Deep Dive: Flushing & Blushing Rosacea Triggers, Plus Skincare Ingredients That Calm Rosacea

[Intro] Hey, everyone. Welcome back to Facially Conscious with myself, Trina Renea, esthetician, Dr. Vicki Rapaport, dermatologist, Rebecca Gadberry, the cosmetic ingredient guru, and our fabulous, overly-educated consumer, Julie Falls. We are gathered here together with you to talk about this crazy world of esthetics. It's confusing out there in this big wide world. 

That's why we are here to help explain it to you all, subject by subject. We will be your go-to girls, and from our perspective without giving medical advice, we will keep things facially conscious.

Let's get started. 

01:00 Rebecca Gadberry: Hello and welcome to Facially Conscious, the podcast that lets you get the skinny on all things skin. I'm Rebecca Gadberry and I am the cosmetic scientist here at Facially Conscious, and I am with…

01:16 Trina Renea: Trina Renea, the esthetician.

01:19 Rebecca Gadberry: The esthetician. 

01:21 Trina Renea: Extraordinaire. 

01:21 Rebecca Gadberry: The master esthetician who teaches other estheticians how to esthetic. 

01:26 Trina Renea: Yes, and dermatologists. 

01:26 Rebecca Gadberry: And even though this is a deep dive, we have Dr. Vicki with us today. 

01:33 Dr. Vicki Rapaport: I can't wait to eavesdrop. Good morning, everybody. 

01:36 Rebecca Gadberry: Hi. 

01:38 Trina Renea: Good morning. We're so happy to have you.

01:39 Rebecca Gadberry: So we're going to do a deep dive, which is where Trina and I usually get together and just talk about ingredients. This time, we're going to talk about ingredients that you can use on rosacea and you can't use on rosacea. 

But before we do, I'd like to share the tip of the day. The tip of the day is, if you are using retinol and you're getting redness or stinging or flaking, you might want to switch to a product with something called bakuchiol. And around here we remember it as coochie-coochie-kuchiol. Bakuchiol. It is an alternative to retinols. It has the same effects on the same parts of the skin as retinols do, but it does not cause inflammation.

And since we're talking about rosacea today, which is an inflammatory disorder of the skin, you might want to also think about using bakuchiol in your daily routine, especially if retinol is contraindicated for you, which it usually is.

So without further ado, I would like to really get into this about ingredients that you can and can't use, and also drugs that you might want to avoid if you have rosacea. Or, if you have to take the drug, be aware that they can trigger rosacea. 

And as we've been saying this month in celebration of National Rosacea Awareness Month, which is suggested by the National Rosacea Society at rosacea.org, rosacea is a complex condition that cannot be treated with a one-size-fits-all solution. 

03:30 Trina Renea: Right. We also heard Dr. Vicki in the previous weeks saying that there's many medications and different things that you can use and you have to find the right combo.

03:42 Rebecca Gadberry: But there are ingredients or drugs that can be taken orally or inhaled, such as your corticosteroids, aminophylline, which is for asthma. It's an asthma treatment. Ibuprofen, your ACE inhibitors, even NutraSweet or some of your synthetic...

04:08 Dr. Vicki Rapaport: NutraSweet?

04:10 Rebecca Gadberry: Yeah, NutraSweet. 

04:12 Dr. Vicki Rapaport: It's an old blast from the past. 

04:13 Rebecca Gadberry: I know. 

04:13 Dr. Vicki Rapaport: People still eat that? 

04:15 Rebecca Gadberry: You can still get it. And niacin and also niacinamide. We were talking about niacinamide causing a flushing in some people. Basically, anything that causes a flushing or blushing, as Trina noted in our last episode, anything that causes flushing or blushing, that's not the problem. The problem is it stick around for a while. And if you are prone to rosacea and you create or trigger flushing or blushing in the skin, it will stick around if you have rosacea and that triggers another episode. So we have to be very cautious. 

Now, we're not saying don't take ACE inhibitors. 

04:50 Trina Renea: Right. And not every trigger is going to be your problem. So if they say, “Don't eat spicy food,” but you can eat spicy food and not be triggered then good for you. 

04:59 Rebecca Gadberry: Then eat spicy food, yeah. 

05:01 Trina Renea: Right. So some ingredients will cause that.

05:05 Rebecca Gadberry: Right. And some ingredients that are used in skincare products, like, well, this isn't a skincare product. This is an over-the-counter drug, the benzoyl peroxide, which is used for acne but it's contraindicated for rosacea.

05:20 Trina Renea: Unless it's Epsolay, which is the new formulation for rosacea.

05:22 Rebecca Gadberry: Oh, yes.

05:24 Dr. Vicki Rapaport: 5% benzoyl peroxide for rosacea. Very well tolerated because it is microencapsulated. But that's why I'm here in your deep dive.

05:31 Trina Renea: Yes.

05:31 Dr. Vicki Rapaport: So I can tell our patients that. 

05:34 Rebecca Gadberry: And that microencapsulation is fabulous. It's also what I'm using in the new retinol product I'm working on. Same kind of microencapsulation. 

