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Rosacea! It’s complicated

KelliVRN • Mar 10, 2022

Rosacea is a chronic skin condition that typically affects the face, however, can affect face, neck, chest and other areas of the body. Just about 16 million people are diagnosed annually, and that’s just the folks that go into the physician’s office for help. So I’m guessing it’s more like 18-20 million.


The most common symptoms are blushing, persistent flushing, visible blood vessels in your face, typically in the t-zone of the face (nose, cheeks, chin). Symptoms can often progress into small pimples that resemble acne also known as “papulopustular rosacea”. Moderate symptoms can be a burning sensation to the affected areas then some people can have “rhinophymatous” changes like enlargement of the nose and an orange peel look to the skin. Rosacea of the eyes ,“ocular rosacea”, can cause dry, irritated, sometimes swollen eyelids. Sounds complicated! Right….


There are triggers for your rosacea that can cause flare ups: Red wine, alcoholic beverages, emotions, hot drinks, spicy foods, temperature extremes, certain drugs, exercise, some cosmetic and skin care products. These triggers are very individual and can differ from person to person. The cause is still being disputed but what we do know is that it can be hereditary, it’s not contagious or caused by poor hygiene. Research is leaning on multiple causes; possibly an overactive immune system, environmental, chronic inflammation which leads to the breakdown of the skin barrier, just to name a few as root causes. Breaking that cycle of inflammation, seems to be a key factor in improving rosacea symptoms.



This chronic Inflammation (inflammation over time ) is looking more like a key factor in the rosacea continuum. Decreasing inflammation can be crucial in reducing the overall symptoms related to rosacea. The repeated episodes of facial blushing, flushing, papules, pustules (acne rosacea) can lead, over time, to the skin barrier breakdown thus resulting in a breakdown of the skin’s microbiome.

Here are some things to consider to reduce some of this inflammation.


STEP ONE


Reduce triggers.The sun can be the number one trigger. Reduce sun exposure during peak sunning hours, between 10am-3 pm.


STEP TWO


Maintain your skin barrier with proper hydration and topical antioxidant therapy. Topical antioxidants contain vitamins which help fight free radical damage. Damage is caused by daily exposure to UV rays, pollution, smoke, stress, and years on the calendar. Just with the natural aging process our bodies produce less antioxidants which in turn increases the risk of more serious skin conditions. Daily use of pure vitamin C, properly formulated to absorb into the skin, can protect against damage and strengthen self repair. I like Skin Ceuticals, C E Ferulic, it’s an award winning Vitamin C combination antioxidant serum proven to give environmental protection. It negates free radical damage caused by daily skin vunerabilies (UV rays, pollution, infrared A radiation). It also helps the skin look more youthful.


Hydration, also part of step two, is using a moisturizer daily. For Rosacea patients I like to recommend the Redness Neutralizer by Skin Ceuticals. According to a clinical study, it can help reduce the appearance of redness and flushing up to 30%. It also can help combat environmental triggers, reduces skin temperature, and reinforces the skin barrier. If you are looking for an over the counter product I recommend the La Roche-Posay Toleraine double repair moisturizer. This product also comes with or without sunscreen. Do not put a moisturizer with sunscreen on before bed. Always wash your face with a gentle cleanser before bed and then apply a moisturizer without sunscreen. The less chemicals you can put on your face the better.


STEP THREE


Use sunscreen before you walk out the door and always carry a wide brimmed hat in your car or your bag. The wide brimmed hat should be tightly woven so no big gaps or holes in your hat. These two items will be a blessing. Sunscreen should be in a lotion or cream form not a spray or aerosol. Aerosol particles can get into the air you breath and cause issues over time. Take it a step further and wear sun protective clothing when doing any outdoor activities or sports. I like the Coolibar brand and they have fashionable clothing and feel cool on the skin in hot weather. Coolibar.com


STEP FOUR


Start an anti-inflammatory diet so basically a plant based diet. I have to say I have switched to a plant based diet during the week and then on the weekends maybe chicken or a bite of tri tip. What a difference!. No more aches and pains and definitely less facial flushing and redness. Getting enough sleep and exercise will affect your mood, rosacea, and overall health.

