two treatments for their whole life. You get a long-term sustained benefit and so I think these vascular lasers are an amazing option for people who have fair skin, not so much in people with darker skin tones, because then it can lead to burns. The downside of these vascular lasers is that you'll have a little bit of downtime for a few days, but more importantly it's that insurances don't cover them.
In most places in New York, the prices vary from around $300-$500 per treatment ,and so even if you times that by 2, at $600-$1000 I think that's pretty good value for money for something that really is a long-term fix. This is also a good time to clarify that I'm not biased, I'm not offering these laser treatments with me, I have no deal with any laser company: this is just the scientific truth. So that was an absolute marathon, and if you managed to make it all the way to the end, drop a comment below with a medal or a trophy because you deserve some recognition for your commitment.
And if you like scientific skincare content like this, you may enjoy the video I did on acne treatments. Otherwise, thank you so much for watching and I will catch you in the next one.