05:43 Dr. Vicki Rapaport: I want to know what a microencapsulated thing looks like in a product. Is it just like a white…

05:47 Rebecca Gadberry: No. It actually looks like a white powder or an off-white powder, depending upon what ingredient you're microencapsulating. And it's very, very fine dust usually. You can see it under a microscope, hence the name microencapsulated. And we put it in the product. It suspends in an emulsion or in a gel. That's why you don't really see them in a thin liquid or toner or freshener. It needs to be in something more viscous. It suspends there and then it goes under the skin where the heat of the body or the pressure of your fingers applying it breaks it open.

06:28 Trina Renea: I have, actually, Jan Marini. Everybody knows who she is, but she owns a product line.

06:34 Rebecca Gadberry: We've had her on.

06:35 Trina Renea: We've had her on. And she actually came out years and years and years ago with a benzoyl peroxide that was 10 microns smaller than your regular, and so it goes into the skin, doesn't irritate the skin. It came in 5%, I think.

06:51 Rebecca Gadberry: Right. You don't need as much of it because it gets in. 

06:55 Trina Renea: Yeah. So I'm glad that, finally, the industry, the medical industry has developed something for rosacea that's nice.

07:04 Rebecca Gadberry: What's interesting about this encapsulation technology, I actually wrote the technology in a chapter for a book 30 years ago about it. So it's been around for a long time. 

07:14 Trina Renea: Wow. 

07:16 Rebecca Gadberry: But I'm glad to hear that somebody is using it for rosacea. 

07:17 Trina Renea: Why did it take so long to get to this point?

07:20 Rebecca Gadberry: That's a very good question. I know a number of formulators you could call and ask that question.

07:28 Trina Renea: So, Dr. Vicki, do you use that ingredient? I mean that actual rosacea cream with benzoyl peroxide for rosacea, and is it helpful? 

07:36 Rebecca Gadberry: Is it a cream or a gel?

07:39 Dr. Vicki Rapaport: It's like a foam. 

07:40 Rebecca Gadberry: Okay. 

07:42 Dr. Vicki Rapaport: I do use it. 

07:44 Trina Renea: Is it in a cleanser? 

07:45 Dr. Vicki Rapaport: No, no, no. It's like just a small, little— it comes in like a one ounce. 

07:49 Rebecca Gadberry: Is it like an airless foamer? 

07:52 Dr. Vicki Rapaport: I don't know.

07:53 Rebecca Gadberry: Because the product is really thin, and then the foamer suspends the microencapsulate. It's tiny enough to get down around into the pore and around the sides of the pore. 

08:03 Dr. Vicki Rapaport: And it's only good for people with rosacea who have the acneiform component of rosacea. So if you’re just red, it's not going to do anything for you. It's for the papules and for the pustules, for the acne component. 

08:13 Rebecca Gadberry: And remember that a papule or pustule that has a liquid coming out of it is more of a rosacea from an irritant as opposed to where there's pus coming out of it, which is acne itself. So these are ways to know what the differences are. 

But going back to this list, corticosteroids, hydrocortisone, hydrogen peroxide, hydroquinone, methyl nicotinate, resorcinol, your retinoid, salicylic acid, triclosan, benzocaine, all of these are contraindicated for rosacea if you blush with them. If you don't blush with them, you can use anything that you don't blush with. But if you do blush with them, know that it may trigger an episode. 

08:59 Trina Renea: Yeah. So you have to really be aware of what you're putting on your skin and what you're putting in your body when you have rosacea. And if you do get red, then definitely be like, “What did I just do?”

09:12 Rebecca Gadberry: Exactly. And if you're keeping track in your diary from rosacea.org, then you can write that down so that you know that the next time you do that, if it happens again, you want to stay away from that. So that's a good way to find out. 

Now, we're going to be posting in our blog at faciallyconscious.com. I was going to say .org, .com. We're not an org. A list of these ingredients that I actually went through the…

09:43 Dr. Vicki Rapaport: The PDR.

09:44 Rebecca Gadberry: The PDR, the Physician's Desk Reference. Took me a week. I went through every entry in the Physician's Desk Reference because they did not note what caused blushing or flushing. And so everything that I wrote down will be in a list on the blog. 

Or you can just go to, if you are prescribed something, go to the name of that drug and look up blushing and flushing. If it is indicated, then be ready for a rosacea episode.

10:17 Dr. Vicki Rapaport: Be ready for it. 

10:17 Rebecca Gadberry: Don't say, “I don't want to take that med,” unless there's an alternative. 

Some reactions are going to occur. Some may not occur. Some people will only react to one or two items on the list. Others may react to all of them. It's, again, up to you and your skin. Any ingredient or product that causes stinging or itching or burning or warming or reddening or what we call vasodilation, where you get that redness from the capillary extending when you put it on can cause a rosacea episode in minutes to hours, even the next day. 

So you may not see it immediately. It may take a little while for that biochemistry to kick in and you get the biochemical kickback of rosacea. Those are things too. 

