160: How To Care For Rosacea Skin To Avoid More Redness w/ Rachael Pontillo

Are you looking for more natural and alternative ways to calm skin affected by rosacea? Today, we'll be talking about the dos and don'ts when it comes to rosacea care: skincare, diet, and more!

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My guest today is Rachael Pontillo, a holistic skincare innovator, author, and educator. Rachael is the bestselling author of the book Love Your Skin, Love Yourself, and co-author of The Sauce Code. She’s a functional nutrition practitioner, AADP and IAHC Board Certified International Health Coach, licensed aesthetician, and natural skincare formulator and educator.

She’s the president and co-founder of the Nutritional Aesthetics™ Alliance, the creator of the popular skincare and healthy lifestyle blog, Holistically Haute™, as well as the much-loved online course, Create Your Skincare. She’s an avid herbalist, skincare ingredient aficionado, and lifelong learner.

Rachael is also my good friend.

Join us as we discuss how to care for rosacea to help avoid more redness.

Have you managed to control your rosacea redness? Let me know in the comments!

In this episode:

  • What does rosacea look and feel like?
  • Causes of rosacea
  • Does rosacea occur in darker skin tones?
  • How to support rosacea skin naturally
  • Face washes you MUST AVOID if you have rosacea
  • What is gua sha and is it safe for people with rosacea?


“There is a type of acne called acne rosacea where they get pustular acne or papular acne.” [2:24]

“I recommend keeping things simple. I do like herbs that have gentle cooling properties, like Aloe vera, marshmallow root is really nice. Calendula is lovely for most people. It is pretty well-tolerated. It's used in a lot of baby products, children's products, you'll even see it in eczema and sensitive skin products.” [15:59]


Find Rachael online

Nutritional Aesthetics

Interested in trying Rachael's online classes to create your own skincare? Click HERE!

Healthy Skin Show episode 024: Most Harmful Ingredients Hiding In Skin Care w/ Rachael Pontillo

Healthy Skin Show episode 114: Why Preservatives In Skincare Can Be A Good Thing w/ Rachael Pontillo

Healthy Skin Show ep. 145: The Problem With Sensitive Skincare Products No One Talks About w/ Rachael Pontillo

Healthy Skin Show ep. 136: Alternative Solutions For Rosacea w/ Dr. Peter Lio

Follow Rachael on Facebook | Twitter | YouTube | Instagram

160: How To Care For Rosacea Skin To Avoid More Redness w/ Rachael Pontillo FULL TRANSCRIPT

Jennifer: Thanks Rachael, for being back on the show. I really appreciate it.

Rachael: Always happy to be here. Thanks for having me.

Jennifer: So today we are going to talk about rosacea. It's one of those topics that has not been discussed a ton here in The Healthy Skin Show, and I'm working really hard to change that. And as I have done a lot of Googling online to see what the options are for women, as far as caring for their skin, I came to the conclusion … When I was dealing with eczema, I was like, “Wow, this stuff is really harsh.” It would burn my skin, a lot of the products just felt really uncomfortable. And in looking at the rosacea products and suggestions for skincare, I was like, “Oh, these don't sound very soothing. That sounds pretty harsh to me.”

Jennifer: So I thought you'd be the best person to talk to because of your background and your experience dealing with, especially, troubled skin and knowing so much about ingredients and how to … I mean, geez, you even transformed my own skin issues, which we talked about in a previous podcast. So for somebody with rosacea, let's start out with number one, what does it feel with, number one, what does it feel like? And what is your advice as you start to feel or see rosacea come on?

Rachael: Okay. So for those who are not totally familiar, rosacea is an inflammatory condition associated with the skin. It typically starts in the area which is the cheeks, across the nose, and that is the most common place. Some people do get flare ups on the neck or on the decolletage area, like what it looks like when you drink red wine, if you're sensitive to sulfites and you turn red there. Some people do actually flush in that area of the face, and actually, wine can be a trigger for people with rosacea. So that association, if you are someone who flushes from red wine or white wine, that might be something to pay attention to and see how long that lasts.

Rachael: But there are other … It's not just redness. Some people in advanced stages can get an issue where they get almost granular looking cysts or acne. There is a type of acne called acne rosacea where they get pustular acne or papular acne. The papular, it doesn't come to a head; the pustular, it does, where you have those big old white heads in that red inflamed area. Not everybody gets that. Some people just get a mild flushing where it looks like they have just had too much red wine, or maybe they've just been out in the sun for too long.

