Integrative Approach to Managing Rosacea

In this blog, we’ll walk through:

✅ The 4 major subtypes of rosacea (plus an emerging fifth)

✅ How to differentiate between them

✅ The root causes and triggers to address

✅ A combined conventional + integrative approach to treatment

🔍  What Exactly is Rosacea?

Rosacea is a chronic inflammatory skin condition affecting the central face — particularly the cheeks, nose, forhead, and chin. It’s influenced by a combination of:

• Genetics
• Immune system dysregulation
• Environmental triggers
• Gut-skin and neurovascular pathways

It typically appears after age 30 and is more common in women, though men can experience more sever forms like rhinophyma.

🔴 The 4 Substypes of Rosacea (Plus 1 Variant)

🌡️Triggers & Root Causes (Beyond the Surface)

While rosacea appears on the face, the root causes often lie deeper, including:

• 🔥 Heat intolerance and temperature dysregulation
• 🧠 Nervous system hypersensitivity (especially with neurogenic types)
• 🦠 Gut dysbiosis, SIBO, or leaky gut
• ⚖️ Hormonal imbalances (especially perimenopause)
• 🍷 Food triggers: Alcohol, spicy foods, hot drinks, histamine-rich foods
• 💊 Skincare ingredients: Retinoids, alcohol-based toners, essential oils

🔬 Testing to Consider (Functional + Medical)

• Stool test (GI360) → to check for dysbiosis, yeast, SIBO
• Micronutrient test →  especially zinc, B vitamins, essential fatty acids and antioxidants
• Food Sensitivity Test (e.g. FIT1 by KBMO Diagnostics) → Identify delayed hypersensitivities — gluten, dairy, eggs, citrus, and histamine-rich foods are common rosacea triggers.
• DUTCH test → if hormonally triggered
• Patch testing →  for suspected contact sensitivity
• Skin swab → to rule out demodex overgrowth or secondary infection

🌿 Integrative & Holistic Strategies

1. Skin Care Routine

Goal: Reduce inflammation, repair the skin barrier, and avoid triggers.

Recommended Products:

• Gentle Cleanser (Non-Foaming, No Actives)
  • e.g., La Roche-Posay Toleraine Hydratiung Cleanser, Avène Antirougeurs Cleanser
  • Avoid foaming cleansers, sulfates, and exfoliants as they can strip the skin.
• Barrier-Repairing Moisturizer (Strengthens and reduces reactivity)
  • Look for ceramides, niacinamide, and peptides.
  • e.g. CeraVe PM, Bioderma Sensibio AR, Avène Tolerance Control, SOS Repair cream by ph Formula
• Anti-Redness Serum or Cream
  • Ingredients to look for:
    • Niacinamide (reduces inflammation)
    • Azelaic Acid (10-15%) (reduces redness and improves skin tone)
    • Ruscus Extract / Vitamin K (helps with visible blood vessels)
  • e.g. Paula’s Choice Azelaic Acid Booster, SkinCeuticals Phyto Corrective gel
• Sunscreen (Essential!)
  • Look for mineral (zinc oxide/titanium dioxide) sunscrees with tinted formulas (iron oxided protect against visible light).
  • e.g. EltaMD UV Clear (Niacinamide + Zinc), La Roche-Posa y Anthelios Mineral SPF, Cellular SPF 30+50 by The Organic Pharmacy

🚫 Avoid these ingredients:

• Alcohol-based toners
• Fragrances
• Essential oils (like tea tree, eucalyptus)
• Retinoids (unless prescribed & tolerated)
• Chemical exfoliants (AHAs, BHAs)
• Harsh physical scrubs

🌿 Botanicals:

Topical Botanicals:

• Green Tea Extract (EGCG) – anti-inflammatory, reduces redness
• Licorice Root (Licochalcone A) – brightens and calms reactive skin
• Feverfew or Chamomile Extract – anti-inflammatory, gentle vasoconstrictors
• Centella Asiatica (CICA) – supports wound healing and skin strength

Barrier-Supportive Base:

• Look for creams with shea butter, ceramides, and squalane
• Avoid known irritants (menthol, eucalyptus, fragrance, high alcohol content)

2. Prescription & Medical Treatments

If skincare alone isn’t enough, medical treatments can help.

🔹 Topical Treatments

1. Brimonidine (Mirvaso) or Oxymetazoline (Rhofade)
   – Helps temporarily reduce redness by constricting blood vessels.
   – Works within 12 hours, but effects are temporary.
2. Azelaic Acid (Finacea 15%)– Helps reduce inflammation and redness over time.
   – Best for sensitive skin.
3. Ivermectin (Soolantra)
   – Addresses inflammation & Demodex mites, which can worsen rosacea.
   – More effective if there’s papulopustular rosacea overlap.
4. Metronidazole (Rozex, Metrogel)
   – Mild anti-inflammatory but less effective than azelaic acid or ivermectin.

🔹 Oral Medications

For moderate to severe cases, systemic treatments may be needed.

1. Low-Dose Doxycycline (Oracea 40 mg)
   – Anti-inflammatory (not antibiotic strength).
   – Reduces persistent redness and flare-ups.
   
2. Beta-blockers (Propranolol, Carvedilol)
   – Used off-label to reduce flushing episodes.

3. Laser & Light Treatments

For visible blood vessels (telangiectasia)or persistent redness, laser therapy is the gold standard. Wait until barrier is robust and inflammatiion is down. Consider 4-6 weeks of internal + topical treatment before IPL or PDL. Start with patch testing on cheek or lower jaw.

🔹 Best Laser Treatments for Vascular Rosacea:

1. Pulsed Dye Laser (PDL) – e.g., Vbeam
   – Targets redness & broken capillaries.
   – May require 3-5 sessions.
2. Intense Pulsed Light (IPL)
   – Helps reduce generalized redness.
   – Not as targeted as PDL, but good for diffuse redness.
3. Nd:YAG Laser
   – Best for deeper blood vessels that other lasers can’t reach.

4. Nutrition & Nutraceutical Focus

• Low-histamine, anti-inflammatory diet (Mediterranean style)
• Probiotics (gut health can impact rosacare)
• Avoid hot/spicy foods, alcohol and caffeine
• Add cooling herbs: coriander, fennel, mint, cucumber, aloe vera
• Consider gut repair protocols if dysbiosis is suspected

Key Supplements: Support the immune system, reduce inflammation, and strengthen vasculature.

Optional for Histamine-Sensitive Patients:

• DAO Enzyme before meals
• Vitamin B6 (cofactor for DAO)

5. Lifestyle & Emotional Care

• Identify and reduce stressors
• Breathwork (especially alternate nostril breathing)
• Acupuncture or vagus nerve support   
• Temperature regulation — avoid hot yoga, steam rooms and cold showers/plunges
• Gentle cardio over high-intensity (less facial flushing)
• Yoga or walking in cooler environments.

🎯 Summary: It’s More Than Skin Deep

Rosacea isn’t just a skin issue — it’s a multi-system condition that needs a multi-pronged approach. Identifying your subtype is the first step to creating a plan that works — whether that includes barrier-building skincare, gut healing, laser therapy, or calming the nervous system.

With the right combination of medical and integrative support, rosacea can be managed, soothed, and even put into remission.

If you need extra support for your skin concerns in an integrative approach, get in touch by emailing [email protected]