And then also the ingredients other than these can trigger reactions in you. So again, keep track of everything in your diary. 

Another one that triggers rosacea is Viagra. 

11:25 Trina Renea: Really? 

11:26 Rebecca Gadberry: Yeah. 

11:27 Trina Renea: Viagra in men? 

11:31 Rebecca Gadberry: In men, yes. Do women take Viagra? I know they talked about it for a while. 

11:35 Trina Renea: No, but I'm just wondering if the Viagra, like how does it— because men get rosacea from Viagra? 

11:42 Rebecca Gadberry: No, they don't get it from it. It can trigger it.

11:44 Trina Renea: They trigger it. 

11:45 Rebecca Gadberry: Yeah. 

11:46 Dr. Vicki Rapaport: I know they were doing topical Viagra for other things, but women don't take oral Viagra. There's no reason, but I think there are topical Viagra applications for people with Raynaud’s who have constriction problems. 

11:58 Rebecca Gadberry: That's right. Yeah. 

12:00 Dr. Vicki Rapaport: And women can certainly do that. 

12:02 Rebecca Gadberry: Because it's the nitric acid. And that nitric acid can kick in. 

12:04 Dr. Vicki Rapaport: Dilates. 

12:05 Rebecca Gadberry: Yeah. We also have nitroglycerin, which is still really common for heart. Opioid narcotics, like morphine and codeine and methadone, Demerol, and all the other ones. 

12:19 Trina Renea: Can trigger rosacea? 

12:20 Rebecca Gadberry: They can trigger a rosacea episode. Progesterone, Zocon. 

12:27 Trina Renea: Oh, so when a woman is in menopause and she's taking estrogen and progesterone, can get a rosacea flare? 

12:34 Rebecca Gadberry: Yes. 

12:34 Trina Renea: Wow! Do you see that in your office, Vicki?

12:39 Dr. Vicki Rapaport: I see it in regular old menopause in women who don't take any other bioidenticals or hormone supplements, and for sure in women who take oral supplements and women who take— I mean oral hormonal replacement. And also women who take birth control pills, it can actually stimulate a flare of rosacea. 

12:59 Rebecca Gadberry: Yes.

13:04 Trina Renea: Oh, birth control. That'd be a problem. 

13:06 Dr. Vicki Rapaport: I do have to say one other thing. When you asked me about Epsolay, I think about in my closet, in my sample closet, because I've never used it. I don't have rosacea. The bottle looks like a very similar bottle that's a foam, but Epsolay is a cream. I know it doesn't really matter. It's a topical, it doesn't matter, but it is actually a cream. But it's in this cute little bottle that usually is a foam sample. 

13:28 Trina Renea: That's just next to your phone. 

13:29 Dr. Vicki Rapaport: Yeah, so in my mind— sorry about that. It is definitely a cream. 

13:33 Rebecca Gadberry: Our minds play tricks on us, even if we're experts. 

13:38 Trina Renea: There's so many things out there. 

13:39 Rebecca Gadberry: I know. There's so many things to remember. It's amazing. 

So let's talk about ingredients that can cause flushing or blushing in your cosmetics, in your makeup. FD&C red dyes can cause flushing or blushing. In your mascara, some of the components of mascara can cause eye irritation, which can cause…

14:03 Dr. Vicki Rapaport: Ocular rosacea. 

14:03 Rebecca Gadberry: Ocular or trigger ocular rosacea. We also have the volatile alcohols, which are ethyl alcohol, alcohol denat, isopropyl alcohol, ethanol. All of those four alcohols can trigger stinging, which then triggers a rosacea episode. 

So if you see something like cetyl alcohol or stearyl alcohol, those are not these alcohols. Those are okay. It's just those four, and again, I will put them on the blog so that you know what you're looking at. 

We also have something called arachidonic acid. Arachidonic acid is…

14:43 Trina Renea: Arachidonic. 

14:44 Rebecca Gadberry: Arachidonic. It's part of your omega group, your omega oil group. Unfortunately, arachidonic acid triggers inflammation in the skin which can then trigger rosacea. 

Bentonite, your ascorbic acid that's free, that isn't time-released or stabilized. 

If a product has vitamin C or retinol or it turns brown, this is a product that has oxidized and that oxidation is an irritant. That can trigger rosacea. It also means that the ingredient that's oxidized is no longer effective for your skin. 

15:24 Trina Renea: Did you say bentonite can trigger rosacea? 

15:26 Rebecca Gadberry: I did, yeah. 

15:27 Trina Renea: Like bentonite clay that's supposed to be calming to the skin? 

15:30 Rebecca Gadberry: Exactly.

15:31 Trina Renea: Really?

15:32 Rebecca Gadberry: Yeah, bentonite, because of the particles. When you look at it under a microscope, it's not smooth. As a granule, it has edges. And those edges can trigger an inflammation, and that can trigger the redness.

Capsaicin, that's a stimulant. It also has a peppery smell. It can be in a perfume or a fragrance. 

We have DMAE, which is a skin penetrant. That's not as used as it used to be. A doctor came out with this years ago, like 20, 25 years ago, but it's not used as much. But it definitely triggered redness. 

