At First Blush
Persistent redness and flushing, bumps and pimples, and visible blood vessels on the face are just a few of the primary symptoms of rosacea—a chronic skin disorder that is common, but often misunderstood. In fact, an estimated 16 million Americans have rosacea, but only a fraction are being treated for the disorder, according to the National Rosacea Society. The number of patients being treated for this condition is on the rise, however, and rosacea is now one of the most frequent skin diagnoses made by dermatologists.
According to Whitney Johnson, global education developer at The International Dermal Institute (IDI) and Dermalogica, rosacea often surfaces between the ages of 30 and 50, and because the baby boomer generation is now entering the age of susceptibility, there is more knowledge and awareness than ever of the condition and how to treat it. Also, in the past, the causes and signs of rosacea were often unclear and misdiagnosed, which is why many cases went untreated. “I think rosacea has always existed, but we’re better at recognizing it,” says Doris Day, M.D., of Day Dermatology & Aesthetics (New York City). “In the past, it may have been lumped in and confused with acne, but it’s a completely different condition.”
Although people with fair skin are at a greater risk of developing rosacea, the condition can affect anyone. Despite the fact that the causes of rosacea ultimately remain unknown, there are some factors that have been found to trigger the symptoms, such as a warm environment, facial cleansing, exercise, overheating and sun exposure, stress, and embarrassing situations. Because diet can also irritate the skin, many medical and skincare professionals recommend keeping a food intake diary to discover what might cause a flare-up. Spicy foods, red wine, dairy, sugar, citrus fruits, and chocolate are just some of the foods that have been known to be possible rosacea triggers. “I believe a combination of preservatives and dyes in foods, increased social behaviors relying on alcohol and caffeine, and increased sun exposure, in addition to a leaky gut, which is a result of the junk foods and toxins that enter our stomach, can cause gut permeability leading us to be intolerant to common healthy and unhealthy foods,” says Nigma Talib, N.D., practitioner at BodyWorksWest (London).
It’s possible that the weather and environment may also contribute to the prevalence of rosacea today, according to Veronica Harris, national educator for DermaQuest. She believes global warming is affecting climate change, and as a result, there is an increase in record heat, drought, and storms, which can have an effect on capillary activity and cause facial flushing. In addition to lifestyle and environmental factors that can trigger rosacea, Rhonda Allison, founder and CEO of Rhonda Allison Clinical Enterprises, believes that the condition is a systemic issue and often requires that a deeper root problem be addressed to bring skin back to optimal health. “The cause is officially unknown, however, some research has attributed it to poor circulation, sluggish lymph, genetic predisposition, digestive disorders, bacteria, and mites attached to cells,” says Allison.
One way to help prevent flare-ups is to reduce stress, which makes spas the perfect place for these rosacea-prone clients, as they can relax and find relief from their symptoms. Only a medical professional can officially diagnose rosacea, but estheticians educated on the condition can help identify the signs and symptoms through a thorough consultation and skin analysis prior to treating the skin. “While we are unable to diagnose as skin therapists, we may recognize, bring awareness, and educate our clients,” says Johnson. “It’s important to talk to clients during the skin analysis portion of the treatment to find out which products they are using and what they are noticing.” This will help the therapist determine whether they are using a product that may be too harsh or if their lifestyle may be the trigger.
Many spas have even added treatments that are specifically designed to address rosacea. Jillian Wright, owner and clinical esthetician at Jillian Wright Clinical Skin Spa (New York City), noticed an increase in the number of clients seeking treatment for rosacea symptoms, which inspired her to include several sensitive skin- and rosacea-targeted services to her spa’s menu. Utilizing a combination of Bioelements and Rhonda Allison products, the Naturally Soothing Facial (starting at $150, 60 minutes) helps reduce inflammation, and stimulate cellular turnover for healthier skin. “Our goal with this facial is to properly clean the skin without causing any additional irritation or inflammation,” says Wright. “We use cooling ice globes or a cool towel to calm the skin with a gel or oatmeal and green tea mask. We also use pure organic double green tea bags for the eyes and use the water soaking the green tea bags for the face.” The spa also offers the Rosacea Facial (starting at $175, 60 minutes), which helps reduce inflammation but also has antibacterial support and helps rejuvenate cells.