Rachael: But other people will get the acne rosacea. Other people in later stages will get something … One of the later stages, they get something called rhinophyma where the tissue in the skin, actually, it almost forms calluses, it gets really thick and starts to have a bulbous appearance, and it actually, physically changes the appearance of the nose and that tissue stays thickened. So that is something that what my advice is, is don't let it get to that point. It's not going to show up like that immediately. You're not going to wake up one day and have a different shaped nose and big old bumps on your cheeks.

Rachael: It will start mildly with that flushing, and then if that flushing persists and you don't take away the trigger, then what can happen is … The flushing happens because the blood vessels dilate because something has told the receptors in the skin that, “Hey, we're under attack. We need nutrition right now. We need that wound healing process to happen.” So the blood vessels distend, they flood the area with nutrients from the blood to help with that wound healing process. And then they stay open because that signal has not been shut off essentially, the trigger is either still there. But if that trigger, if it's consistent enough, the trigger stays there. Even when it goes, the signal has just stayed, where it's a glitch now, where it's constantly, the skin is sending the signal, “I need nutrients. I need nutrients. I need help healing. I need help healing. I need those red blood cells.”

Rachael: So that's where if the blood vessels stay distended too long, the vessels themselves stay permanently distended. The medical term for that is telangiectasia, And then in the aesthetics world, we call that couperose veins. But really, the capillaries themselves, the blood vessels are not necessarily broken, but they're distended and they stay distended, and they can come to the surface. Because many people with rosacea also do have issues with a compromised epidermis, not just in the barrier function, but the epidermal layers also sometimes tend to get thinner, so those blood vessels really come to the surface and they're visible and they're really-

Jennifer: Prominent, it sounds like.

Rachael: … prominent and they're susceptible to just further irritation.

Rachael: So if you are starting to notice blood vessels, visible blood vessels in the corners of the nose, across the cheeks, the apples of the cheeks, and it's not from something that is a specific cause … So an example of that, if you're someone who uses really harsh exfoliants, like those apricots scrubs, or you get a lot of microdermabrasion, or you've had a lot of chemical exposure creation treatments like glycolic acid, or a TCA peel, or even something like a lactic acid peel or something like that, even in a spa, it doesn't even have to be a dermatological treatment, it could be a spa treatment, or you use a cleanser that has alpha-hydroxy acids, and then you use a serum with alpha-hydroxy acids, and then you use a moisturizer with alpha-hydroxy acids, and you're just using, your either over-exfoliating with those acids and enzymes, or you're using too much friction with a scrub.

Rachael: Or if you have a clay mask and you're harshly removing it when it dries and you stretch your face to make it crack because it looks cool, that's actually really not great for your skin. It can be overly irritant. So physical trauma to the skin can cause those blood vessels to distend because that is the signal that, “Hey, I need some help healing here. I'm being traumatized over and over again.” That's one thing. But then on the inside, just like with eczema, psoriasis, there's a huge gut link to rosacea. People who have candida overgrowth or other types of dysbiosis are really, that is certainly something that can be associated with rosacea.

Rachael: Also, I want to point out, rosacea is a condition that in East Asian medicine, as well as Ayurvedic medicine is associated with heat, so it feels hot. When you have rosacea on your face, and I have to say, I had a rosacea flare up for the first time last year when I first got diagnosed with Lyme disease. I didn't know why my skincare products that I make for myself with all natural ingredients that hadn't been bothering, all of a sudden, my face was just feeling like it was literally on fire. I had redness in my cheeks, the skin felt dry and tight and it felt like it was on fire. Only on my cheeks, nowhere else.

Rachael: I looked closer and I could see some tiny blood vessels. I'm like, “Oh my gosh, what the heck?” I am of the age where women do sometimes start to get rosacea. It does happen typically around the perimenopause time. Some people get it earlier, after their pregnancies. It is a condition that we are starting to see in younger women who have not had hormonal events like pregnancy or anything like that, just because of the toxic world we live in and the poor quality of our food supply.

Jennifer: Rachael, I wanted to add to this, one really interesting thing that I came across is that when I was reading a lot of studies, they were saying, “Oh, in fair-skinned individuals,” but then I found other data saying that there's probably a lot higher incidents in people of color. And unfortunately-

Rachael: They just can't see it.

Jennifer: Correct. They can't see it, and so it's, a lot of times, underdiagnosed. So I think it's an important point to make, to anybody listening to this, that this does not just impact fair-skinned individuals, as you will most commonly read in a lot of research and just articles written on pretty well known websites. That's how it's described and that's not accurate.