Essential oils can do that and fragrances as well. Your fruit enzymes, especially your papaya and bromelain from papaya and pineapple. So you want to stay away from those. Or if you're using them, let's say as an esthetician you're using them on a sensitive rosacea skin, make sure you keep the steam on so that it's not allowed to dry. Because it's when they dry that they become a flushing agent, so you want to stay away from that. 

Granular exfoliants, even your really fine granular exfoliants. Mica, which is in eyeshadows and blushes and foundation, you might also find it in skincare products because it's a blurring ingredient. A lot of companies are no longer using mica because it is harvested, I forget, mined by children in Africa under very bad conditions, so the whole industry is turning off to mica. And for the same reason that we've turned off to several other things. 

17:23 Trina Renea: Hasn't mica, that's been on the out for a long time, right? 

17:27 Rebecca Gadberry: Oh, for about three years. It depends on what you consider a long time. I've been in the industry for 50 years so three years is not a long time. But if you've been in it for 10 years, it's a long time. 

17:38 Dr. Vicki Rapaport: But Rebecca, you said something about when you had a certain product on, you should keep the steam going. I have a question about steam in general. I've always told my patients about rosacea. 

17:46 Rebecca Gadberry: Cool steam. 

17:48 Dr. Vicki Rapaport: When they get a facial, steam is fine as long as it's cool. 

17:52 Rebecca Gadberry: Yes. 

17:52 Dr. Vicki Rapaport: Is that what you agree with, Trina, or do you not do steam at all? 

17:57 Trina Renea: No, I do steam on people with rosacea, actually, but I keep it at a distance because I do want to, like, just give them a little heat to open up the pores and to get everything kind of open for me to be able to get in there. But I do certain enzymes that are not irritating and they don't sting or burn with it. And so that's on and then the steam is kind of activating that.

But I definitely, if somebody gets red and stuff, I won't. Sometimes I don't do steam at all, but I'll do it at a distance. But I always do, like with those people, I do like a super gel mask or sheet mask.

18:35 Rebecca Gadberry: Cooling mask. 

18:36 Trina Renea: Yeah, and I use the ice globes to really cool. It feels really good. 

18:40 Dr. Vicki Rapaport: Sounds amazing. Ice globes. 

18:43 Rebecca Gadberry: And those ice globes you can buy and keep them in the refrigerator if you have rosacea because it'll help bring down a flushing episode really fast.

18:50 Dr. Vicki Rapaport: I love that. 

18:52 Trina Renea: Yeah, even like spritzing your skin with a cool mist or something, or putting some kind of a gel and then rolling those ice globes around will help to bring the flare out. 

19:03 Rebecca Gadberry: And in some people, peanut oil can be a flushing agent. So watch out for peanut oil. Now, people say, "Oh, I'm allergic to peanut oil." Well, allergies are different than rosacea triggers. So you run to the allergist and you get an allergy test for different foods that you're allergic to. It has nothing to do with rosacea. 

So you might be allergic to peanuts and be able to use peanut oil. You might not be allergic to peanuts and not be able to use peanut oil. And remember, peanut oil it's not supposed to have proteins in it. That's what you're allergic to. Anyway, that's a whole different story.

19:45 Trina Renea: So if you’re allergic to peanut oil, you might not be allergic to peanuts?

19:49 Rebecca Gadberry: That's right. It depends upon whether the protein has been refined out of the oil. But just to be cautious, most people don't eat peanut oil. 

We also want to caution against sesame oil, which has a high oleic acid content. That can be an irritant. 

Avocado oil can be an irritant. High oleic acid content so you want to be cautious of that. 

Now, some people use tea tree oil on the Demodex mites or to calm the lipase, but tea tree oil in and of itself can be an irritant. So use that with caution. 

And then your niacins or your nicotinamides or your nicotinic acid, internally as well as on the surface of the skin. Again, and there's also something called tocopheryl nicotinate. We want to be cautious of those because they are flushing agents and blushing agents and they can trigger an episode that lasts longer than a few minutes. Anything that stings when you put it on is a sign that there's inflammation or irritation going on.

And then we also want to be very cautious about retinol, nols, N-O-L. That is your alcohol of vitamin A. That when it is freely added to a product, there's no delivery vehicle, no encapsulation or micro sponge involved, then we want to be cautious of that. 

21:22 Trina Renea: For rosacea. 

21:24 Rebecca Gadberry: For rosacea. 

21:25 Trina Renea: But not for not rosacea?

21:27 Rebecca Gadberry: Well, I don't like free retinol in anything, personally. 

21:30 Trina Renea: I didn't know they did that. 

21:31 Rebecca Gadberry: Yeah, they do. They do. 

21:33 Trina Renea: I thought they always use retinol. 

21:35 Rebecca Gadberry: The days. That's retinaldehyde and that's a different form of retinol. When we talk about retinols later this year, we'll address all of those things. 

