What is 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 Trina Renea: Good morning, ladies. Welcome back to Facially Conscious. How are you today? 

01:04 Dr. Vicki Rapaport: Good morning, everybody. 

01:05 Julie Falls: Good morning. 

01:06 Dr. Vicki Rapaport: So nice to see you all fresh faced. 

01:08 Rebecca Gadberry: Good morning. Fresh faced and not red. 

01:11 Dr. Vicki Rapaport: And not red. 

01:12 Trina Renea: I'm red. 

01:13 Dr. Vicki Rapaport: And no rosacea flaring. Julie? 

01:16 Julie Falls: You know, it's better. 

01:19 Rebecca Gadberry: There's good days, there's bad days.

01:21 Julie Falls: So true.

01:22 Trina Renea: I also have rosacea, so…

01:24 Julie Falls: I think a lot of people have it.

01:24 Trina Renea: Two of us out of four of us have rosacea. 

01:27 Rebecca Gadberry: Dr. Albert Kligman is the one who diagnosed me.

01:30 Trina Renea: You have it too? Oh, my gosh. Do you have it, Vicki? 

01:33 Dr. Vicki Rapaport: I had an episode of rosacea once, and I thought, “Oh, it's coming.”

01:37 Rebecca Gadberry: Once?

01:37 Dr. Vicki Rapaport: Yeah, once. Isn’t that weird?

01:40 Rebecca Gadberry: That is. 

01:40 Dr. Vicki Rapaport: It must have been the start of some kind of hormonal change, but then it never came back, which is weird. My sister has it so I know I'm prone, but it really never came back.

01:48 Trina Renea: How do you know you have it if you don’t?

01:50 Julie Falls: It's too afraid of you.

01:51 Dr. Vicki Rapaport: How do you know?

01:51 Trina Renea: So today, let’s talk about this, because today we're talking about rosacea. This is the start of Rosacea Month and we are going to talk about it throughout the month and we're going to do a deep dive into it and procedures you could do with it. 

But, today, we're going to talk about what is rosacea and how do you know if you have it and you don't just have some flare up or red skin or something. I mean, how do you really know if you have rosacea? Because a lot of people misdiagnose it, especially estheticians. So I just want to let everybody know, like, what can you look for on your skin. I'm going to ask Dr. Vicki, like, how do you know?

02:28 Dr. Vicki Rapaport: Okay. A classic rosacea patient, you know from the doorway, so we call it a doorway diagnosis. From many, many feet away, you can say, "Oh, my God, that person has rosacea." And that's a real extreme case, which is typically redness and acneiform lesions, like papules, pustules on either just the cheeks or in the center of the face, like nose and medial cheeks. 

02:55 Rebecca Gadberry: Isn't that called the butterfly zone? 

02:58 Dr. Vicki Rapaport: Butterfly rash is more associated with lupus, but, yeah, I guess you can have like a butterfly redness with rosacea. But some people— and then remember, it's a spectrum of diseases. So very mild rosacea is barely pink cheeks. Just pink cheeks. And it can be there and it can be fixed or it can be triggered by alcohol or flushing from being embarrassed or when people public speak. 

Then of course, there's a super extreme version of rosacea, which is like nodules and cysts later in life. 

So, typically, the answer to your question is if you are an adult and you are no longer a teenager and you are experiencing acne, that's either in the center of your face or scattered, not just on your chin, because on your chin acne, that's a little bit more just hormonal. So if you are an adult experiencing some kind of acne, there is a really good chance it's rosacea, called acne rosacea.

You know, a dermatologist and a very good esthetician will help diagnose that for you and then make a plan of treatment for you. 

04:04 Rebecca Gadberry: I thought that rosacea also doesn't have blackheads, whereas acne does. 

04:10 Dr. Vicki Rapaport: Correct. That's right. So great for estheticians. If there's somebody with tons of blackheads and papules and pustules, it's probably not rosacea. If there is a pustule or primarily pustules and no blackheads, it's most likely rosacea. 

04:27 Trina Renea: You mean in the cheek area, not on the face? 

04:30 Dr. Vicki Rapaport: Cheek area or scattered on the face. Some rosacea, there always versions that are not going to fit the exact definition, and there are plenty of patients who have scattered papules: chin, forehead, cheek. And every month it's different and that is actually rosacea. That's not classic. That wouldn't be a doorway diagnosis. That would be more of like a good history taking, a really good exam of the face. 

