reduce rosacea

Reduce rosacea

Rosacea  is a rather frequent, chronic skin condition characterized by facial central facial erythema (redness), teleangiectasia (dilated superficial vessels), papules, pustules and swelling. Studies assessed that Rosacea prevalence in normal population is around 10%, predominantly affecting fair-skin, Caucasian descent individuals. Rosacea debuts and diagnosed usually between 30 and 50 years, and its likely to affect three times more women than man. The cause and mechanisms of Rosacea are still unclear, being attributed to various intrinsic or extrinsic factors such as Demodex or Helicobacter pylori. Sun exposure, genetic predisposition, topical steroids are risk factors.  

Depending on the area, surface and types of symptoms involved Rosacea has 4 subtypes but there are also Rosacea types as an effect of other skin problems such as acne or sebaceous imbalance. Even though the exact cause is not identified the majority of the affected patients seem to suffer from topical sensitive skin, pH imbalance, unusual bacterial populations, and exacerbated immune response.

Due to the high sensitivity of the Rosacea skin the treatment options are limited. Cosmetic procedures involving laser or intense pulsed lights are available but besides being costly their effect is limited. Since the usual pharmaceutical treatment scheme includes antibiotics, retinoids, and azaleic acid in medicinal concentrations which are quite aggressive and hard to tolerate, especially in sensitive skin, lately the focus shifted to natural active ingredients that can provide visible effects with little to none side effects.

There are several active ingredients that are effective in attenuating Rosacea by various mechanisms that address the disease’s symptoms, from restoring the skin barrier, regulating sebaceous activity, rebalancing pH, controlling the local peripheral circulation, exfoliation, antibacterial and antioxidant.

Alpha Bisabolol, an essential oil extracted from chamomile family plants has been used since antiquity for a wide array of skin conditions.  It has numerous active effects, from antibacterial, antifungal, anti-inflammatory to wound healing promoter.  A combination of these actions makes alpha bisabolol effective in reducing Rosacea effects. While the antibacterial properties control the demodex population (considered by some sources responsible for skin redness), the anti-inflammatory action controls the local vasodilation, reducing the appearance of the peripheral capillaries. Furthermore, several studies revealed that α-bisabolol facilitates skin penetration of other active ingredients, enhancing their potency. This makes it an ideal candidate for topical mixtures [4].
 
Niacinamide (Vitamin B3), is a multipurpose cosmetic active agent with multiple cosmetic utilizations. Because some of the Vitamin B3 deficiencies symptoms – such as excessive skin dryness, sensitivity to sunlight, skin lesions - are similar to Rosacea manifestations, several studies observed niacinamide’s capacity to attenuate Rosacea when topically applied. The complex Vitamin B3 mechanisms involved in restoring the skin barrier, rebalancing pH and reducing inflammation led to visible and durable results in treating Rosacea [5].

Phytosterols are plant produced sterols unavailable in the human body. Beta-sitosterol is known to accelerate healing, reduce scarring, and prevent bacterial growth, which is useful in controlling the native bacterial population and rejecting harmful bacteria and reducing local inflammation. Phytosterols are also known to reduce the overall levels of LDL cholesterol (“bad cholesterol”). The reduction of the cholesterol levels has an important effect at skin level, since several studies proved that LDL accumulations are aggravating factors in acne, Rosacea, seborrhea and other skin diseases. [6]

Salicylic Acid (Beta Hydroxy Acid) - a botanical active extracted from the white willow bark - and the white willow bark extract (salicin) are renowned  for their benefits for the whole human body, from the omnipotent aspirin to topical salicin mixtures - efficient anti-inflammatory, antioxidant, and also great in regulating sebum production and maintaining clean, healthy pores. Both compounds are suitable for topical mixtures for Rosacea, with visible results on diminishing its symptoms. Salicylic acid is lipid soluble and it mixes well with oily, greasy substances being an excellent ingredient in moisturizing mixtures. This characteristic allows it to penetrate deep into pores cleaning them and dissolving sebum excess. This prevents the formation of blackheads, blemishes, papules and pustules caused by dirt and oil becoming trapped under the skin and prevent inflammation. Because of its lipid solubility, salicylic acid is particularly useful for oily skin. As a natural source of salicylic acid, salicin extracted from the white willow bark is a natural and gentle option ideal for sensitive Rosacea skin [1][7].
 