And then the ones that I really have a big bugaboo about, that a lot of people believe in, are your alpha-hydroxy acids and your salicylic acid. I don't like them on rosacea skin. They cause stinging, especially if they are free, low pH, high percentage above 3.5. I don't like them. I like them delivered in a time release or…

Also, mandelic acid, which is a new AHA. It's not new, but it's becoming very popular. Mandelic acid is especially effective on rosacea. So if you're going to be Looking at an AHA, look at mandelic acid. It's also really good for skin of color, by the way, that is easily irritated. 

22:36 Trina Renea: Lactic is also a little gentle, more gentle, if you were… but the mandelic, I have— you know, it is becoming the new cool ingredient.

22:45 Rebecca Gadberry: It is. I really like it. I've just finished doing some formulations with it and I very much like it. 

22:50 Trina Renea: Yeah, it doesn't irritate the skin. It's brightening. 

22:52 Dr. Vicki Rapaport: Which one? Lactic or mandelic? 

22:53 Trina Renea: Mandelic. 

22:54 Dr. Vicki Rapaport: Oh, my God, I love mandelic.

22:55 Rebecca Gadberry: Yeah, isn't it great? 

22:56 Dr. Vicki Rapaport: We have these mandelic pads in the office that are really nice and light.

23:02 Rebecca Gadberry: It's a good acid for— it's an antimicrobial as well, which a lot of your acids are not. So mandelic is antimicrobial. It helps to control sebum. It doesn't irritate. It's the largest of all the AHA molecules, without going into something called a PHA, a polyhydroxy acid. 

And your PHAs, I don't think are effective. They're marketed as not being irritating, but that's because it's like glycolic molecule linked to a glycolic molecule linked to a glycolic molecule. That's where you get your poly and hydroxy acid. They're so large they don't go into the skin, so they don't do very much. So if it's supposed to sting and it doesn't sting, is it really getting into the skin? Is my question. 

23:50 Dr. Vicki Rapaport: I always like a good sting, but you're right. It doesn't have to sting to be effective, and mandelic does not sting. 

23:55 Rebecca Gadberry: Right. No. 

23:56 Dr. Vicki Rapaport: I like mandelic for my patients that have acid FOMO that can't use all those other really good ones, like my rosacea patient.

24:03 Rebecca Gadberry: Acid FOMO, fear of missing out of acids? 

24:05 Dr. Vicki Rapaport: Yeah. They get the mandelic.

24:06 Rebecca Gadberry: I like the term.

24:08 Dr. Vicki Rapaport: They get the mandelic, darling.

24:11 Rebecca Gadberry: Oh, and it works wonders.

24:12 Dr. Vicki Rapaport: Works wonders. 

24:15 Rebecca Gadberry: And then the last group is your formaldehyde-releasing preservatives. These are preservatives that go into your product as one type of ingredient. Then as the ingredient degrades over a period of weeks, they degrade into releasing formaldehyde. So they don't go on the label as formaldehyde, they can be picked up as formaldehyde through a chemical assay within two weeks or longer. Those are ingredients Quaternium-15. 

Not all Quaterniums, Quaternium-15, it must have the 15 behind it. DMDM hydantoin, which is more used in Europe than it is in the United States. So if you're buying a European line, you might want to take a look at that. 

25:00 Trina Renea: Can I ask you a quick question? If these turn to formaldehyde, wouldn't that just not be good for any skin? I mean, it might trigger rosacea, but that's what we're specifically talking about, but wouldn't it trigger some irritation in any skin? 

25:18 Rebecca Gadberry: Well, these formaldehyde releasers are the most common allergens in cosmetics. So, yes. There are actually regulations that are being considered in Europe to ban them in European products. 

Our industry, especially professional products and dermatological products, like you and Dr. Vicki sell, they don't really use these ingredients anymore. But you might find them in a drugstore line or a line that's sold on television. I doubt if you'd find them in something sold in Whole Foods, for instance. 

So the industry is transitioning away from these ingredients, which means that the skincare companies that are the most likely to lead a transition are your professional products that are sold by estheticians or in skin clinics or dermatology offices. The last ones to pick up the back end of the transition are usually sold in places like drugstores. So you'll see those transitions. 

And I'm not saying this is always true, so please don't come after me for that. But this is like, it's been the normal transitioning process. Like when we started to eliminate parabens from products in the middle aughts, the professional industry was the first and then it kind of dragged out.

26:37 Trina Renea: I heard this has become a real problem with finding other ingredients to replace the parabens. It's like…

26:44 Rebecca Gadberry: Oh, it's horrible. 

26:45 Trina Renea: It's really bad. Things going moldy in jars and ingredients. 

26:50 Rebecca Gadberry: When we had the parabens, we very rarely had any positive plate counts. Plates are like your Petri dishes where we take the product, we put it in the Petri dish, we feed it a bacterium, mold, yeast, fungus, or virus, and we see if it grows. After a few days, if there's nothing in the plate or there's a very low count, it's fine. 

But we're getting more and more positive plate counts that the industry is starting to panic, because some of these types microorganisms can become entrenched in your facility that you make the products in. Very hard to get rid of. 