And, yes, if there's a comedone— not a comedone. If there are comedones, blackheads, whiteheads, typically it's not rosacea. But if it's just red papules and pustules, yes, it is rosacea.

05:05 Rebecca Gadberry: What's a papule and pustule? I hear that all the time. 

05:10 Dr. Vicki Rapaport: A papule is a pink bump. A pustule is a bump full of pus, usually like a little white bump. Not a whitehead, but slightly bigger than a whitehead. 

05:20 Trina Renea: I'm glad nobody has that. 

05:20 Rebecca Gadberry: I hope you're not eating while you're listening to this, everybody. 

05:24 Dr. Vicki Rapaport: I don't know. Some people really like to talk about this stuff and like to go online and watch all the P-poppers.

05:27 Rebecca Gadberry: Oh, yes. 

05:28 Trina Renea: So, wait. So you're saying if somebody has acne on their face and it's not blackheads, it's rosacea? 

05:35 Dr. Vicki Rapaport: Nope. I said if they're an adult, typically past the typical years of acne, which is teenage, so after their 20s. If they're in their 30s, 40s, 50s, and they're starting to break out, it's probably rosacea. 

05:53 Rebecca Gadberry: And about 50% of people with rosacea also have their eyes involved. That's another probably good cue that it's not acne.

06:01 Dr. Vicki Rapaport: Right. And that's in the history taking. So maybe an esthetician can also consider asking if their eyes feel like there's sand in there, like grit. That could be ocular rosacea. But sometimes it's just redness in the mucosal membrane. So when you look at their lower lid, a normal lower lid is pink but a red lower lid in rosacea is bright red. 

Sometimes they don't feel like there's sand in there. Sometimes it's just redness and they don't know why. And some people just have ocular rosacea and don't have the actual papules and pustules on the face. 

06:36 Rebecca Gadberry: Yeah, I have ocular rosacea. 

06:38 Dr. Vicki Rapaport: What are your symptoms? 

06:40 Rebecca Gadberry: Weeping eyes, very, very sensitive eyes, soreness, burning. 

06:49 Dr. Vicki Rapaport: It's terrible. 

06:50 Rebecca Gadberry: Yeah, it's a problem. 

06:52 Dr. Vicki Rapaport: Well, better, I guess, than some other things, because it is treatable. 

06:56 Rebecca Gadberry: Yeah. I have drops. 

06:58 Dr. Vicki Rapaport: Okay. And do they put you on doxycycline? 

07:00 Rebecca Gadberry: No, they didn't. They didn't. 

07:02 Dr. Vicki Rapaport: Okay. It can help. 

07:04 Rebecca Gadberry: Okay. Well, I have another condition that antibiotics are contraindicated for. 

07:09 Dr. Vicki Rapaport: Again, why we take a good history. 

07:10 Rebecca Gadberry: That's right. Also, if people decide to treat it on their own and they use acne medications or acne products, doesn't it, a lot of times, aggravate the rosacea instead of help control it? 

07:24 Dr. Vicki Rapaport: Yes, because acne rosacea is a little different than regular acne. People with rosacea typically have very sensitive skin. 

But when we start to talk about all the treatments, there is a brand-new medication that has been FDA approved that is kind of shocking. 

07:41 Rebecca Gadberry: I was hearing about that. 

07:41 Dr. Vicki Rapaport: That helps rosacea that we would have never thought. So we will get to that.

07:45 Trina Renea: So excited to hear about that. So, basically, like if somebody's at home and they're like, they have some red skin, if they flush and blush, if they turn red and stay red for a while, that could be rosacea as well. That's an indication, that that they get red from heat, wine, sun, anything with heat elements. 

And then if they're jogging, exercise, and then they stay red for long periods of time, it doesn't go away right away, it stays on there.

08:21 Dr. Vicki Rapaport: That’s my definition of rosacea. So if you flush and stay flushed, that could be a sign of rosacea. Again, without any acne component, just redness. 

But you're right, not every red face is rosacea. So, some people who just flush and then it goes away, they could have— with alcohol, for instance, they could have what's called alcohol dehydrogenase deficiency. That is not rosacea. 

08:48 Trina Renea: Right. So if you're at home and you're wondering if you have rosacea, it starts with that flushing that stays for a long time, the redness. Second, there's like four stages, right? So the second stage is you're starting to get those little pimples in the cheek area that look like pimples, but they're not pimples. They're red papules.