Rachael: No, that's a really good point to bring up because really you're correct, it's fair-skinned people, and I'm talking … In aesthetics, we have a scale called the Fitzpatrick scale from 1 to 6, where 1 is the lightest, 6 is the darkest. The purpose of that scale is to determine what skin type in the Fitzpatrick skin types is going to be most susceptible to sun damage. How does each type tan? Does it tan and then burn? Does it only tan? Is it dark that it gets dark to the point where it's almost black or even bluish? How does the skin respond to the sun? Those are ways that we can predict certain types of skin aging and stuff like that.

Rachael: So they typically say that a Fitzpatrick 1 or 2 is going to be most susceptible to rosacea, but that's not true because a Fitzpatrick 1 or 2 could be from anywhere in the world. It's not necessarily somebody who's from Northern Europe or Scandinavia who would have those fairest skin types with, blonde or red hair and blue eyes and freckles. But what you just said, that on those lighter skin tones, those tiny little blood vessels in that red flush might be more visible, is absolutely true.

Rachael: Me, I'm a Fitzpatrick 3-1/2. I have Eastern European, Southern European, Mediterranean genetics for the most part, and my skin has pretty prominent olive undertones. I had to look closely and it really wasn't until I felt that heat and I felt the change of texture. Literally, the skin on my forehead and my jaw felt completely different from the skin on my cheeks. It was almost like … I had my regular, oilier skin everywhere else, and then it was almost like sandpaper on my cheeks. I looked and I said, “Oh my goodness, that's what this is.”

Jennifer: So for somebody who is like, “Oh my gosh, I have rosacea. I was just diagnosed with rosacea. The dermatologist wants me to use this. I have gone to a rosacea website and it said these are the best products for your skin,” and maybe you're also of the mindset that you might want better quality products than just growing to the pharmacy and picking up something that they suggest.

Jennifer: Because you and I also know that a lot of skincare products are loaded and packed full of ingredients, as we've discussed before on the show-

Rachael: Right. We have.

Jennifer: …with things that manage, maintain, bandaid, because they … Even my Google Alerts, for those of you who don't know what that is, it's like Google me an alert every single day about rosacea, and 99.5% of those alerts are about drugs for rosacea. It's almost never about solutions. There's very little research considering how many people in the world, let alone the US, have this condition.

Jennifer: So what could someone do, from a more natural perspective, to address and support this type of skin condition?

Rachael: Absolutely. So the drugs that are out there, the majority of them are some type of anti-inflammatory, usually a steroid. And for some reason, a lot of dermatologists still prescribe antibiotics for rosacea. Rosacea is not a bacterial infection. It has been associated, if you want to talk microbiome stuff, it has been associated with an overabundance of Demodex mites in some people. So that is a microbial counterpart, but that is not necessarily going to get taken care of by an antibiotic, which is going to affect the biodiversity of the rest of the beings that live in that microbiome. And the steroids are also known notoriously to mess with the microbiome on the skin, as well as in the gut.

Rachael: So really, what we want to do is we do want to continue to think along the lines of anti-inflammatory. There are plenty of-

Jennifer: Not anti-aging. Right?

Rachael: Right. Not anti-aging. Because, well, first of all, we don't like that phrase, but it's what people still Google, so we still say it when we have to. Anti-aging, that is going to have mostly very harsh ingredients like the acids and the enzymes that I mentioned earlier, which can actually bring more heat to the face, more inflammation to the face, and really can make rosacea worse.

Rachael: So anti-inflammatory, what we really want to do is look for ingredients that are meant to soothe, so almost like put a nice comfy blanket on top, but not suffocate it. So I don't like seeing heavy occlusives or heavy emollients in a product for rosacea because even though those epidermal layers can be thinner and it might make sense to add an extra barrier layer to it, the skin still needs to breathe. Now, the skin does not breathe the same way the lungs breathe. However, the skin does respirate, respiration is one of its functions, and it also needs to have its own detox pathways clear.

Rachael: So we need the skin to be able to function the way it's supposed to function. So while it's important to moisturize the area, we do not want anything too heavy. So I would recommend either a cream or lotion which is an emulsion, that is a mix of oil-based and water-based ingredients held together by something called an emulsifier, and it does have to have a preservative in it. I would look for one that is plant-based, and while it might have some synthetic ingredients in it, I would look for the product to have very few ingredients.