So there's issues with this and parabens are the most effective. I'm not going to continue going down that rabbit hole, because parabens are absolutely safe with rosacea. That's what we're talking about today. Unfortunately, they had some issues.

27:54 Trina Renea: We have to face not using them. 

27:56 Rebecca Gadberry: Yeah. I, for one, am a formulating chemist that really regrets not being able to have parabens. Most of us are. But if the consumer doesn't want them, then we can't sell them.

28:09 Trina Renea: The consumer doesn't even know what they're talking about. They got fed misinformation. 

28:14 Rebecca Gadberry: Well, they did, but that's another story. Listen to Trina’s and my deep dive on preservatives where we go into the entire paraben issue. 

The last two preservatives that we want to avoid because they are primary formaldehyde releasers.

28:27 Trina Renea: For rosacea.

28:29 Rebecca Gadberry: We want to avoid for rosacea, is imidazolidinyl urea and diazolidinyl urea. All four of these will be on our blog. You'll be able to look it up and see, “Oh, that's how that's spelled,” so that you can look for them if you want to avoid ingredients that can trigger rosacea. 

Now, let's talk about what you can use. First of all, we should be washing the face with a gentle cleanser, cool water twice a day. The reason for that is because two-thirds of all people who have rosacea say that they can control it with washing twice a day with a gentle cleanser and cool water. So why not do that? It's one of the simplest things that you could do.

We want to use a sunscreen because sun, not only the UV light, but the high energy visible or blue light from our devices can trigger rosacea episodes. We want to protect from that. Unfortunately, most of the sunscreens that are out there work by taking in the energy of the light, lowering it, and it comes back on the skin as heat. 

Well, as we talked about in a prior episode, if we get the surface of the skin temperature at 99 degrees or higher, that can trigger an episode. So we want to avoid those kinds of sunscreens. 

What's left to us are your mineral sunscreen, your zinc oxide and titanium dioxide. As a matter of fact, zinc oxide is recommended to help with rosacea. So it can have a multifunction on the skin protecting from UV light and high energy blue light as well as protecting or working with keeping the trigger down.

So we want to go to a mineral type sunscreen. SPF, I prefer 50 myself. We used to recommend 15. I don't think it's nearly strong enough for rosacea, so we want to do that. 

So 61% of all people who were interviewed, and there were over 1200, almost 1300 people that were interviewed under a grant from the at National Rosacea Society, 61% found out that they could reduce their flare-ups by wearing an appropriate sunscreen. So that's something else you could do. 

31:01 Trina Renea: I mean, heat's the biggest thing for flaring rosacea.

31:02 Rebecca Gadberry: Absolutely. 

31:04 Trina Renea: And the sunscreens help to protect you from that.

31:04 Rebecca Gadberry: Yes. Just avoid…

31:09 Trina Renea: Sun. 

31:10 Rebecca Gadberry: Avoiding the sun is the best bet, absolutely. But If you are in an area where you're avoiding sun but you're still getting heat, the heat can trigger the rosacea because you're flushing or blushing. That's a no-win situation. 

31:25 Trina Renea: But doesn't the zinc and titanium bounce the sun off the face, right? It doesn't soak it in.

31:32 Rebecca Gadberry: Well, we used to think that. We don't think that anymore.

31:35 Trina Renea: Oh, really? 

31:35 Rebecca Gadberry: Yeah, we don't think that anymore. We think that part of the molecule is a physical, what we call block. I don't believe in blocks. I don't think there is anything that totally blocks the sun, unless it's a brick wall, which is really hard to apply to the skin. And I don't know any products that feature brick walls in them? 

31:54 Trina Renea: When I explain to clients about what their skin looks like, I always compare it to a brick wall. 

31:59 Rebecca Gadberry: Right. The brick and mortar wall. That's the skin itself, but not the product. 

Also, 91% in this poll that was taken said that they improved their rosacea, their rosacea improved when they went to a skincare routine for sensitive skin.

32:18 Trina Renea: Yes, I agree with that. 

32:20 Rebecca Gadberry: Yeah, as an esthetician, you've had that experience.

32:23 Trina Renea: Yup. It's the easiest thing you can do. Look for things that say ‘sensitive’. 

32:28 Rebecca Gadberry: Right, look for things that say ‘for sensitive skin’. 

32:29 Trina Renea: Yeah, because there's going to be nonirritating ingredients in there and things that don't flare and things that are calming, usually. So if you're red and inflamed, go for sensitive. 

32:40 Rebecca Gadberry: Exactly. And also look for EGCG, which is the active molecule in green tea. We don't want to look for just green tea. We actually want to look for EGCG on the ingredient label, because that means that that phytochemical has been put in at the right concentration every time. When you rely on it being in an extract, like green tea extract, you don't know how much is actually making it into the product. 

33:06 Trina Renea: And will it say green tea and, in parentheses, EG? 

33:10 Rebecca Gadberry: It will actually say EGCG, in parentheses, epigallocatechin gallate or something like that. 

33:16 Trina Renea: So it doesn't say green tea at all. 