And then it can get worse. It can swell, it can grow, it can go to your eyes.

09:13 Rebecca Gadberry: Your nose.

09:13 Trina Renea: And it can grow, can get bulbous. 

09:14 Dr. Vicki Rapaport: You're right. Yes, all that. And the bulbous nose is typically seen in men, so it's called rhinophyma, and that is a very sebaceous nose, because even though people with rosacea have sensitive skin, they also have very sebaceous skin and their sebaceous glands are overactive. Usually, that is triggered by a hormonal change later in life, which we can't control. That's just normal, natural. 

But this very sebaceous skin is definitely part of rosacea, where the pores get bigger. It's like literally thickened skin, typically in the medial cheeks and definitely on the nose.

09:47 Trina Renea: And I've seen it on the chin too. 

09:49 Dr. Vicki Rapaport: And the chin, absolutely. Vessels, like broken vessels on the cheeks can be a sign of rosacea. 

09:56 Trina Renea: All those little capillaries that are broken. 

09:58 Dr. Vicki Rapaport: Right. And those can be treated, but it typically is more of a cosmetic treatment. It's not necessary, because it doesn't usually cause them to break out. Having blood vessels doesn't mean you're going to break out more. It just means you're going to look red. 

10:14 Rebecca Gadberry: You mean cosmetic treatment, not what you put on the skin as a cosmetic but an elective treatment? 

10:20 Dr. Vicki Rapaport: Yes. Sorry. 

10:20 Rebecca Gadberry: Okay.

10:21 Trina Renea: Like a laser. 

10:22 Rebecca Gadberry: Yeah, like a laser. 

10:24 Dr. Vicki Rapaport: Exactly. Just like, yes. 

10:26 Rebecca Gadberry: So you'd have to pay for it yourself instead of insurance covering it.

10:29 Dr. Vicki Rapaport: Correct. 

10:30 Rebecca Gadberry: Okay, got it.

10:31 Dr. Vicki Rapaport: Some doctors put it under insurance, but I think that that is not— I wouldn't say that's insurance fraud, but it's not something that insurance likes to cover. And so there are sometimes like putting in a different diagnosis to get it covered so the patient doesn't have to pay.

10:46 Rebecca Gadberry: So it's insurance non-kosherness.

10:49 Dr. Vicki Rapaport: Uh-hmm. 

10:51 Trina Renea: Also, with my rosacea…

10:53 Julie Falls: Insurance doesn't cover rosacea treatments.

10:56 Dr. Vicki Rapaport: Not typically. 

10:57 Trina Renea: That's crazy. 

10:59 Dr. Vicki Rapaport: I know. 

10:59 Julie Falls: I know my medications for rosacea…

11:01 Dr. Vicki Rapaport: No, no, no. Insurance covers medications, FDA-approved medications…

11:04 Trina Renea: Oh, but not the treatments. 

11:05 Dr. Vicki Rapaport: But not the laser treatments typically. 

11:07 Julie Falls: Oh, laser. 

11:07 Dr. Vicki Rapaport: Sorry, yes. 

11:08 Julie Falls: Got it.

11:09 Trina Renea: And sometimes, patients will request us to write a letter to their insurance and see if they can get approved, and then sometimes the insurance will say, “Sure, we'll cover it. We might cover it.” But they're really not going to cover the expense that it costs the doctor to operate the laser. Most doctors just don't even, they don't bill insurance for lasers for rosacea. 

11:29 Trina Renea: Another way to tell you have rosacea, which is— so I have rosacea, but it doesn't flare up all the time, and I keep it controlled with my products. But when I go out on a boat and it's hot and there's sun and I'm drinking, my cheeks will swell up, like painfully swollen where I have to ice them. 

And so that is another sign that you have rosacea, is if you swell and they're burning your face, that's... 

12:00 Dr. Vicki Rapaport: Well, you're putting all those triggers together, right? Heat, sun, alcohol, and it's like bound to happen in somebody who's predisposed to that. 

12:09 Julie Falls: You just told me something I didn't know. I suffer from rosacea. It's mostly controlled. I really don't even know what a trigger is for me because I've really had it under control so much lately. I have not touched any of the meds that I have. But I had a procedure to get rid of some actinic keratosis and I've been putting some aftercare balm that has a steroid in it on some of these spots that are healing. I think I've put it on the rest of my face and Dr. Vicki said that could have started this little flare-up I've had on my nose and the sides of my nose, on the cheek area. Did not know. 