I’m not going to get into the ins and outs of a plant based diet, and proper sleep and exercise, that is something you can google and discuss with your primary care physician. I will say it starts with you taking the first steps to a better you. Nobody is going to do it for you. As with all things worthwhile, it takes time, patience and perseverance. Remember, nothing happens overnight.


STEP FIVE


No matter how mild or severe your symptoms are, seek out the help of a dermatologist. Dermatologists treat rosacea daily and are up to date on the most helpful treatments, therapy, topicals, and laser treatments. You will need your treatment to be tailored to your specific needs and that’s where your dermatologist plays a key role, organizing your treatment regime. Remember Rosacea is very individual and symptoms can vary from patient to patient. A dermatologist may start with topicals and prescribe oral medications for acne rosacea ( bumps,pimples) and facial flushing.


When fitting, vascular laser treatments may be used to remove visible blood vessels, and reduce redness. I have been treating patients for about 18 years with laser treatments and they work well and rejuvenate the skin in the process. How it specifically works is the laser emits a wavelength of light that targets hemoglobin (tiny vessels under the skin) the heat causes the vessel to break up. Bye bye broken vessels! It may take more than one treatment depending on the severity and treatments will probably be ongoing. There is no one and done. Rosacea is lifelong and management is key. In severe cases, a CO2 laser may be initiated to remove undesirable tissue and reshape the nose, as in rhinophyma.


I will make a suggestion. When choosing a Dermatology office make sure that office is equipped with the latest technology to help your rosacea needs. At our office we are armed with three different laser systems: Fractionated CO2 resurfacing system, Candela’s Nordly’s multi platform system (IPL/1064 Nd yag/ LHR/ frax 1550/frax 1940) and 532 nm iridex. We can treat up to skin type 5 for specific skin conditions. Just as a rule of thumb, the darker the skin the darker the eyes the harder it is to treat for fear of post inflammatory hyperpigmentation. Skin types 4-6 are always going to be a more conservative treatment regime.


All these lasers come with a big responsibility. Make sure your technician (nurse, PA, MD. etc. ) is certified on these laser systems and has completed a laser safety officer course (LSO) I took Patti Owens course, physics and safety core of knowledge, laser/intense light generation and characteristics, hazards and risks from equipment and laser/ipl beams, laser & intense light source radiation tissue interaction, and relevant legislation and safety standards. www.aestheicmedconsulting.com, info@kenteklasersstore.com or LIA (Laser Institute of America) are good sources, if you are interested. As always, patient safety is number one!!!



Remember to consult with a board certified dermatologist for all your rosacea questions, needs and treatments.


My sources


  • Dermatology Times, Jan 17,2022, “Answers to your patients questions on skin care”.
  • Dermatology Times, May 25, 2021. “ OTC Skin Care Products Enhance Rosacea Therapy”.
  • National Rosacea Society
  • The Dermatologist, December, 2017, “Updated Rosacea Classification Pathophysiology System”.

SUNSCREEN

By KelliVRN • 10 Aug, 2021
Summer is here and the weather is hot! I would like to say, the best protection from the sun’s radiation over time is a wide brimmed hat, sun protective clothing, staying in the shade, and of course your sunscreen. Recently there has been some controversy over some sunscreens containing benzene. Benzene is a known human carcinogen for at least a hundred years. A recent article in “Dermatology Times”, highlights a recent batch testing done by a pharmacy (Valisure), that found up to 78 different sunscreens and after sun care products contained benzene. This is startling to say the least. Attached (see below) is what Valisure has posted, Attachment A, table 5, product description of various batches of sunscreen for which benzene was not detected through initial tests, of at least one sample from each batch. You can check on your own with the UPC (Universal Product Code), lot number and expiration date. I believe some sunscreens have already been recalled. Best to check yours at home or any recently purchased sunscreens, and check table 5. Things to consider when purchasing a new sunscreen; When you apply sunscreen and then go into the sun, your pores will dilate from the heat allowing the sunscreen chemicals to be absorbed into your skin and into your bloodstream. Certain chemicals can cause issues later on in life. In addition, consider staying away from sprays and aerosol type sunscreens. The reason behind that is, you can breathe in those chemical/mineral particles getting into your lungs. I do not recommend any sunscreens that are in a spray or aerosol form.  I will list a few sunscreens that are over the counter that I like and are on table 5, from Valisure (see attachment below).