33:18 Rebecca Gadberry: It doesn't say green tea at all. Now, it may say green tea and EGCG, but those are two separate ingredients.

33:24 Trina Renea: Okay.

33:25 Rebecca Gadberry: Another one is Chinese licorice. The active molecule in that is what we call licochalcone. That is L-I-C-O-C-H-A-L-C-O-N-E. Again, it's going on the website under our blog.

Licochalcone is a yellowish molecule that works to reduce or eliminate lipase. And as we said in the first of the series of our rosacea episodes in April, lipase is one of the chief causes of rosacea triggers. So if we can control that, we can control the trigger.

34:08 Trina Renea: And that ingredient is in a lot of products?

34:11 Rebecca Gadberry: Well, remember when Dr. Vicki, in one of the earlier episodes, said that there was a product line that had come out to control the redness of rosacea and it worked in some people and not in others? The basis for that product was licochalcone.

So you want the product to be yellow. If it's not yellow, it doesn't have enough licochalcone to do anything. So that will be your clue that it's enough. It doesn't have to be at the top of the ingredient list. It's very effective under 1. It just has to be yellow. 

34:42 Trina Renea: Okay. Like your product will be some sort of a yellow, not bright yellow, but just a yellowish. 

34:47 Rebecca Gadberry: A yellowish. The more mild the yellow, the less is in there. So if it's a strong yellow, it's going to be more. 

Also, zinc oxide in a mask, for instance., Very effective. And resveratrol, which is that antioxidant from grapes and bamboo and other things. Resveratrol. 

35:10 Trina Renea: I didn't know it was from bamboo. 

35:11 Rebecca Gadberry: Yeah, it's from a Japanese bamboo, I think. No, Mexican bamboo. 

35:16 Trina Renea: Really? 

35:17 Rebecca Gadberry: Yeah.

35:17 Trina Renea: I only knew it from grapes. 

35:19 Rebecca Gadberry: Yeah, it's a really interesting ingredient. 

35:22 Trina Renea: That's cool.

35:22 Rebecca Gadberry: Also, bisabolol from German chamomile. Very calming to the skin. 

So we want to use ingredients that are going to calm and then we also want to use ingredients that are going to repair the barrier. And anytime you get stinging, you have a breached barrier. You have a damaged barrier to your skin. 

Now, we've done a lot of discussion this year and last year about damage to the skin barrier, the stratum corneum and all of that. If you want to learn more about those, please look at our website under the blogs. We've written about it. We also have several episodes on this that if you're new to the podcast, you can go back and listen to. 

But we want to repair that barrier, so you're going to look for things like ceramides and omega oils, linoleic, linolenic acid, sunflower, safflower oils. Help me out here. I need more barrier repair ingredients. Cholesterol, phytosterols, there's a number of them. They're on the website, so if you want to take a look at that.

Look for products that say ‘barrier repair.’

36:32 Trina Renea: Yes, they usually do if they have those ingredients in it. Somewhere on the label it will say barrier repair. 

Another thing is when you were saying if their skin is stinging, I mean, across the board, rosacea or not, if your skin is stinging and it doesn't normally sting, like since birth, you've done something irritating to your skin and it's probably in one of your ingredients. So the first thing I tell people is just stop using anything active and just give your skin a break, because even if your cleanser or your moisturizer that never stings is stinging, the surface is very compromised. 

And so you want to just put like water gentle and put on some Aquaphor or something for a couple of days to really help the barrier repair itself.

37:18 Rebecca Gadberry: Cerave. So how long should they rest? A couple of days? 

37:25 Trina Renea: I say at least three and then give it a go again. And if they're still stinging, keep it going like use nothing. 

37:33 Rebecca Gadberry: Even Vaseline, which is just straight petroleum jelly.

37:37 Trina Renea: Yup, and just do that for a few days until it repairs itself. 

37:42 Rebecca Gadberry: Vaseline has been shown to repair the barrier without having to add anything else to it. It just triggers your cells to create more of those lipids that repair the barrier. 

37:52 Trina Renea: Yeah. Sometimes like the weather can attribute to that.

37:56 Rebecca Gadberry: Exactly. 

37:57 Trina Renea: You may be used to using your exfoliators and things like this all the time and then all of a sudden there's a weather change and you're getting stinging. It could just be the weather is affecting your skin in that way. So you still have to just back it off for a minute and then look at what ingredients you're using and take out the exfoliators and try and repair. 

38:17 Rebecca Gadberry: Right. And Julie, was Julie talking about your microdermabrasion for rosacea skin?

38:23 Trina Renea: Yes. 

38:24 Rebecca Gadberry: Because that is usually contraindicated. 

38:27 Trina Renea: 100%. But she likes me to do microdermabrasion on her skin. She gets rosacea, but I avoid her rosacea areas. I don't do microdermabrasion over rosacea, but I do do microdermabrasion. 

And I do tell people, estheticians, like just because somebody has a compromised area on their face, like they might have a flare-up of eczema or psoriasis in one spot, you just avoid that spot. It doesn't mean you have to avoid it on the whole face. You know what I mean? You can still do it in other places what you would normally do.