12:58 Dr. Vicki Rapaport: Cortisone can definitely be a trigger for rosacea. In fact, we call it steroid rosacea.

13:04 Trina Renea: There you go. 

13:05 Dr. Vicki Rapaport: - And even over-the-counter, it's weak, but it can definitely cause a little bit of a flare. But we love steroids when they're appropriate and over-the-counter is available, so people can choose to use it whenever they want. But, yes, if you have a history of rosacea, I would say please beware of putting steroids on your face. 

13:21 Trina Renea: Wow, interesting.

13:21 Julie Falls: Good to know.

13:22 Trina Renea: I did not know that. 

13:24 Julie Falls: The other thing for me that's been helpful, Trina, my esthetician here, suddenly this is my show…

13:31 Dr. Vicki Rapaport: It is your show, Julie. 

13:33 Julie Falls: When she does microdermabrasion, and people are like, “Oh, no, no, no, that really can cause…” it has, to me, been a gamechanger. I feel like it really…

13:43 Trina Renea: She makes me do it. I'm like, “No.”

13:45 Julie Falls: I think it helps. I'm probably going to get a lawsuit from a lot of listeners who…

13:51 Dr. Vicki Rapaport: No.

13:52 Trina Renea: Also, people are going to be beating to me.

13:54 Dr. Vicki Rapaport: I think that with rosacea, you just have to know yourself. Because some patients with rosacea, you're right, would not be able to tolerate microderm.

14:00 Trina Renea: Don’t do microdermabrasion. This is Trina right now. 

14:03 Dr. Vicki Rapaport: But some people with rosacea…

14:04 Trina Renea: Do not do microdermabrasion on people with rosacea. I mean, you can do it around the face, but not directly on the rosacea area. 

14:13 Julie Falls: Well, maybe the type I have, it's…

14:16 Rebecca Gadberry: I think that's what you're probably going to say, is that everybody's different because this is a very complex disorder or disease. So you might have…

14:26 Julie Falls: The condition.

14:27 Rebecca Gadberry: Several of the symptoms and causes, but not others. So everybody reacts differently. The fact that Julie is saying, “I have microdermabrasion,” doesn't mean that Sally who's listening goes out and gets microdermabrasion. 

14:38 Trina Renea: But also, let's be clear. She's not with a flare-up when it's happening. She also has no broken capillaries in the area. 

14:45 Julie Falls: Yeah, it's very mild. 

14:46 Trina Renea: It's very mild and I turn that thing way down. It's just like a very surface exfoliation. So, I want to be very clear that I'm not doing that…

14:56 Rebecca Gadberry: Does your insurance company listen to this podcast, so they know that you’re doing it?

15:01 Dr. Vicki Rapaport: And when we as dermatologists treat rosacea, I think the easy overview we tell patients is you can treat this topically, you can treat this orally. So if somebody who's really mild, we're going to give them something topical. And besides topical medication that's FDA-approved, we will guide them towards really nice skincare products that we think will be great for them. 

And then if they decide to do the oral medication, it's really oral plus topical. It's not just oral, because the lovely part about the oral is that it gets them under control really quickly. When I say oral medication, it's typically an antibiotic. Typically, it's either doxycycline or minocycline. They get under control beautifully. 

I love having them have little extra pills left over or have a bottle around because if they flare and they're an educated human, they can use them if they have another flare, if they'd like. But then they maintain with the topical medications. 

And the topical medications range from topical antibiotics, there's a topical…

16:01 Trina Renea: Azelaic acid. 

16:03 Dr. Vicki Rapaport: Azelaic acid is a really nice over-the-counter, but there's also a prescription version. 

16:08 Julie Falls: And then Dr. Wang, who we interviewed on our show, talked about mites. 

16:14 Dr. Vicki Rapaport: Right. There's a topical anti-mite medication. It's called Soolantra. There's this theory that some people with rosacea have an increased amount of these little microscopic mites, and the mites are like the bacteria or the viruses. They're so small, you can't see them unless it's like an electron microscope. 

But these mites are the ones that are causing the inflammation that causes the rosacea. So the topical anti-mite medication helps kill the mites. You kill the inflammation and then you don't have the rosacea. 

