When is a bit of redness something more? Skincare experts explain the difference and how to manage.
As someone with almost permanently rosy cheeks (not that you can tell beneath my full-coverage concealer), combating redness has been my personal Roman Empire for going on a decade.
While my skin is now in the best shape it ever has been, it wasn’t always this way. As someone in the elder cohort of Generation Z, I’ve seen (and survived) several waves of skincare fads, from the days when Proactiv was the height of product innovation to the 10-step regimen obsession and beyond. How did my poor, delicate dermis respond to the onslaught? By becoming redder than ever. In my quest to try anything and everything that whispered promises of even-toned skin in my (red) ear, I had done the opposite; my face was inflamed and acne-prone, my stressed skin barrier crying out for respite.
While I have curated my anti-redness arsenal over years of trial and error, if you’re suffering from chronic flushing, your first step should always be a consult with a dermatologist or skin therapist; not only to address your concerns, but to diagnose the root cause of your red face.
For me, it was a sensitised, damaged skin barrier, but doctors have also suggested a mild case of rosacea.
Below, we unpack the differences between redness and rosacea, the triggers and what ingredients can help or harm - plus the treatments and products that will help fight the flush. Let’s get into it.
Redness v rosacea
The difference between redness and rosacea is an important distinction to make. Redness is a reaction within the skin caused by vasodilation, or the widening of blood vessels and superficial capillaries. This is usually due to physical irritation, dehydration, lipid dryness, medication, or topical products that sensitise the skin.
“Redness can be temporary or prolonged and it usually varies in intensity depending on the trigger present. Redness is best managed or treated by identifying and addressing the trigger,” explains Katherine Williams, director of education at Caci Clinic.
Rosacea is a chronic inflammatory skin condition that is tricky to treat and requires a medical diagnosis. The intensity of symptoms — which include rashes, pustules, skin thickening, and a tendency to flush or blush — can be managed with a dedicated treatment plan, but there is ultimately no cure.
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Advertise with NZME.“Common symptoms include strong visible redness accompanied by damaged blood vessels that are easily visible. You may also experience a burning, stinging or irritating sensation alongside the visual cues. Rosacea has multiple stages of severity and requires a comprehensive treatment plan,” Williams explains.
Speaking from experience, suffering with redness or rosacea can be a major source of insecurity. It can be incredibly embarrassing in social settings, particularly in already heightened situations like job interviews or dates, and I rarely go a day without wearing makeup.
“It is a chronic disease that often has a very relapsing and remitting course,” says dermatologist Dr Vania Sinovich, the founder of The Skin Company. “It may be associated with a significant psychological and social burden.”
Triggers
While the cause of rosacea is unknown, scientists have attributed it to skin sensitivity and environmental and genetic factors. Flare-ups of the condition are typically prompted by individual triggers, with hot weather and sun exposure being common examples.
Food sensitivities, certain medications, alcohol, or an underlying systemic condition can also be causes of rosacea or flushing, explains Sinovich.
“Impaired skin barrier and altered microbiome of the skin and gut are thought to play an increasing important role. There is thought to be a hyper-reactivity to the cutaneous nerves and vessels in rosacea-prone individuals.”
Emotional stress is also a trigger — even people without rosacea can become red and flustered in high-pressure situations. However, a survey of more than 700 patients by the US National Rosacea Society found 67% were able to reduce their flare-ups through stress management techniques such as meditation, fitness and better sleep.
Determining your individual triggers with the help of dermatologist or other expert is critical before proceeding with treatment; everyone has different skin and stressors, and copying and pasting another person’s skincare routine into your cabinet won’t bring you any closer to your goals.
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Advertise with NZME.How can I treat it?
The good news is redness and rosacea can be managed with a combination of professional treatments, skincare products, lifestyle adjustments and most importantly, commitment, says Williams. Here’s what you need to know.
DO ACTIVE INGREDIENTS HELP OR HARM?
In a nutshell, actives are scientifically proven ingredients that help a product target a particular skin concern; common examples include retinol, hyaluronic acid, and alpha-hydroxy acids (AHAs).
While it depends on the stage of redness or rosacea and the individual triggers, ingredients such as niacinamide, hyaluronic acid, and omegas may be beneficial, Williams says.
A good toner to balance the skin’s PH may assist with product absorption, while SPF is a non-negotiable — Sinovich recommends daily application of a broad-spectrum sunscreen with a sun protection factor of 30 or more to protect the skin from further inflammation and UV exposure, which can stimulate angiogenesis, the formation of new blood vessels.
“You will want to steer clear of any astringents such as witch hazel, or heavily fragranced products. Rosacea skin can be very delicate, sensitised, and you may find your skin reacting to gentle products and ingredients as well. If this is the case, I strongly suggest that you seek professional treatments to repair your skin from the inside out before considering topical products,” Williams adds.
“I’ve found no high-strength acid (think glycolic or lactic) is best for rosacea. With any inflammatory condition, I would never reach straight for an acid. Acids should be used as a tool to further enhance strong skin or to treat particular skin concerns such as hyperpigmentation, scarring — they cannot be used to enhance impaired skin.”