Spa-goers with rosacea should be treated with care, as it is best to avoid irritating the skin further. Excess heat, microdermabrasion, peels, and aggressive massage should be avoided, for example. At IDI, estheticians refer to the Less Rule when dealing with clients with rosacea. According to Johnson, the rule calls for the use of less heat, which means avoiding steam and using cool towels instead; less time, which means spending more time de-stressing the client with reflexology or a scalp massage versus too much time on the skin and risking over-stimulation; less product; and less stimulation, because friction, such as massages that promote blood flow, should be avoided, as well as harsh scrubs that can cause inflammation. Even mild exfoliation, massage, and extractions should at times be avoided, depending on the condition of the client’s skin.
At Spa Ojai at Ojai Valley Inn & Spa (CA), estheticians take special care when dealing with rosacea-prone clients during the Sensitive Skin and Rosacea Facial ($160, 50 minutes; $310, 1 hour 40 minutes). “We use enzymes to exfoliate delicate skin, avoiding the stimulation of scrubbing, and also use a chilled soothing mask that infuses skin with vitamin E to help it build more of its own protective function,” says spa director Gloria Ah Sam. “And depending on the level of sensitivity present, we might choose to do a facial without steam, use chilled bowls and cool towels, and use less stimulating massage techniques.”
Certain skincare products and ingredients, including menthol, SD alcohol, and witch hazel, should be avoided during treatments. Instead, Johnson recommends using products that are free of irritating ingredients and help calm inflammation and restore the barrier function of the skin, such as arnica, evening primrose oil, ginger, oats, pilewort, red raspberry, and seabuckthorn.
At The Sagestone Spa & Salon at Red Mountain Resort (Ivins, UT), clients with rosacea can find relief with the Booster Blue Rosacea Facial ($120, 50 minutes), which uses B. Kamins products with ingredients like soluble collagen and German blue chamomile to soothe fragile skin. The products help to gently cleanse, cool, and calm the skin while maintaining hydration. “This is one of our most popular facials,” says spa director Myrna Beardshear. “In recent years, we have noticed that guests are more aware of their condition if they have rosacea, whereas they would usually just refer to their skin as being sensitive.”
While there is no cure for rosacea, as with many other diseases and disorders, early detection is key. This is why pre-rosacea symptoms—usually a sudden and recurrent reddening of the face—should not be ignored, as the chances of the disorder progressing and getting worse are higher if not addressed early. According to Johnson, by recognizing changes in the skin early, a skincare routine can be modified or changed so that it no longer triggers inflammation, as chronic inflammation can lead to advancement of the subtypes of rosacea. “The key to healthy skin is balanced skin,” says Harris. “I often tell my clients that their skin speaks to them. It will always tell them when something is wrong or unbalanced. Flushed skin is a way to detect early signs of rosacea. If you begin to control the flushing and soothe and protect the skin early, then you will avoid persistent redness, inflammation, and irritated skin.”
Ultimately, estheticians should leave it to the medical professionals to diagnose and treat rosacea in clients, as they can prescribe topical antibiotics, if necessary, to help prevent flare-ups and rosacea from progressing. However, estheticians can learn how to identify the symptoms and offer ways to avoid further irritation. They can also suggest rosacea-targeted services and skincare products that can provide relief to the skin and educate clients on how lifestyle and diet can help, as well.
At the Spa at Stoweflake at Stoweflake Mountain Resort & Spa (Stowe, VT), clients with rosacea can opt for the Organic Rosacea Facial ($140, 50 minutes), which utilizes Ilike Organic Skin Care products to help calm and reduce inflammation. In addition, these clients are invited to partake in an Ayurvedic Diet & Lifestyle Consultation ($250, 1 hour 50 minutes) to educate them on herbal remedies, nutrition, and stress-reducing practices and treatments, like a yoga class during their visit or a walk in the on-site meditative labyrinth. “Talk to clients about healthy habits—getting adequate sleep, eating healthy, and avoiding triggers such as excessive UV exposure and smoking,” says Allison. “When the body is under constant stress, the immune system weakens and isn’t able to ward off attacks. Sleep, exercise, taking time to rejuvenate, eating life-giving foods, and treating the skin with healthy, intelligent ingredients will help support a healthy immune system.”