16:48 Rebecca Gadberry: Here's an interesting little…

16:49 Julie Falls: I knew I was waiting for you to find that.

16:51 Rebecca Gadberry: Here's a piece of trivia that I absolutely love. The guy who named the mites, which are called Demodex, also named dinosaurs. Isn’t that wild? 

17:02 Trina Renea: The biggest and the smallest.

17:04 Julie Falls: It's a mite prehistoric?

17:06 Trina Renea: Yes, I think so.

17:06 Dr. Vicki Rapaport: He called them Demodex?

17:07 Rebecca Gadberry: He called them Demodex and he named dinosaurs ‘dinosaurs’. It was back in the 1800s. isn’t that crazy?

17:13 Trina Renea: Wait, he knew about Demodex back in the 1800s? 

17:16 Rebecca Gadberry: Yes, he was one of the first people to ever see it. 

17:19 Julie Falls: He found the mites. Vicki, there's also a medication I've been given that's for acne. 

17:26 Dr. Vicki Rapaport: Oh, yes.

17:26 Julie Falls: And I've been told that that can be also very helpful.

17:29 Trina Renea: Which one?

17:29 Julie Falls: It's called Winlevi. 

17:32 Dr. Vicki Rapaport: Well, that's the topical spironolactone. 

17:35 Julie Falls: Can you tell us about that? 

17:37 Rebecca Gadberry: Could you spell it first? 

17:38 Trina Renea: Is that the new one you were going to tell us about? 

17:40 Dr. Vicki Rapaport: The new one is something different, which I'll touch on in just a second. But the Winlevi is a topical spironolactone. Topical spironolactone helps the hormonal component of rosacea, because spironolactone is a very weak anti-testosterone. It's also, when given orally, spironolactone is also a diuretic. So it's given for blood pressure. But dermatologists use it for hair loss and for acne. 

Some people can't tolerate orally, for whatever reason, so they decided to try it topically, and it seems to work pretty well. It is not irritating. It's not drying. It takes a little bit of time, at least in my hands, it takes a little bit of time for it to work, but we do love it. And, you can't give men oral spironolactone, but you can give men the topical spironolactone, which is the Winlevi that you're talking about. 

18:27 Trina Renea: Do you use that topical spironolactone for the cystic acne, too, as well? 

18:34 Dr. Vicki Rapaport: Yes. 

18:36 Trina Renea: And it works as good as the oral over time? 

18:39 Dr. Vicki Rapaport: No. Oral, hands down, is the fastest way to get the rosacea under control, if there's an acne component. If it's just redness in vessels, the oral antibiotic won't work. But for the acne component, the oral antibiotic works within one to two weeks, sometimes three if it's really stubborn. The topical takes four to six weeks to work. 

But it's a really nice maintenance and it's not drying and it's great for people who can't take oral medication, just like Rebecca was saying, she has a contraindication for that. The important part about rosacea is that there are so many medications out there that you just have to find the right combination for you. 

And whether, like you said, azelaic acid or Winlevi or topical antibiotic, but the new, new, new FDA-approved medication is called Epsolay, which is 5% benzoyl peroxide, which you would never normally give a rosacea patient. 

19:33 Rebecca Gadberry: That's the one that's encapsulated?

19:35 Dr. Vicki Rapaport: Yes.

19:35 Rebecca Gadberry: Okay, got it.

19:36 Dr. Vicki Rapaport: It's encapsulated, so what does that mean? Just, it gets into the skin. It kind of bypasses the layer that would be irritated if it got exposed to benzoyl peroxide in a rosacea patient, and it gets underneath to where it needs to work and kill the bacteria. 

19:51 Trina Renea: What's it called again? 

19:52 Dr. Vicki Rapaport: E-P-S-O-L-A-Y, Epsolay, 5% BPO, and it's very nice for rosacea. I love it. Again, because all these other rosacea medications kind of takes some time to work, this one, for a topical, works really fast. 

20:05 Julie Falls: Any side effects? 

20:06 Rebecca Gadberry: And it's time-released so that you don't have to put— like with other BPOs, you have to put them on throughout the day, like when you use them for acne. But because this one is time released, you don't have to put it… 

20:17 Dr. Vicki Rapaport: Once a day.

20:19 Rebecca Gadberry: Just once a day, which is incredible.