TRUST

By KelliVRN • 03 Jun, 2021
Good morning all, I haven’t posted anything in over a year, I sooooo apologize. Today I’m bringing up the issue of trust. Lately I’ve been hearing of the resurgence of “Botox” parties. Usually these are at an off site location of someone’s home or place of business ( not a medical office). Alcohol and appetizers are usually served. The person injecting comes from out of town to make money on a small group of folks. I have a real issue with this for several reasons. One, I don’t think its a good idea to mix alcohol with decision making regarding your face or anything for that matter. Second, injecting Botox is considered a medical procedure and there can be complications. Let’s face it , it’s not like you are having a Tupperware Party. Injecting Botox or other injectables is a medical procedure and should be done in a medical setting by a medical professional. Another thing you should be asking yourself is, “Do you trust this person”? Can you get a hold of them if something does go awry? What if I faint? These are just examples of unforeseen medical complications, the list goes on. Rest assured if you are in a medical office any of these circumstances can be addressed, promptly. I have spent hours fixing other people’s botch jobs and sometimes it’s not an easy fix. Let’s look at the cost benefit analysis: Say your husband doesn’t want to pay a professional to trim his trees/yard. So he does the work himself and injures his back. Ends up in the hospital eventually needing surgery. What could have cost maybe $1,500 now is costing $50,000. Sometimes it’s better to put your trust in a professional who performs that service regularly and is good at it. Why put yourself at risk? Finding an injector you trust, that has the knowledge base to address your particular needs and works in a clean setting is imperative for consistently good outcomes. At our office we have a medical professional on call after hours and on the weekends for urgent situations related to procedures. I have been at the same office for the last 17 years, everyone knows where to find me. I inject everyday.  The next time you search for the cheapest botox or dermal filler, just remember this is your face! YOU CAN’T PUT A PRICE ON TRUST AND EXPERIENCE.

DefenAge's Key Performance Ingredients and Technologie

By KelliVRN • 27 Aug, 2020
We infuse each of our formulas with a fine collection of high-functioning ingredients and advanced, multi-action technologies. Our unique skincare compositions reverse visible and textural aging on a global scale. The formulas are effective regardless of age, ethnicity or skin condition.

NEW GUIDELINES

By KelliVRN • 10 Jul, 2020
Your Safety Is Important To Us  Some new guidelines when visiting our office for cosmetic treatments When arriving to the parking lot please call 805-434-5563 to check in from your car. We will call you on your phone when your room is ready to be entered. A mask is required when entering the building, once you are roomed with your mask on, you will be instructed on mask removal, if necessary. Once you are roomed you will be given hand sanitizer If applicable, a pre-rinse may be given before your treatment Please do not come in to the office if you are not feeling well. Please use hand sanitizer again on your way out

