Maggie Stasek (6:58)

It is so interesting. And just a side note, hormones impact so many things. And I think you said this, we discredit it often.

Ella Cressman (7:09)

Mm, absolutely. Stress. We've talked about, like cortisol face and such. They are fascinating subject. I am deep, deep, deep into the research and the like book work is done. Check. And now I'm doing the in vivo stuff. So watching it happen in the skin, applying some information. So stay tuned for more of that. But hormones play a huge role and we don't really address more than are you in your menstrual cycle or not? But there's androgen hormones, there's stress hormones. There is even the GLP1s and how those influence the hormones and how that then influences the skin. It's fantastically cool. There's even more research that happens. We've known for a long time that rosacea can be a vascular issue. Actually, that's what they thought it was. It's venous, meaning like telangiectasia or the cofrose that you see in the skin that that's a problem, but it's really not known what the cause is. It's really more of a side effect, in my opinion. What do you think? I don't know.

Maggie Stasek (8:11)

I don't know that I know enough to say. I mean, it's easy to say this is a vascular issue cause you're seeing the flushing in the skin. People do experience cuprose, but maybe that's not it. Or maybe that's secondary to what the trigger is.

Ella Cressman (8:24)

That's what I think the Key is chicken or egg, which comes first. So there is something called the calcitonin gene related peptide. And what they found is there's elevated plasma levels of this. What they're. I'm gonna be grateful for this acronym CGRP and its role in vasodilation and inflammation. They're watching this to see what's going on. And these findings are going to suggest is this a cause or is this a solution or a therapeutic target, which will then open avenues for other treatment opportunities. Pretty cool, huh?

Maggie Stasek (9:01)

Very cool, yeah.

Ella Cressman (9:02)

The other thing that's happening is that they have FDA approvals for emerging medications, which is different because we haven't really had a whole lot in the rosacea field. This, to me signals we're getting closer to understanding it. We're getting closer to seeing what can potentially be ground zero, if you will. And these that we're going to speak on are really just addressing symptoms, but they're addressing specifically rosacea symptoms. So that's why it's exciting. There's something called Imrasi that is a minocycline hydrochloride, extended release capsule hydrochloride. Kind of interesting there because we see hypochlorous acid. These are cousins in the market space now, so keep that in mind. But in November 2024, so really recently, the US Food and Drug Administration approved this IMRASI for treating rosacea. It's an oral medication, which there's another indication there. Hey, this is not just a topical issue which was thought of before. What they saw is an effectiveness in reducing inflammatory lesions, facial redness and all of that in the clinical trials, all while minimizing safety concerns. So this is great for all stages and all grades, especially Papo pustular rosacea, which is like the most unfortunate, the most uncomfortable, I think. So very interesting. When I said hold that thought on the hypochlorous acid is because the spray. Have you seen a lot more of that emerging?

Maggie Stasek (10:36)

I have not specifically, no, but I am familiar. Yeah.

Ella Cressman (10:39)

Is especially effective for or indicated for acne at the moment. Supposed to be cleansing. There's lots of information on it for acne. But when we think about rosacea, not just the redness, but the imbalance, the microbiome imbalance that could be then perpetuating the symptoms of rosacea. The hypochlorous acid is also topically is also shown to have some relief. It kills the environment for the other triggers. So fascinating. But we have basically a hyperproliferation of skin cells, a hyperproliferation of Sebum, and then they're noticing, like, this increased population of Demodex mites. So is it a Demodex mites issue, or is it just that the Demodex mites have more food and so they're eating Thanksgiving every day, and then they're hanging out and procreating. Let the details surface in your mind for a little bit, and then they're, you know, expanding these populations. So interesting. So you're taking away some of those factors, and the rest come down specifically addressing the skin cell proliferation, the sebum proliferation, and then the rest is kind of like a domino effect. The other thing that they have is an encapsulated benzoyl peroxide cream is a 5% from Epsila Galderma. So this is really interesting for a few reasons, but utilizing a silica encapsulation process, this cream actually releases gradually this 5% benzoyl peroxide into the skin, which is important for minimizing irritation and controlling bacteria. Clinical trials reported a significant reduction inflammatory lesions with tolerability comparable to placebo. So meaning minimal inflammation, which is really key because when you're with rosacea, you don't want to light the match. That starts thing. So another really promising option for rosacea patients.

Maggie Stasek (12:40)

And I think going back to what you said, is it the chicken or the egg? Hard to know. I'm sure that they, quote, unquote, have their finger on the pulse there. But just using your example, with increased cell proliferation, Sebum and the Dermadex mites, who came first, the mites or the food?