Rachael: There are a lot of herbs that are anti-inflammatory in nature. They might have cooling properties, they might have soothing properties. That's all fine and good. But if the product has too many of them in it, that can overstimulate, over, I'm sorry, that can overstimulate already compromised skin. So I really recommend looking for products that are super simple. And if you can't find one that is, because even a lot of the natural product finds out there, you'll look at the label and there might be 40 different herbs on there. Even people with uncompromised skin can react to that because there's just too much going on.

Rachael: A lot of times, I will tell you, it's just not necessary because so many of those plants do the same thing. So it's almost like the ingredients start to compete with each other and it's just not necessary. So I recommend keeping things simple. I do like herbs that have gentle cooling properties, like Aloe vera, marshmallow root is really nice. Calendula is lovely for most people. It is pretty well-tolerated. It's used in a lot of baby products, children's products, you'll even see it in eczema and sensitive skin products.

Rachael: Calendula is lovely because it actually helps to stimulate fibroblasts, which are the cells that produce collagen and elastin, which are not in the epidermis, those are produced in the dermis, which is the layer where the blood vessels are, but it helps to add to that plumpness and that overall function of the skin's structure. So it's a really nice ingredient, and calendula is also one of the herbs that actually heals from the outside in. So if the problem is on the outside, it can help on the outside. And then from the inside, you want to be working with somebody who can help you with functional testing and getting your gut in check, getting everything balanced.

Rachael: And also, I will say that there are some liver associations with rosacea as well, so you want to make sure that … If you have rosacea, I will say this, I know I mentioned red wine before, if there is a liver component, drinking alcohol really might not be the best choice. Not just because … I mean, not because it's causing the flush, but if it's overloading the liver, which is already overloaded, if it's having that reaction, it just might not be a great choice.

Jennifer: Yeah. And as far as washing the face, because I learned from you that there are all different types of face wash, and now I'm using a bar of soap, which never in my life did I ever think I was going to use a bar of soap, but it's the best choice for me, given my particular skin issues.

Rachael: Right.

Jennifer: So for rosacea, what would be some good guidelines to look for, as far as washing the face?

Rachael: Okay. Something that does not have any exfoliant in it at all. So no enzymes, no alpha-hydroxy acids, no granules. So that even includes honey pearls or jojoba beads, none of that, and definitely nothing like an apricot scrub. Do not bring that anywhere near rosacea skin, please. I also recommend tepid water, not too hot. Because if it's too hot, then you're going to be adding more heat to an already heated situation, which will perpetuate the inflammation and keep those blood vessels distended. So I recommend … But you don't want cold either, we don't want to shock the system. So a nice lukewarm, tepid water temperature is really great.

Rachael: I also want to say, reduce friction to the skin as much as possible. So when you're applying your cleanser, don't scrub it in, don't rub it in real hard, just really gently pat it in, instead of using a rubbing motion. Because adding friction also adds heat, again, to an already heated situation.

Rachael: I really like aloe-based cleansers. You can also use a honey-based cleanser, even just regular old raw honey, for some people can work. Just make sure that when you apply it, you're not letting it get too sticky because that can inadvertently add friction as you try to remove it. You can just take some of the raw honey, add some of the tepid water and mix it in your palms, and then just pat it in. To remove makeup, you can use something like a hemp seed oil or a jojoba oil, and then just use honey to clean off the rest, rinse it with the tepid water. And then again, just pat it dry with a really soft cloth, no harsh towels. Don't rub it dry or anything like that.

Rachael: Toners, I do like something that has naturally astringent ingredients. So even though the blood vessels are open because they're trying to deliver nutrients, there are plants, plenty of plants that have naturally astringent properties, and by astringent, I don't mean sea breeze or anything harsh, I mean, it will gently help to contract or constrict those vessels. Not in a way that it shuts down their function, it just encourages them to calm down a little bit. So rose hydrosol is a really good ingredient to look for in those toners. Witch-hazel, as long as it's one that does not contain too much alcohol.

Rachael: Alcohol in the form of ethyl alcohol or ethanol, that's what you would see in skincare. I'm not talking sugar alcohols or fatty alcohols. I'm talking straight up alcohol like you would see on a label of witch-hazel. Try to find one that either doesn't have alcohol or that has a very low percentage of alcohol, like 10% or less. And even just mixing rose hydrosol with the witch-hazel or even rose geranium is really good for people with reddish skin. It helps to hydrate, but naturally encourage those vessels to constrict without over-drying the skin. So it's adding that cooling and soothing property, as well as the gentle constriction. Aloe also can help with that. It does have gentle astringent properties. Cucumber is another herb that is wonderful because it's both cooling and astringent. So those are some things to look for in your products.