20:19 Julie Falls: Are there side effects?

20:20 Dr. Vicki Rapaport: The side effect would be dryness and irritation, but it's less. 

20:24 Trina Renea: I find it doesn’t do that. Oh, okay. 

20:25 Dr. Vicki Rapaport: It's less than just plain old 5% BPO. Somebody might say, "I'm just gonna buy 5% BPO over the counter," which you can, but it would not be micronized, it would not be micro-encapsulated. It would dry, irritate. People can get a rash. This one is like super sexy boutique benzoyl peroxide that goes in slowly and releases itself slowly over time.

20:47 Rebecca Gadberry: I use the sexy type. 

20:47 Trina Renea: Is it only medical? Prescription?

20:50 Dr. Vicki Rapaport: It's only Rx.

20:51 Julie Falls: It is also used for acne? 

20:54 Dr. Vicki Rapaport: Also used for acne, but you know what? Yes, it might not be strong enough for plain acne, but also in those acne patients who can't handle benzoyl peroxide, it's a great one for that and it's a great spot treatment. You could spot treat, you could do a thin coat. 

Oh, Julie's going to write this down and get a prescription. 

21:07 Trina Renea: Is it out now?

21:09 Julie Falls: Well, I'm also thinking of somebody I know who has little flare-ups with acne every once in a while.

21:10 Dr. Vicki Rapaport: It's out. 

21:15 Trina Renea: Epsolay, and you've been liking it?

21:19 Dr. Vicki Rapaport: I have been. I'm liking it a lot. I love BPO. I'm a sucker for BPO, benzoyl peroxide.

21:22 Trina Renea: I love it for cystic acne, for so many reasons. I use it as well. But specifically this medication that you're talking about, Epsolay for rosacea. 

21:36 Dr. Vicki Rapaport: Exactly. It's just for rosacea. Although we know we use everything off-label for, like what Julie said, we use it for acne, you could spot treat on a one cyst if somebody has like one individual cyst. 

And then just to touch on benzoyl peroxide for a second, because you can buy every strength over the counter. They're not all created equally. So if people have rosacea, they're listening to this, they want to jump out and get the Neutrogena or the AcneFree or the Proactiv, just be careful. Just be careful using it and use it slowly, because if you overuse it, you'll burn your skin. It's strong.

22:14 Trina Renea: Right. And one thing that you've also told patients in the past, that I now repeat, is you can always, if you're using benzoyl peroxide and it's drying out the surface, you can put your moisturizer on first because it can act like a little bit of a barrier, and then put the benzoyl on top of that so that it doesn't dry out the surface as much. Because it's not that we want you to stop using the benzoyl peroxide. So put the moisturizer on first if you need to, because you should keep using it. 

You can slow it down sometimes if it's over drying at the surface, but just don't stop using it.

22:53 Dr. Vicki Rapaport: Exactly. Right. So people who get a rash or a burn or think, "Oh, I'm allergic," they probably just overused it. So a thinner coat and less often is what we typically say. 

23:03 Trina Renea: Right. Okay. So what should some people avoid when they find that they have rosacea? What are some of the triggers? I mean, we talked about them earlier, but what do you tell patients? Like, avoid this, this, this if you can.

23:21 Dr. Vicki Rapaport: I tell them not to go on boats in the sun and forget their sunscreen and drink alcohol. 

23:25 Rebecca Gadberry: And drink, yes. 

23:27 Dr. Vicki Rapaport: I tell them to avoid their known triggers. As dermatologists, we can list the triggers…

23:30 Trina Renea: I'm not going to stop drinking and going on boats. I'll just put ice on my face. 

23:33 Dr. Vicki Rapaport: Just wear your hat and put sunscreen on. 

23:35 Trina Renea: I do that, but I still get swollen and red. 

23:37 Dr. Vicki Rapaport: It's the heat, yeah. 

23:39 Rebecca Gadberry: I have another question, though. When a patient comes in and is meeting with you about rosacea, what can they expect from meeting with you? 

23:52 Dr. Vicki Rapaport: First, we'll confirm or un-confirm the diagnosis and then make a plan. Again, it can be topical plus oral, and oftentimes it will also be maybe laser in the future, because laser will get rid of all those blood vessels. And if people, sometimes they don't have blood vessels, they just have redness and flushing, laser once or twice a year can actually decrease the flushing. So we’ll just give them a…

24:17 Trina Renea: What laser?

