287: Rosacea Myths (That People Think Are True)

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Like other common skin rash conditions, there are many pervasive myths that you can read online or that people think about rosacea that simply is not true!

My hope is that by talking about these six common myths, you’ll discover that there is more to rosacea than a frustrating diagnosis.

Since April is Rosacea Awareness month, I want to dive into common questions to help you connect some dots that will offer insight into your skin (and health as a whole).

So let’s dive in!

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In this episode:

• Is rosacea the same thing as acne?
• Different types of rosacea + progression to rhinophyma
• Rosacea common skincare triggers
• Is rosacea contagious? (Kind of…)
• Alcohol consumption + risk of rosacea
• Why rosacea ISN’T a skin-only problem
• Does rosacea impact only fair skin tones?

Quotes:

Rosacea is not triggered because your face isn’t clean, but harsh exfoliation; strong, drying ingredients in skincare and makeup as well as excessive use of anti-aging products can trigger rosacea.

Though rosacea as a condition isn’t contagious, a Demodex mite infestation that can cause rosacea IS contagious!

 

287:Rosacea Myths (That People Think Are True)  (FULL TRANSCRIPT)

Welcome back to episode #287 of the Healthy Skin Show!

In today’s episode, I want to talk about some pervasive rosacea myths to help provide some insight into what is and is not a factor driving your rosacea especially since April is Rosacea Awareness month.

Rosacea is a chronic skin condition that impacts approximately 16 million Americans + 415 million people worldwide.(1,2)

And just like many of the other chronic skin conditions that I talk about here on the Healthy Skin Show, there is a lot of misinformation out there that can leave you feeling ashamed + very disempowered about your skin.

My hope is that this episode will provide some direction for you (if you or someone you know is struggling with rosacea) based on helpful resources I have pulled together for you along with what’s already available on the show!

Know that there ARE things you can dig into + try even if your rosacea is now more severe so don’t give up.

The severe cases I’ve worked on have experienced major improvements (even when the nose has become impacted experiencing pretty bad rhinophyma). Many clients have no longer needed to wear concealer anymore to hide the redness + feel much more comfortable in their own skin.

So while there are certainly external factors at play, there are internal imbalances that should be considered.

Let’s dive into some rosacea myth-busting!

 

Myth #1 – Rosacea Is The Same As Acne

Despite the commonly used name Acne Rosacea, rosacea is not acne nor is acne the same thing as rosacea.

They are two very different conditions.

Here’s a great chart from Medical News Today that breaks down the differences:

There are different types of rosacea that include Erythematotelangiectatic rosacea, Papulopustular rosacea, Phymatous rosacea, Granulomatous rosacea, and Ocular rosacea.(4,5)

Rosacea can also vary in severity and, for some individuals, become disfiguring!

One of my clients with severe rosacea would only go out if he was wearing thick makeup because of how embarrassed he was after living with it for 3 decades.

Like others with severe rosacea, his progressed causing changes to the texture of the skin + size of his nose. This progression is known as rhinophyma, which impacts men more so than women.(6)

Though rhinophyma is often assumed to be due to heavy alcohol consumption, research doesn’t support this connection.(6)

 

Myth #2 – You Triggered Rosacea Because You’re Dirty

One of the most common assumptions from people who don’t have a chronic skin condition is that your red, inflamed skin is due to poor hygiene.

To be clear – rosacea is not triggered because your face isn’t clean.

But harsh exfoliation; strong, drying ingredients in skincare and makeup as well as excessive use of anti-aging products can trigger rosacea.

According to Healthy Skin Show guest Rachael Pontillo, rosacea skin requires a simpler, more gentle skincare routine since heat, harsh chemicals and even gentle exfoliation can trigger or worsen rosacea. We discuss strategies for caring for rosacea skin (and how to clean your face) in episode 160.

 

Myth #3 – Rosacea Is Contagious

Without a doubt, rosacea as a condition is NOT contagious.

However, if there is a skin infection helping to drive the rosacea, the infection could be contagious.

One overlooked type of skin infestation with a strong link to rosacea is from Demodex mites (which I’ve talked about in episode 136 with Dr. Peter Lio).(7,11)

Demodex mites can be contagious + pass to others in your home.(8)

More research is emerging on the relationship between Demodex + rosacea including this new study that is still under review at the time of this episode’s release. Researchers compared the Demodex burden in 82 patients with rosacea versus 82 healthy controls without any skin conditions.(9)

They found that the “Demodex burden in patients with rosacea was approximately 30 times higher than in healthy controls” and “caused by coinfection of D. folliculorum and D. brevis”.(9)

So if your dermatologist has not checked your skin for this type of mite (which is a parasite that can impact not only your skin but also the eyelid area), ask them to evaluate your skin for a Demodex infestation.

I mention this because there is also research demonstrating that there can be an inflammatory (or cytokine) component to rosacea!