Ella Cressman (13:02)

Yeah, and so killing the food kills the mites either way.

Maggie Stasek (13:05)

True, true. Yeah, you make a really good point there. I mean, you know, there's also so many other factors that have been pointed to as a result of rosacea, like fungus, for instance, yeast as a trigger for rosacea, and gut health. Again, pointing to yeast as a trigger for rosacea. Um, so it's. It is really fascinating.

Ella Cressman (13:30)

It is a fascinating subject. And I think my takeaway, or what I would love for our listeners to take away, is keep your eyes and ears open and don't get stuck in a certain way. And then also understanding how you can manage triggers, because I ha. I think I shared this with you. I have a rosacea client who does not really respond to mandelic acid in an unfavorable way. It's like, cool, yeah, we can do it. No problem. And I have another client who has rosacea who cannot tolerate it at all. So when we're told by the brands that oh, this is perfect for rosacea. It's okay that it's not okay for everybody, because it's case by case. So if you have someone who truly has rosacea, you want to think about a couple things. You want to think about the cell turnover. Is it hyper? Is it going so fast? That could be an indication. So what do we do about that? Hyperproliferation. That factory is moving super fast. What can we do as estheticians? Because it might be from spicy food that they ate. And the skin is responding, going, oh, yeah, I'll fix it. I got you. Because the skin, you know, thinks it's a superhero.

Maggie Stasek (14:42)

It's.

Ella Cressman (14:42)

It's pretty great, but. Or is it too much sebum? Trying to, like, balance out the microbiome, which is what I'm imagining is like, oh, my gosh, something's wrong. We've got to protect. We've got to protect. Let's put our force field up. But it's not going where it needs to go. Or is it? You know what? So what can you do? You have to have that perfect balance. And that perfect balance, in my experience, is unique for every person. So what I would suggest is in the treatment room, you can't just go off of a protocol that was designed by somebody. You can take it, but you have to make it, like, custom to that person.

Maggie Stasek (15:16)

Adaptable.

Ella Cressman (15:16)

Yeah, you have to adapt it. That's a great word. You have to adapt it. So you. You need extra time, which is awesome, because point number two is you need less variables, so less product. So take your time. Cleansing. Give. Allow time for the skin to dry completely after it's cleansed. And look at it. Assess. Ask questions like, what is the sensitivity level on a scale from 1 to 10, are you. What sensations are you feeling? Great. Next. Now you're gonna go in with whatever the next product is, be it a some kind of preparatory or a serum or whatever you're gonna put it on, you're gonna stop, you're gonna wait. Allow time in between. So you might be using five products, six products in the treatment. But stop and enroll. Add in other modalities. Sometimes even physical manipulation can instigate. So stop and chill. Stop and chill. Focus. While you're waiting. You can do like a decollete or neck and back massage, if you will, something else, but go really slow. Keep the routines very simple so that you can swap out products and control the variables. That is the key to relief. You're not going to cure it is the second thing. It's relief and it can come back really quickly. What do you think?

Maggie Stasek (16:31)

I have nothing to add. You a hundred percent said it. We've talked many times about the importance of analysis and consultation and adapting to each individual and protocols provided by your manufacturer are simply a template to go off of.

Ella Cressman (16:45)

Just my opinion, but Rosacea is widely researched but yet greatly misunderstood, and I think each case to to echo needs to be handled as an individual and with customization and with an understanding that clinical cooperation may be in the client's best interest. Now, listeners, we really want to hear from you. Have you seen a rise in Rosacea? Reach out via an Instagram, Facebook or send us an email@getconnectedcpskincare.com we want to know all the details. In the meantime, thank you for listening to ASCPSI talk. For more information on this episode or for ways to connect with Maggie or myself, or to learn more about ascp, check out the show notes and stay tuned for the next episode of ASCP STTalk.

Tyzo Skin (17:37)

This podcast is sponsored by Lamp Probe. Lamp Probe is a popular esthetic tool that enables skincare practitioners to rapidly treat a wide variety of common minor skin irregularities or msi. Red MSI treated by Lamprobe include dilated capillaries and cherry angiomas, yellow MSI cholesterol deposits and sebaceous hyperplasia and brown MSI treated include skin tags and more. Lamprobe MSI treatments are non evasive and deliver immediate results. Lamprobe can empower your skin practice with these new and highly in demand surfaces services. For more information, visit lampprobe.com that's L-A-M P R O-B-E.com and follow Lamp Probe on social media. Lampprobe.