Silymarin is a generic name for the entire group of flavonolignans principles that can be only found in the seeds of silybum marianum (milk thistle). It is one of the most study-validated natural active for Rosacea treatment. Several studies with statistical relevant results were conducted on silymarin effects in reducing Rosacea and inhibiting its facial manifestations. Topically applied silymarin has several actions by directly modulating cytokines and angiokines involved in colour and pigmenting skin manifestations and regulating their levels. S. Marianum extract also has anti-inflammatory properties, which are helpful in reducing the teleangiecstasia [8][9].
 
Zinc oxide, though not a botanical active per se, is renowned for its sun damage protection properties. One of the first aggravating factors in Rosacea is sun exposure. Due to its ability to absorb UVA and UVB radiation ZnO is widely used in physical sunscreens as a protection against UV radiation. Furthermore, zinc oxide based sunscreen offers the best UVA and UVB coverage and protection according to FDA. That is why ZnO is the perfect DIY sunscreen for rosacea skin, which is catalogued as a sensitive type [10].

Licorice (Dipotassium Glycyrrhizinate), Oat (Oat beta glucan) and Green Tea extract are other natural active used in the treatment of Rosacea, primarily due to their skin barrier involvement,  mild action and lack of side effects [11][12]. 

The advantage of DIY cosmetics is the possibility of developing and refining a unique recipe containing only selected ingredients and using premium quality vehicles. Especially for the treatment of Rosacea a ceramide enriched liquid crystal pre-emulsion is recommended as a base cream. The ceramides will act like an adjuvant in the skin barrier repair, while boosting the potency of the other active ingredients, leading to an overall better effect. The end result is a highly compatible and effective custom product that will provide the expected results
 

References

[1]  L. Bauman, “Cosmetic Dermatology – Principles and Practice”, second edition, ISBN: 978-0-07-164128-9
[2] C.Burgess,Cosmetic Dermatology, ISBN 3-540-23064-5 Springer Berlin Heidelberg New York, 2005
[3] Y. Tüzün, R. Wolf, Z. Kutlubay, O. Karakuş, B Engin, "Rosacea and rhinophyma", Clinics in Dermatology, 32, pp: 35-46, 2014
[4]  K. Maurya, Anil; Singh, Monika; Dubey, Vijaya; Srivastava, Suchita; Luqman, Suaib; U. Bawankule, A. Dnyaneshwar, “α-(-)-bisabolol Reduces Pro-inflammatory Cytokine Production and Ameliorates Skin Inflammation”, Current Pharmaceutical Biotechnology, 15, pp. 173-181(9), 2014
[5]  D. Draelos, K. Ertel, and C. Berge, “Niacinamide-Containing Facial Moisturizer Improves Skin Barrier and Benefits Subjects With Rosacea,” Therapeutics for the Clinician, vol. 76, pp. 135-141, August   2005.
[6] Phytosterols also have health benefits in other areas. They reduce the levels of LDL cholesterol, commonly known as “bad cholesterol” [1]. This is relevant not only to the cardiovascular system, as cholesterol accumulation in the skin causes seborrhoea, acne, rosacea and other skin diseases.
[7] D. Kligman, A.Kligman, “Salicylic acid peels for the treatment of photoaging”, Dermatologic Surgery, 24, pp: 325-328, 1998
[8] P. Feher, M. Vecsernyes, F. Fenyvesi, J. Varadi, T.  Kiss, Z. Ujhelyi, K. Nagy, I. Bacskay, “ Topical application of Sylibum Marianum Extract” , Jurnal Medical Aradean (Arad Medical Journal) Vol. XIV, issue 2, pp. 5-8, 2011
[9] E.Berardesca, N.Cameli, C.Cavallotti, J.L. Levy, G. Pierard, G. de Paoli Ambrosi, “Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation”, Journal of Cosmetic Dermatology, doi: 10.1111/j.1473-2165.2008.00355.x, pp 8-14, 2008
[10] United States Environmental Protection Agency (EPA), Air and Radiation,  EPA 430-F-06-013, 2006 
[11] J. Wu, “Treatment of Rosacea with herbal ingredients”, Journal of Drugs in Dermatology, 5, pp:29-32, 2006
[12] JF. Fowler Jr., H. Woolery-Lloyd, H. Waldorf, R. Saini, “Innovations in natural ingredients and their use in skin care”, Journal of Drugs in Dermatology, 9, pp: 72-81, 2010