Rachael: I don't want people with rosacea using a cotton pad with a toner, where they're rubbing the skin, because again, friction. I recommend a spray. So if you don't have a spray, what you could do instead, is just pour a small amount of the toner on the palm of your hands, pat it together like a man would with aftershave, and then just gently press it in to the face. No friction at all.

Rachael: If you're going for a facial, the estheticians should know not to use hot towels or steam, but you would be shocked at how many still do that. So absolutely request no steam, no hot towels. And instead of a traditional facial massage that's like European style, ask for acupressure, which does not include friction. Instead, it just applies pressure to very specific points, so it's preferred for people with rosacea over a traditional facial massage.

Jennifer: And what about gua sha for someone with rosacea? Would that be okay to do? Because I mean, I know when I did it, I really felt like I was not hard pulling, but you're applying some pressure.

Rachael: Sure. Great question because that's a huge trend these days, and I love it. I recommend gua sha in areas that are not affected by the rosacea. So you can absolutely still do it around the clavicle bones, on the neck, on the jaw line, in the temples and below that cheek area. But just do not do it on any area that you see distended blood vessels, you feel that excess heat or you notice visible redness.

Jennifer: That's a good point to be made. It just came to me, as you've been talking about creating friction and pushing into the face, and I'm like, “What about gua sha?”

Rachael: I know. It was a great question.

Jennifer: Everybody talks about that, and you talk about it a lot. I know you have some great … By the way, if you guys want to learn how to do gua sha, Rachael has an excellent tutorial on Instagram.

Rachael: Yeah.

Jennifer: I'm such a nerd. I sit there and follow her tutorial to do gua sha when I do it because I can't-

Rachael: Great.

Jennifer: I don't do it often enough to remember, but it's a really great tutorial in her highlights. So it's nice to have someone like Rachael, who has so much experience with this kind of stuff. I just feel like sharing this type of information can really help people because yes, there is that internal component.

Jennifer: I think it's also worth mentioning that rosacea can impact your eyes. It can cause a reddening of the conjunctiva, which is the white part of your eye. And for those of you who might not have started this podcast in the beginning, we do have Dr. Weinstock talking about rosacea, ocular rosacea, and facial rosacea, and looking at it from the SIBO perspective because there is a potential SIBO connection here. So that may be another area of interest you want to dig into.

Jennifer: But I love that you brought up the liver, we've talked about the different products. I am one, because of my experience with sensitive skin, I'm putting that in air quotes, everybody, I made a lot of mistakes and now I'm a lot more careful, especially with my face because you only have one face to put forward. And a lot of us who end up with rashes or some type of issue on our face, it really can impact your confidence. So the way that we care for our skin, I have learned the hard way, and the products that you buy, really do matter because you can't go backwards in time.

Rachael: That's true.

Jennifer: Can't undo it.

Rachael: [crosstalk 00:25:16] people might want to. Not be attached to the past.

Jennifer: No.

Rachael: We have to look into the future.

Jennifer: Exactly, exactly. So I want to make sure that everybody knows how they can find you, Rachael. You're over at rachaelpontillo.com.

Rachael: Correct, yeah.

Jennifer: And I know that you've got some good freebies for everybody. We'll make sure to link to those in the show notes.

Rachael: Perfect.

Jennifer: Anything else that you want to point anybody toward?

Rachael: Definitely my Instagram. You've inspired me, Jen. I've been doing a lot more with my stories.

Jennifer: I noticed.

Rachael: Yes. And it's because you kill it with your stories. I love your stories. So I have a few different story highlights, but the gua sha tutorial that Jen was referring to is in the DIY facials one, so check that one out. And I also have an herbs for skincare one, where I feature a couple of different herbs and talk about the properties and how they can be used for skincare. And if you don't make your own products, you can just look for these ingredients in products that you buy.

Rachael: And then at rachaelpontillo.com, like Jen said, I've got some stuff for you, but I've also got a blog that has a ton of information that is searchable.

Jennifer: Cool. Cool. We will link up to all of that. Thank you, Rachael, so much for joining us. I really appreciate it.

Rachael: Thank you for having me.

“I recommend keeping things simple. I do like herbs that have gentle cooling properties, like Aloe vera, marshmallow root is really nice. Calendula is lovely for most people. It is pretty well-tolerated. It's used in a lot of baby products, children's products, you'll even see it in eczema and sensitive skin products.”

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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