39:03 Rebecca Gadberry: What is microdermabrasion? A lot of our listeners probably don't even know what it is. 

39:08 Trina Renea: Oh, it's a manual exfoliation. Basically, I call it like buffing and polishing the skin with little crystals that get sandblasted on your skin.

39:15 Rebecca Gadberry: Little microcrystals.

39:17 Trina Renea: Little microcrystals that a machine sandblasts it onto the skin and sucks it back up in the same tube. It's like, as you're rolling over the skin, it just gives it kind of an exfoliation, almost like as if you were using a sander. 

39:32 Rebecca Gadberry: A mini sandblaster. 

39:36 Trina Renea: Yeah. And don't ever do this, but like a file. You're filing off the surface. 

39:40 Rebecca Gadberry: Right, like a fine…

39:43 Trina Renea: Really fine, fine, fine. But don't file your skin. 

39:46 Rebecca Gadberry: Yeah, don't do that. 

39:48 Trina Renea: So microdermabrasion has been around for so long. It's a manual exfoliation and so it's kind of a bit aggressive. You can turn it up or down. You can do it really gently or really aggressively, but it does make the skin feel really soft after a facial. 

40:09 Rebecca Gadberry: Okay. I also wanted to talk about gels, cooling gel masks that you keep in the refrigerator. Not in your freezer but in your refrigerator, to keep the temperature of the skin under control. Especially if you've been out in the sun or a windy day or it's been really arid, super no moisture in the air. 

40:32 Trina Renea: Yes. That is a really good thing to do, keeping that mass, something cold and gel that has calming ingredients and aloe and things like that in the fridge to put on your skin to cool it. 

Also, when you go to a spa and you want to go in the steam room or in the hot sauna, they have that bowl of ice towels, towels that are in the water full of ice. I have flare-ups, so I have rosacea. And I always tell people with rosacea you can still go in them, but you take one of those ice towels and put it over your face where you get the rosacea and keep your face cool. Once that towel starts getting warm, go get another one. 

You can do the same thing at home. You can put a really icy cold— put a towel, a washcloth, wet washcloth into your, if you want to do it really fast, into your freezer for 10 minutes and then take it out. You can put that over your face if you're having a heated moment. 

41:31 Rebecca Gadberry: Yes.

41:31 Trina Renea: Too much wine. 

41:32 Rebecca Gadberry: Too much wine, red wine. White wine seems to be okay. It's the red wine that seems to be the problem. 

41:37 Trina Renea: It's weird. For me, I'm pretty good with red wine, unless it's got too much, I don't know if it's sulfates or I don't know what. What's inside red wine that does that?

41:47 Rebecca Gadberry: Sulfates.

41:47 Trina Renea: Sulfates, yeah. So if it has too much of that, I can get a flare. But, oddly, champagne does it for me. That's my trigger. I hate that.

41:57 Rebecca Gadberry: Well, remember when we were talking about drugs don’t shake them up.

41:59 Dr. Vicki Rapaport: No champagne on yachts.

42:00 Rebecca Gadberry: Don't give up the champagne. Just be ready for the rosacea.

42:03 Trina Renea: Right. So when I'm on a boat and I'm floating in the water drinking champagne, my two triggers, I automatically have a paper towel with ice from like a cooler or something and I'm putting it on my face right away because I know it's going to happen. It's so annoying. 

42:20 Rebecca Gadberry: Right. I think the takeaway from this is you're going to have to experiment. And don't stop using a drug because it's triggering rosacea. You might ask for something else if it's triggering your rosacea. But if there isn't anything else, you're going to have to be working with your rosacea. 

Use a good skincare line. Remember, 91% of all rosacea, they say sufferers. I don't like the term suffering. It's more Buddhist. But if you have rosacea and you have a trigger, 91% of the people polled have found that just going to a real simple routine, so as few products as possible with as few ingredients as possible is the best way to start at least.

43:11 Trina Renea: And labeled ‘For Sensitive Skin’. 

43:13 Rebecca Gadberry: Yes, and labeled. And it should be tested on sensitive skin. So a very gentle cleanser. No sulfates in it. Just a very gentle cleanser, may be foaming but you don't feel tight when you get done. If you feel the tightness, your barrier has been damaged. So none of that.

Cool water, a barrier repair cream and a good sunscreen SPF 50 or higher that's mineral based. Don't rely on your sunscreen to be in your moisturizer. We've gone through that before, so listen to other episodes where we've talked about that.

And I think that's a takeaway. 

43:48 Trina Renea: That is. I got to get that on a little— that's a good takeaway. 

43:54 Rebecca Gadberry: Okay. I think that's it. I think that'll work. And I'm really looking forward to looking into rosacea more this year, because I don't think it's something that should be just discussed during the month of April during Rosacea Awareness Month. 

44:08 Trina Renea: Yeah, I agree. All right. Well, we will be back with one more episode on rosacea and we will talk to you guys again soon. All right.

44:19 Rebecca Gadberry: Bye. 

44:20 Trina Renea: Bye.

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