The exceptions? Salicylic acid and hyaluronic acid.
“For some people with papulopustular rosacea (commonly known as acne rosacea), salicylic acid can be used mindfully within a treatment plan to assist with managing the demodex mites associated with this condition, and to break down thick oil within the pores,” Williams explains.
As people with rosacea often have impaired barrier function — which makes the skin more susceptible to damage and dehydration — hyaluronic acid, an ingredient that attracts and retains water, can help boost and maintain moisture.
Dr Sinovich agrees, adding: “Avoid products that are fragranced, contain drying alcohols, such as isopropyl, and contain camphor, witch hazel, menthol, peppermint oil, or eucalyptus oil, as these are traditionally pro-inflammatory.”
Then there’s retinol, a pure form of vitamin A. This skincare superpower encourages cell production, addresses free-radical damage and promotes skin renewal, leading to improved texture, tone and radiance. When tolerated, it can be suitable for people with redness or rosacea — with a few caveats, says Williams.
“I find [retinol] particularly useful to aid in cell turnover and exfoliation without causing any abrasion to the skin. You want to find a retinol that is formulated with other beneficial ingredients or oils, rather than a raw or unconcentrated option which can cause further irritation. It’s best to seek advice from a professional on the frequency and method to apply your retinol.”
WHAT ABOUT TREATMENTS?
There are several treatments on the market designed to help combat redness; as always, these treatments shouldn’t be performed without the recommendation of an expert and results may vary person-to-person.
One treatment Williams suggests is Profhilo, a treatment that involves injecting a high concentration of hyaluronic acid just beneath the skin to deeply hydrate and stimulate collagen and elasticity. The injectable is known to help improve skin tone and quality, with several clinics recommending it to reduce redness and the appearance of rosacea.
Another potentially beneficial treatment is photo-rejuvenation, which uses pulsed light to target signs of pigmentation, reduce redness, treat broken capillaries, and boost collagen production. The procedure works by breaking down damaged capillaries, the debris flushed away with lymphatic drainage. “It supports the skin to develop a fresh, strong capillary network,” Williams says.
LED light therapy can also be a good bet, she added, with at-home or in-clinic options available. “Red light therapy is used to enhance the skin’s natural defence mechanism, speed up healing and even skin tone. With regular treatments, you can expect calmer, clearer skin with a more even skin tone.”
HOW OFTEN SHOULD I BE EXFOLIATING, IF AT ALL?
“Any redness or rosacea represents an inflammatory imbalance within the skin, usually accompanied by an impaired skin barrier. One thing you don’t want to do with an impaired barrier is use a harsh exfoliant and in some situations, you should avoid exfoliating altogether,” Williams explains.
“When exfoliation is appropriate, I would always recommend an enzymatic or chemical option rather than a physical or granular exfoliant.”
Chemical exfoliants work by encouraging gentle shedding of the uppermost epidermal cells, prompting new ones to emerge. However, people with rosacea should avoid any exfoliants containing alpha-hydroxy acids (AHAs) or beta-hydroxy acids (BHAs) — potentially irritating active ingredients. For example, common AHAs include glycolic and lactic acid, the high-strength actives Williams suggests steering clear of.
Alternatively, physical exfoliants (St Ives Apricot Scrub, anyone?) are abrasive, granular products with coarse ingredients that buff away dead cells. However, experts say these formulas can increase inflammation and cause micro-tears in the skin — probably better reserved for sloughing off fake tan.
“Avoid topical products that may irritate the skin such as toners, astringents and chemical exfoliating agents, such as alpha-hydroxy acids. Manual exfoliation with rough sponges or cloths should also be avoided,” Dr Sinovich adds.
Instead, people with redness or rosacea should look for a gentle exfoliant with soothing ingredients such as oats or coconut. Keep an eye out for products with a formula designed for sensitive skin or that helps support the skin’s moisture barrier.
WHAT INGREDIENTS CAN HELP?
I would love to say there is an untold formula, but the boring truth is that a simple routine and gentle yet effective ingredients are the best un-kept secrets. Sinovich recommends a mild cleanser, lightweight moisturiser, and sunscreen (SPF30+).
“Topical products that contain niacinamide (B3), liquorice, caffeine (vasoconstriction) and ceramides (barrier restoration) that are fragrance free are typically good for rosacea-prone individuals,” she says.
Soothing ingredients that can help calm angry skin include azelaic acid, an acne-killing and anti-inflammatory powerhouse commonly used in topical rosacea treatments; hyaluronic acid, an active that helps the skin retain moisture; glycerin, a moisturising humectant that helps seal water into skin cells; and products that are fragrance-free and allergy-tested.
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Those with redness and rosacea should look for brands with dedicated sensitive skin ranges or products that are marketed as rosacea-safe. For example, Dermalogica has an UltraCalming line designed to target redness, strengthen the skin barrier and support reactive, sensitised skin.
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