For example, rosacea skin tends to show higher levels of IL-8, IL-1β, and TNF-α produced by keratinocytes when “TLR-2 is activated by external stimuli or triggering factors”.(8)

I mention this because IL-8, IL-1β, and TNF-α can be increased in response to Demodex mites.(8)

 

Myth #4 – Alcohol Consumption Causes Rosacea

While it’s a common assumption that people with rosacea must drink a lot of alcohol, that’s not always the case.

In my clinic, I’ve not worked with a single rosacea case where alcohol consumption was a factor. The clients who did occasionally have a single serving of alcohol had stopped long ago because they noticed that their skin did seem to get worse with alcohol.

And yet, the rosacea persisted!

Research shows that alcohol consumption may slightly increase the risk of developing rosacea.(10)

If histamine issues are present as an underlying trigger, this would further explain why alcohol (which is very high in histamines) would make your rosacea flare.

I dove into the histamine-rosacea connection in episode 139 if you’re not familiar with this, however I would caution you from assuming that you have a histamine issue just because you have rosacea.

A high histamine diet is not a problem for every case of rosacea so if following a low histamine diet isn’t helping within a couple of weeks, it is safe to assume that histamine may not be a factor for you.

 

Myth #5 – Rosacea Is ONLY A Skin Problem

If there was one thing that I wish more rosacea warriors knew, it would be that rosacea can be a sign of internal imbalances. This connection is often overlooked such that people fixate on topical-only solutions to mask, reduce or cover the redness.

But after working on many cases of rosacea, there are significant internal imbalances that should be considered.

First and foremost is the pretty big connection between Small Intestine Bacterial Overgrowth (SIBO) + Rosacea.

Most research on this relationship indicates that approximately 77% of rosacea cases also have underlying SIBO. And that when the SIBO is addressed, the rosacea may improve or resolve!

If you might recall, Dr. Leonard Weinstock was on the show back in episode 19 discussing his findings and clinical experience as a gastroenterologist working with patients who also had rosacea.

There also may be a connection between rosacea with Helicobacter pylori infection in the stomach, but the research at this point in time appears to be mixed.(7)

In my clinical practice, I’ve also found that a number of rosacea clients had hidden parasitic infections in the GI tract such as Dientamoeba fragilis, Endolimax Nana + Blastocystis Hominis.

Conventional medicine doesn’t always treat these protozoan infections.

But I’ve found that addressing them can be helpful to reduce, if not resolve rosacea symptoms.

 

Myth #6 – Rosacea Only Impacts Light Skin Tones

As I’ve shared previously on the Heatlhy Skin Show, inflammation in the skin doesn’t look the same in every skin tone.

Often darker skin tones will show inflammation in different shades such as purple or even grey.

This problem was highlighted by Dr. Hope Mitchell in episode 168 underscoring how much a more inclusive approach to looking for inflammation in different skin tones is needed to ensure that all people regardless of skin tone are diagnosed appropriately!

So the assumption that rosacea only shows up in lighter, paler skin tones is completely wrong.

More current thinking is also acknowledging that perhaps the notion that rosacea prevalence in darker skin tones may be underestimated due to underdiagnosis.

One recent paper from 2022 states that “In patients with skin of colour, the characteristic manifestations of rosacea, particularly centrofacial erythema, can be masked, impacting the recognition of the diagnosis.”(12)

And the publication continues pointing out the importance of having a knowledgeable  dermatologist look for other signs that rosacea is present such as “xerosis or scale, edema, facial acneiform papules and pustules, and hyperpigmentation.”(12)

As one final point that I do want to make – rosacea impacts many more people than is often thought… and yes, rosacea impacts both women and men!

I hope that you’ve found this episode insightful and that you can see that rosacea is so much more than just a potentially progressive condition.

That it could also be a sign of other issues – both topical + internal that may be helping to drive the inflammatory process that you experience as the cluster of symptoms known as rosacea.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

Thank you so much for tuning in and I look forward to digging deeper with you in the next episode!

 

REFERENCES

1. https://www.aad.org/media/stats-numbers
2. https://www.rosacea.org/blog/2018/april/415-million-people-affected-by-rosacea-worldwide
3. https://www.medicalnewstoday.com/articles/rosacea-vs-acne#comparison-table
4. https://nyulangone.org/conditions/rosacea/types
5. https://rarediseases.org/gard-rare-disease/granulomatous-rosacea/
6. https://www.medicalnewstoday.com/articles/322166
7. https://www.mdpi.com/1422-0067/17/9/1562
8. https://my.clevelandclinic.org/health/diseases/22775-demodex-face-mites
9. https://www.researchsquare.com/article/rs-2628308/v1
10. https://www.aad.org/public/diseases/rosacea/insider/drinking
11. https://link.springer.com/article/10.1007/s13555-020-00458-9
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165629/