Part 2: How to adapt your skincare routine and diet.
Missed Part 1: how to manage flare ups? Read it here.
Before you read this part, I want to highlight that you should always follow your doctor's advice and in cooperation with them find out what the best treatment is for YOU. Long-term prevention can minimise the risk of rosacea getting worse, but sometimes treatment is necessary to avoid flare-ups.
I didn’t need to treat my rosacea for most of 2019, as I barely experienced any flare-ups (this is also partly why I didn’t believe I had it until last year). Some people don’t find any relief from using prescription treatments and if you do live a healthy lifestyle, you might need to. My experience so far is that it can help with redness and minimise pustules.
I have tried both topical and oral antibiotics. For me, it works like a charm - when you use them. When I used Metronidazole during my POD time it calmed the redness and pustules, but as soon as I didn’t use it my skin flared up. Oral antibiotics are mainly for pustules, which I had barely experienced before I started antibiotics. The come-down (read further down) is the worst I’ve ever experienced and I have never had as many pustules or angry skin as in THIS MOMENT. My doc did say, that we’d have to see how my skin would act when I finished the course, and hey...IT’S. NOT. GREAT.
Azelaic Acid is an organic compound found in grains. It has anti-inflammatory effects and works by killing the bacteria causing rosacea, redness and swelling. I used Azelaic Acid for 6 months before trying brimonidine. I have never had clearer skin for so long a period, and even though it doesn’t completely remove my redness, it seems to make it less aggressive in its flare-ups. It has been calming and clearing up my skin, but as I still experienced redness, my doctor and I discussed other solutions:
Just before finishing my course of Lymecycline, doc and I discussed using beta-blockers, as they can be very effective on redness (spoiler: my biggest problem re. rosacea). Beta-blockers aren’t created as a treatment for rosacea, but a result of using them is that they can minimise redness because it slows down your heart rate and relaxing your blood vessels. The side effects? They can (but may not always) make you dizzy, affect your athletic performance and you should avoid alcohol when on propranolol. Plot twist: I thought it was scary AF to use heart medicine to avoid redness. I wasn’t that bothered - especially NOT if it could affect my athletic performance and mate, not being allowed a glass of wine? Not. Under. My Terms!
Instead of beta-blockers, we went with an alpha-blocker (alpha 2 adrenergic receptor antagonist). Brimonidine works by improving the redness of rosacea by stimulating the alpha-receptors on the skin, causing the blood vessels to contract and narrow which reduces the blood flow. And oy kids, it bloody works! I have never had such a neutral coloured face and as you only use it once a day, I could use niacinamide in the evening again.
Brimonidine needs to be applied carefully, you need to work your tolerance up over a week and it must be applied evenly (surprise: I messed this up a couple of times, see picture further down). Using brimonidine can go both ways, many people experience that it works, but for a limited amount of time and then the redness comes flushing back, often worse. Overall my experience is that it works, however, it didn’t have the same effect on the redness everyday (can be if I had applied it unevenly), and when I had a trigger, the brimonidine seemed to stop working and my skin reacted worse than it would normally do.
Oh WOWZA is this how ‘normal’ skin looks?
Azelaic Acid VS. Brimonidine. These images were taken when my skin is at its best, absolutely glowy, happy and healthy and this is where rosacea doesn’t bother me at all, despite redness which on its good days looks more like a tan (see, rosacea isn’t always that bad). There’s no doubt that Brimonidine helps reduce redness and even out skin colour. It takes a lot of practice to apply evenly though, and a slight mess up leaves your skin with weird patches.
My skin at it’s best, looking natural, dewy and great AF.
Skincare: prescription cream, Mega Mist, Buriti Booster and a simple moisturiser + SPF (for both Azelaic Acid and Brimonidine routines).
Makeup: only mascara and brow gel.
The above right image was taken 4 days before my skin flipped the switch. That’s how quickly different triggers can turn it upside down.
This image illustrates how strong Brimonidine is. It also illustrates WHY it has to be applied evenly.
Skincare routine for rosacea
I recently read that you have to think about rosacea as a constant inflammation in your skin and if you have sensitive, inflamed skin the last thing you want is to aggravate it even more, when it’s already in a constant flight-or-fight mode. I’m looking at it like this: what is the last thing you wanna do to sunburned skin? Be in the sun. So what’s the last thing I want to do to my skin that’s working full-time on keeping inflammation down? Use products that will irritate it.
Key is to keep it simple, make sure your skin is hydrated and to always wear an SPF (in case you can’t, like me when I have POD break-out, wear a hat!).
Ingredients you want to look out for are glycerin and hyaluronic acid, which are hydrating agents, antioxidants to protect against free radicals from pollution and niacinamide, salicylic acid and Azelaic Acid to prevent and soothe redness. If you can, it might be easier to use a day-cream with SPF to avoid pilling and to make sure that you use enough sunscreen.