PERCUTANEOUS COLLAGEN INDUCTION

By KelliVRN • 12 Mar, 2020
Otherwise known as medical needling

My Take on Neuoroxins

By KelliVRN • 04 Dec, 2019
There are four neurotoxins. These four neurotoxins: Botox, Dysport, Xeomin and Jeveau all work the same way. Basically it’s a protein taken from the Botulism neurotoxin and this protein is injected into certain muscles to relax them. This protein works by blocking the neurotransmitter acetylcholine (the messages being sent to the muscle) and those injected muscles relax. It is this relaxation of certain muscles that smooths the forehead or the frown lines, etc… There are four different pharmaceutical companies creating these neurotoxins, and the proteins come from four different neurotoxins. I have used all four neurotoxins on myself and they all seem to do the same thing and last pretty much the same. I feel sometimes I have to use more Xeomin to get the same result as Botox or Dysport. Jeveau is the newest of the bunch and seems to do fine so far. I’m thinking though that Allergan (Botox) has been doing it for 30 years , has a great track record, their lab has been doing this a long time and a medical team waiting to answer any of my questions or concerns. Dysport comes in at a close second. My top two products would be Botox and Dysport. Botox seems to be the more expensive out of the bunch but they also have a huge resource system in place as well. Each product has its attributes. It’s really what your injector is most comfortable injecting. When it comes to finding someone to do your injections the most important thing to consider is how well your injector knows your anatomy. Anatomy knowledge is key to seeking natural and consistent results. Your injector should get to know you and vice versa. Your injector should be very proficient in knowing your anatomy. Talking before injecting is important especially if it’s your first time. I usually do a follow up appointment at two weeks to make sure the patient is happy and there isn’t anything we need to add. Its way easier to add on but you can’t take away. Everything is documented, where, how much, how often, what product etc… It’s not a point and shoot kind of thing! I feel like some people shop around for the best price. Really? You really want cheap Botox for your face. Or a person will hop around from place to place and the injector doesn’t get to know your likes and dislikes. Your face is, well, your face. You’ll spend $200 on your hair and maybe $60 for a mani/pedi, and $400-500 on a purse but then want to spend less on your face? Do you really want a groupon for your face? What it comes down to is just finding someone you are comfortable with, and is available to you for any questions or concerns.

Staying Healthy Both Inside & Out

By KelliVRN • 04 Sep, 2019
The Importance of Your Skin Barrier and Moisturizing (Part 1) A recent pilot study has linked keeping a proper moisture barrier may have an interconnection to a person’s health and wellbeing. Researchers at UC San Francisco found that age damaged skin in older adults could be related to a variety of conditions such as heart disease, Alzheimer’s, just to name a few. So, here’s what researchers found, as we age our skin barrier breaks down, which then leads to an increase in cytokines circulating in the body. Cytokines are proteins that signal there’s inflammation. If the cytokine level in the body is substantial, it will provoke inflammation throughout your system. This continuous inflammation over time then can lead to health issues. Researchers were trying to figure out what organ of the body is big enough that even a small portion could cause such inflammation. Bingo! The Skin. As we age, the circulating cytokines increase, our skin gets dryer, itchier, acidity changes, and so on. Our skin barrier breakdown plummets as we age causing more inflammation. Young people don’t have as many circulating cytokines and young skin is plump and intact, a safer skin barrier (less aged). The experiment went like this, they took older adults (ages 58-95) and had them moisturize their bodies twice a day for 30 days. After 30 days, these adults had cytokine levels tested again and it seems these folks had a decrease in three different cytokines to that of a 30-year-old. Wow! Let’s get back to that skin barrier. Even young skin can be compromised, people with eczema or psoriasis, for instance. These conditions break down the skin barrier at a younger age, so are these folks more susceptible to inflammation sooner then most? Is there a study linking eczema to Alzheimer’s? The sun in general will break down your skin barrier over time, including pollution, radiation, chemotherapy and the list goes on. Again, your skin is the largest organ of your body, take care of it, moisturize it, protect it, baby it. Skin Barrier (Part Deux) We now understand that moisturizing the body is important. What should you use? Which ingredients are going to be the most helpful in reducing inflammation? According to Skin Inc. magazine the July 2019 issue, Vitamin B3, also known as Niacin or Niacinamide, enhances the skin barrier. Niacin is found in meat, fish, beans, cereal, eggs, and vegetables. Our body doesn’t make this particular vitamin, so we have to ingest it through the foods we eat. Studies have shown that a topical application enhances the skin barrier lipids! Niacin also helps reduce redness and pigmentation, increase elasticity, and has a bit of anti-inflammatory effect as well. I think this will be a great ingredient. The skin barrier is SO important. The other ingredients you will look for are emollient oils and butters. Shea butter is good. Mango seed butter is good. See if you can get these ingredients in your moisturizer. What I mean by oils are, sunflower oil, or sweet almond oil. These are just examples; you can be creative. These natural oils work well and they contain fatty acids that help support your skins moisture barrier. The oils and butters are over the counter, just be sure to go organic. Another ingredient that is super important is hyaluronic acid. This stuff is a natural moisturizer and can hold in moisture 1,000 times its weight in water. It can repair your skin and lubricate! Now anything with anti-oxidants like vitamin C, vitamin E, that would be the Skin Ceuticals; C, E, Ferulic acid, just add that to your regime. You should be using that already anyways. Just e-mail me if you have any questions. I have two kids launched and only one at home. I am happy to help. Product Suggestions:

Kelli Approved Sunscreens

By KelliVRN • 31 May, 2019
Sunscreen is important these days, but some sunscreens are better then others. This summer get yourself a good sunscreen, always have a wide brimmed hat (tightly woven one) with you. Sun protective clothing is also a good option. No matter what, you still need to put sunscreen on those parts of your body that get sun exposure. You want a sunscreen that is a mineral screen avoid the chemical screen if you can. Mineral ingredients include zinc oxide, titanium dioxide, and avobenzone. Avobenzone is good but some people are allergic to it. If you can use avobenzone as an ingredient go for it. Stay away from sunscreens with insect repellent in it. So, the reason you want a mineral sunscreen is because when you go out in the sun what happens? Heat! The sun causes heat and heat dilates, it will dilate your pores and then you absorb all those chemicals into your blood stream time and time again. So, stay away from a chemical sunscreen. A mineral sunscreen will do this a lot less and kind of sits on the skin and absorbs much less into skin. Remember the skin is the largest organ of the body it does a lot of absorbing of whatever you put on it. Ingredients to avoid: Oxybenzone Octinoxate Homosalate Retinyl palmitate Aerosol sprays Over the counter sunscreens that are good include; Blue Lizard Australian sunscreen baby SPF 30, Vanicream sunscreen SPF 30, Neutrogena Sheer Zinc Dry-touch sunscreen SPF 50. If you are looking for something with a little more oomph! try Skin Ceuticals Physical fusion UV defense sunscreen SPF 50, this has a little universal tint to it and is nice. Skin Ceuticals physical matte UV defense SPF 50 has an oil absorbing base with a matte finish perfect for oily skin types. When you are at the beach use a lot and reapply frequently.

Should you use a retinol?

By KelliVRN • 22 Mar, 2019
WHAT A VITAMIN A RESURFACING SERUM CAN DO FOR YOU. What is a retinol cream or serum? A retinol cream or serum is a topical form of Vitamin A, also known as retinoids. There are many derivatives of Vitamin A, which can reduce fine lines, and wrinkles, and help even out certain skin pigmentations. Retinoids are usually prescribed by a dermatologist, retinols can be used in over the counter formulas.

About Defenage Skin Care

By KelliVRN • 20 Feb, 2019
Besides putting on your antioxidant therapy (C, E Ferulic by Skin Ceuticals) on in the morning, you will need something to help turn back the clock as well. Something with a wonderful study to back up the claims. Defenage Skin Care Trio has a comprehensive clinical trial to back things up. Defenage has this magical thing called “defensins,” in two of the three products. Defensins are peptides that seem to wake up stem cells at the hair root follicle, but only wake up stem cells that are related to skin repair. So, the repairing starts from the inside out, kind of like a reprograming issue. Defenage can be combined with many other skin care lines. According to the attached study, Defenage helped reduced large looking pores, reduced visible lines, improved skin evenness and pigmentation. This isn’t just a little ol’ study, it’s kind of a big thing. Why not add C, E Ferulic and Defensins together? Yippee, you can! The 8 in 1 Bio Serum has 5 times the defensins in it, the 24/7 Barrier Cream has 1x the defensins in it. The cream is nice, but the Serum is better.  This is what I do; I apply C, E Ferulic two drops to a cleansed face in the am followed by 24/7 barrier cream. In the evening, I wash my face then apply an eye cream (talk about that later), apply 8 in 1 Bio Serum (sometimes I add a retinol product just before Bio Serum is put on). Seems to work well with my 51-year-old post-menopausal skin. I use a lot less moisturizers then I used to, I think the combo of Vitamin E and defenage has improved the capacity of my skin to hold in moisture. Now this works for my skin, you may need more work, especially if you smoke, lay out in the sun, or have never taken care of your skin at all. Don’t expect miracles overnight, but these products are a good start.
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