24:18 Dr. Vicki Rapaport: Vbeam is the gold standard, but an IPL, a good IPL that is focused on the red settings can really help a rosacea face. And just like a long-term plan and what to expect. 

Then just to touch on the triggers, from Trina’s question, it's a personal trigger. Some people exercise as a trigger. Some people alcohol is a trigger. Some people tomatoes are a trigger. Some people think a trigger could be spicy food, but it really was the alcohol. It's nice to kind of figure it out yourself.

24:47 Julie Falls: Stress.

24:48 Dr. Vicki Rapaport: Stress. And then of course if you can avoid the triggers, that would be really helpful for the long term, because long term, if you don't control your flares, the skin will change. The skin will transform. It'll look really sebaceous, like we talked about.

25:02 Julie Falls: It's also genetic and based on where your cultural background, where you're oftentimes... 

25:09 Trina Renea: Yes, it can be hereditary, for sure. 

25:10 Rebecca Gadberry: I think 33%. As a matter of fact, 23andMe, the gene…

25:19 Julie Falls: The rosacea gene.

25:20 Rebecca Gadberry: Yeah. They have done a study on rosacea genes. You can go and learn more about yourself and rosacea and your family on 23andMe if you subscribe to them. 

25:32 Dr. Vicki Rapaport: Well, yeah, it is 100% genetic. I mean, not that everybody gets it. but the people who get it…

25:36 Julie Falls: Is it a form of inflammation? 

25:38 Dr. Vicki Rapaport: It's an inflammatory process that's genetically predisposed. If you have the gene for it, you're probably going to get it, but you might get it less intense than your brother or your sister or your parents. Or, like me, you might get one flare in your lifetime and never get it again, but it is definitely a genetic predisposition. The triggers come usually with a hormonal change. 

25:58 Rebecca Gadberry: So the triggers will exacerbate the genes.

26:01 Trina Renea: Yes.

26:01 Dr. Vicki Rapaport: Yes.

26:02 Rebecca Gadberry: So if you have the genes and you do any of the triggers that you're susceptible to, then it'll get worse. But if you don't have the genes, then…

26:10 Dr. Vicki Rapaport: You're never going to get it.

26:12 Trina Renea: Right. And I always tell clients, if you have rosacea, avoid things that cause inflammation, the heat things, the elements that cause inflammation in general. And also, like you said, watch your triggers. Not all of those things trigger your rosacea. So as soon as you do have a flare up, look at what happened that day. What caused that flare up and then avoid that. That's really what you have to do. And then use products that are for sensitive skin. 

26:41 Dr. Vicki Rapaport: What do you like product-wise? What do you suggest skincare-wise for your patients? 

26:43 Trina Renea: I like using antioxidants. They help a lot. And exfoliants, like glycolic, azelaic, salicylic blend is what I use on my skin. I think exfoliating a little bit with some AHAs is helpful. 

27:01 Rebecca Gadberry: Mandelic acid is very over the lactic or glycolic. 

27:07 Trina Renea: Uh-huh. Mandelic is great for people with red skin and helping to balance that as well. So I think a little bit of AHAs and a little bit of antioxidants daily help me to maintain it and more sensitive moisturizers for sensitive skin.

27:22 Rebecca Gadberry: Whereas with me if I want to trigger my rosacea, I'll use even 5% AHA. I can't even look at the bottle. 

27:36 Trina Renea: I use a gentle one and it helps to keep it. 

27:38 Julie Falls: Yeah, everyone's different. 

27:42 Trina Renea: So we are going to come back and speak to you guys more about rosacea this month, in the next few weeks. We're going to talk about different ingredients you can look out for, different treatments you can do, and lifestyle.

27:54 Rebecca Gadberry: Lifestyle.

27:58 Trina Renea: So, stay tuned. We'll be back soon. We just wanted to give you a quick overview of rosacea, and thanks for listening. Bye.

28:05 Julie Falls: Bye.

28:05 Rebecca Gadberry: Bye. 

28:05 Dr. Vicki Rapaport: Goodbye, everybody. Your rosacea is treatable. 

28:08 Trina Renea: It's treatable. Go to your dermatologist. 

28:10 Rebecca Gadberry: Yes. 

28:11 Dr. Vicki Rapaport: Bye.

28:15 Trina Renea: Bye.

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