Some people are having good experiences with Vitamin A, but my perioral dermatitis is freaking out when I use retinol (cute info, our Bakuchiol Booster is a 100% natural alternative to retinol without the side effects!).
Ok ok. So Anthonia, our Formulation Magician told me, that this sounded like a lot. Other people say that rosacea sufferers should stay away from heavy oils. But hey! This works for me! These are the skincare routines that've been most effective for me, adapted to whether I have been on treatment with Azelaic Azid or Brimonidine.
I always use Crystal Clear for cleansing, my FAVE BYBI product. It doesn’t strip my skin and it’s antimicrobial ingredients work really well on getting rid of my POD. If I double cleanse, I use Emma Hardie's cleansing balm first. The smell is a bit grandma (and it’s V £££), but it is doing wonders.
Nelsons calendula cream is a very simple moisturiser, but it’s rich in glycerin, shea and calendula and is easy to mix with other ingredients like Niacinamide. I have been using The Ordinary’s Niacinamide for a year, however, it pills a lot and it’s difficult to layer but its price point makes it reasonable. I am looking into an alternative for when I run out the next time.
Buriti Booster (currently sold out) is an antioxidant protecting against free radicals from pollution and it leaves the most brightening glow on your skin. Our Blueberry Booster is a great alternative.
Mega Mist is great for providing hydration and it honestly makes your skin SO dewy. Night Nutrition is a nutrient dense protein night cream, including broccoli seed oil, antioxidants and fatty acids (all the things you should eat as well!). It calms my skin and leaves it uber soft. A good alternative is Weleda’s Skin Food, but it’s not as soft in the consistency and the scent is less flirty.
CBD Booster is a calming facial oil which improves redness and blemishes and is really good to use as a night oil.
Disclaimer: I might be partially influenced by working at BYBI but it’s a part of my routine because it WORKS. I have tried multiple products from pai, REN and Youth To The People and BYBI honestly does wonders at a very fair price point. In my opinion nothing compares to Crystal Clear and Buriti.
Things I am avoiding:
Like I mentioned previously my current flare-up is a result of me flirting around with too many triggers (no wonder we need a divorce lawyer), but I am convinced it is related to the cocktail I topped on my skin of 4 different highlighters and falling asleep with a BB cream that contains silicone. I try to avoid make-up (mostly because I have no clues on what to purchase that’s worth the money and doesn’t contain s*it) and I prefer to keep things as simple as possible (therefore products with longer INCIs than the bible isn’t for me).
I stay clear of (or try to):
- Parfume and fragrance
- SLS (especially in shampoo and cleansers)
- Mineral oils (like petroleum)
I am very careful with masks and exfoliating acids (like AHA) and only use chemical exfoliants as a treatment when my skin isn’t in a trigger mode (sometimes you do need a good exfoliation, rosacea or not). If I use acid masks I make sure to soothe my skin afterwards and give it an extra layer of hydration. I avoid using classic clay masks if they dry out my skin rather than soothe it.
My come-down from antibiotics
(and my worst flare-up so far)
I am currently on the come-down from antibiotics and experiencing my worst flare-up ever. I didn’t see a noticeable difference in my redness on antibiotics, but my skin was almost clear from pustules and very blemish-free. I finished the course 2 weeks ago and in the past 10 days my skin has been the worst since I first experienced POD and rosacea when I got the diagnosis.
The day I finished my treatment with antibiotics, I had a total fun lockdown weekend, with a house party scheduled. I decided to make an over-the-top-freaking-gorgeous-dewy-dumpling look (find ‘Namvo’ on Instagram and you'll see what I mean) and I woke up with a facial hangover, worse than I’ve seen my skin for a very long time; pustules on my cheeks, perioral dermatitis (which I’d been free of for a long time) around my mouth and serious redness.
And you are just like ‘WWHAAAAAAT ON EAAARTH HAVE I DONE TO DESERVE THIS BLOODY S*IT’. Well, lemme be honest. Slathering 4 different highlighters from Mac, NARS, Pat McGrath and Huda beauty on my face, a BB cream from Origins with dimethicone (silicones) and SPF in it and had given my eyelids an extra layer of shiny eye shadow. For someone who rarely wears more than mascara and a brow gel and then decides to use some of the toughest players in the field, I pretty much asked for hell to come down on me. Let’s just top it up with having a few glasses of rosè (which is a known rosacea trigger) AND falling asleep with my bloody make-up on.
