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ASCP Esty Talk
Ep 320 – Facing Rosacea: Breakthroughs in Care and Treatment
00:18:30
This episode of ASCP Esty Talk finds Ella and Maggie tackling a topic that’s red hot—literally! Yep, we’re talking about rosacea. With over 415 million people affected worldwide, this condition is more common than you might think. But here’s...
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- [00:00]
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- [01:32]
Ella Cressman
Hello and welcome to ASDP Esteetalk. I'm Ella Cressman, Licensed esthetician, International educator and content contributor for Associated Skincare Professionals.
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Maggie Stasek
I'm Maggie Stasek, Licensed esthetician and ASCPS Program Director.
- [01:48]
Ella Cressman
Well, today we're talking or tackling a topic that is red hot. Literally. Yes, yes, yes. We're talking about rosacea. We talk about it every year. We talk about it every year in April because this is National Rosacea Awareness Month. But here is the exciting part. There are new advancements in rosacea treatments that are making waves. This is one of my favorite subjects because there is so much change so often. And the other thing that I am very well aware of is that we often associate or treat or address skin and aesthetics as rosacea. But I think there's a confusion between rosacea and sensitive.
- [02:30]
Maggie Stasek
Yes, I would agree with that.
- [02:32]
Ella Cressman
So one of my favorite things to teach on or to speak on is rosacea because there's so many different changes this year. What we've got are breakthroughs from skincare ingredients really to cutting edge medical solutions. So let's dive into all the good stuff. If you've never dealt with or experienced it, rosacea is an unexpected flushing or pesky redness or that why is my face mad at me feeling. A lot of people have felt that and they are not alone. The global prevalence of this is increasing. There is a bigger understanding and not only what this condition is, but who's afflicted. Approximately 5.46% of the adult population worldwide is affected by rosacea and that equals 415 million individuals. Another fun fact is it used to be thought that it was a northern European ailment because I think of they could visually see it, but it's something that afflicts all Fitzpatrick types, all skin types, all skin tones, all ethnicities. In the United States alone, There are over 16 million Americans who suffer from rosacea. That is estimated. There is a difference between women and men in that women are more frequently diagnosed with rosacea than men and the Prevalence rates are 5.9 to 4.4. So close, but definitely more women. And there's something else to be said about the age distribution. This condition is commonly manifested between the ages of 30 and 50 with a notable prevalence in 3.7% among individuals aged 25 to 39. And I think that there is something to that. I have a client. Her name is. Well, I won't share her name, but I want to share her story. She fit all the markers. And recently, well, let's go back. Historically she's been sensitive. Recently in the last three years, we've seen this facial flushing increase. And then also she's had a skin cell buildup increase. It's like the proliferation of the skin cells is, is speeding up but then hanging on. So like, for lack of a better term, crusty. And then the distribution of oil in her face has increased. She came in, I want to say last June, so nearly a year ago now. Nah, kind of irritated and such. And then in August, she had some issues that we now can recognize as rosacea triggers. It was a super stressful time for her and she flared up like crazy, like she had never seen, to the point where she actually stayed home from work, work from home for six weeks. Her skin was flaky. Her skin was red, it was hot. She felt like she couldn't do anything. It happened seemingly like overnight. It went from yeah to bam. So unfortunate for her. But it was a really cool experience for me, a rosacea enthusiast, to try some things out. I'm not. That's a bad. That's a bad way to put it. But to really put into practice some ideas I had had and some other things I had been working on and that was taking it slow. But understanding some of her changes. Let me tell you say this real quick. There was a recent study published in Skin Research and Technology that delved into the correlation between perimenopause and the incident in the severity of rosacea in middle aged women. Guess what she was experiencing at the same time? Perimenopause and so we discount. I know menopause and perimenopause are hot topics right now, but we discount things and think, oh, did you eat spicy food? Were you stressed? Did you go through weather changes? Which are all valid triggers, but it was this rosacea and this increase also in intensity. So now she's got these symptoms and this obvious condition increase at the same time. It was really, really interesting. So now that I'm into two of my favorite subjects, which is perimenopause and rosacea, and seeing this trigger opportunity, I'm having a blast with really addressing this in the treatment room. One of the things that is most exciting that comes out of the study is it's exploring the role of the hormonal changes, specifically estrogen levels and the pathogenesis of rosacea. So this observational study concluded that the dermatology outpatient department of a West China hospital spanned over a year. That this is what they were seeing, which is very interesting. Right? New development.
- [06:59]
Maggie Stasek
It is so interesting. And just a side note, hormones impact so many things. And I think you said this, we discredit it often.
- [07:10]
Ella Cressman
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.
- [08:11]
Maggie Stasek
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.
- [08:24]
Ella Cressman
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?
- [09:01]
Maggie Stasek
Very cool, yeah.
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Ella Cressman
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?
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Maggie Stasek
I have not specifically, no, but I am familiar. Yeah.
- [10:40]
Ella Cressman
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.
- [12:40]
Maggie Stasek
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?
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Ella Cressman
Yeah, and so killing the food kills the mites either way.
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Maggie Stasek
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.
- [13:30]
Ella Cressman
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.
- [14:42]
Maggie Stasek
It's.
- [14:43]
Ella Cressman
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.
- [15:16]
Maggie Stasek
Adaptable.
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Ella Cressman
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?
- [16:32]
Maggie Stasek
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.
- [16:45]
Ella Cressman
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.
- [17:38]
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