I had tried to calm it down from the above during the week, as my POD flared up so I couldn’t use much skincare and my lips were absolutely broken. I couldn't understand why my skin freaked the F out over the weekend. Then I remembered the past 4 days: Friday you made a healthy, great quinoa dish BUT spiced it up with korma and fell asleep without cleansing your face (I promise, this happens less than it sounds like), Saturday you were in the sun (without SPF because of your POD flare-up), then you ate a dangerous cocktail of pick’n’mix and milk chocolate. And then you realise, this flare-up is something you brought upon yourself. And you are just like ‘Bloody hell, Karen - like your skin hasn’t had a rough enough week already. THIS NEEDS TO STOP’.
Despite looking like Henry The Hoover I didn’t want to cover it up. It was most important for me to 1) make my skin calm down and 2) make it look as healthy as possible within the limitations I had. I have been out of Azelaic Acid and have been using Niacinamide instead, which helps on the redness and Buriti provides an excellent glow.
No, above flare-up was not fun or comfortable but I will NOT let it bring me and my self-esteem down. It’s just a rainy day (or the British version, which equals 5 in a row) and on those days you just wear an extra layer of mascara and treat yourself to blueberries and kombucha (and a yoghurt mask because my face was hotter than a mexican fajita).
Why does the skin react so bad, you might think?
My verdict is, that it comes down to the bucket theory (Talonted Lex explains it great here. If you have had a week where you have been living a healthy diet, followed your normal routine and stayed free of triggers like sugar and products that irritate your skin a thing like a glass of wine or a doughnut might not affect you massively. But if you’d had a week where you’ve been a bit stressed, slept less and been indulging on Snickers, having a glass of wine might be the drop that makes your body say ‘oh-stop-there-hunnaaaay-you-aren’t-pulling-this-one-on-me’. Or, in my case, coming down from antibiotics, falling asleep with FOUR different highlighters silicones on and drinking wine has most likely been a few to many drops in the bucket.
If you do have a heavy weekend coming up (oh boy, I hope you aren’t into festivals) you can try to balance out your ‘bucket’ by being quite restrictive during the week. The most positive balance would be to live healthy on a daily basis, but sometimes, we all gotta let our parades down, eh? By keeping your lifestyle balanced and consistent it might also be easier for you to identify triggers and learn how different things are affecting you. Somehow being ‘guilty’ in my own flare-ups makes it easier, because it teaches me to avoid triggers.
Anti-inflammatory diets and probiotics are the best prevention for rosacea
Pro-tip (Erk. And this is the boring part). Depending on how your body and skin is reacting to your diet, you might have to amend it. What I have realised is a consistent lifestyle with loads of greens and all the good-gut stuff (yes baby, you wanna keep your microbiome in balance, because these cute micro-organisms have way more power than we’ve been aware of for years) is affecting how my skin looks.
I live by (or try to) getting my 5 a day as a minimum, I eat loads of antioxidants and I eat sweet potatoes, broccoli and salmon almost daily (according to ‘The Gut Stuff’ you should aim to get 30 different greens a week). I add healthy fats like hemp seeds and chia seeds to my breakfast and greenies and I aim to get fermented foods weekly.
It can’t be quite challenging to get 30 different greens a week (hint: I don’t) but besides my food I make greenies with spinach, broccoli, cucumber, apples, parsley, mint, lime juice, ginger, green tea, liquorice powder, ashwagandha and herbal tea. You can add seaweed, avocado, kiwi and grapes as well. The above provides you with 8-10 different veggies, is yummy for your gut bacteria and it helps with your digestion. You can make it as a bowl and add goji berries and hemp seeds or add more tea and drink it as a greenie.
You want to feed your gut with the good stuff (ok you might have guessed it, I am a SUCKER for gut health) and if the newer studies are correct about the relation between your gut and your skin condition, it makes sense to avoid things that can create an imbalance like alcohol and sugar. I try to avoid gluten and dairy (except for eating skyr and some cheese) and I am currently on my 2nd week of the live culture supplement Symprove which I hope will work wonders plus I take probiotics from Holland and Barrett.
Antibiotics aren't selective when it comes to bacteria and they are known for vaping everything out on their way. If you do use antibiotics you can supplement with probiotics (I have heard that you should get a minimum of 9 billion cells per day). You can also supplement with the yeast Saccharomyces boulardii (which antibiotics can’t kill because it’s a yeast).
To improve your rosacea you should look for ingredients with beta-carotenes, antioxidants and things good for your gut like asparagus, brussel sprouts, broccoli, onions, parsley, cauliflower, spinach, green beans and turmeric. I have just ordered Eat Yourself Healthy and I can’t wait to get more inspiration food wise whilst treating my gut-fellas to some delish nutrients.
Stay tuned for Part 3: my verdict on prescription treatments and what I'm trying next
Written by Karoline, BYBI Design Executive