Rosacea is a complicated skin condition that not much is known about. However, as skin care professionals, we are often faced with a client who suffers from it . . . or do they? What is the difference between rosacea and inflammation? Who is at risk of having rosacea? How do we address it in the treatment room? Join Maggie and Ella as they discuss rosacea.
ASCP Esty Talk with Maggie Staszcuk and Ella Cressman
Produced by Associated Skin Care Professionals (ASCP) for licensed estheticians, ASCP Esty Talk is a weekly podcast hosted by Maggie Staszcuk and Ella Cressman. We see your passion, innovation, and hard work and are here to support you by providing a platform for networking, advocacy, camaraderie, and education. We aim to inspire you to ask the right questions, find your motivation, and give you the courage to have the professional skin care career you desire.
About Ella Cressman:
Ella Cressman is a licensed esthetician, certified organic formulator, business owner, and absolute ingredient junkie! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.
She has spent many hours researching ingredients, understanding how and where they are sourced, as well as phytochemistry, histological access, and complementary compounds for intentional skin benefits. In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several skin care lines, including several successful CBD brands.
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About Maggie Staszcuk:
Maggie has been a licensed esthetician since 2006 and holds a bachelor’s degree in business administration from Stephens College. She has worked in the spa and med-spa industry, and served as an esthetics instructor and a director of education for one of the largest schools in Colorado before coming to ASCP as the Advanced Modality Specialist.
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0:00:50.3 S?: You are listening to ASCP Esty Talk, where we share insider tips, industry resources and education for aestheticians at every stage of the journey. Let's talk, 'cause ASCP knows it's all about you.
0:01:06.0 Maggie Staszcuk: Hello and welcome to ASCP Esty Talk. I am your co-host, Ella Cressman, a licensed aesthetician, certified organic skin care formulator and content contributor for Associated Skin Care Professionals.
0:01:18.0 S4: And I am Maggie Staszcuk, licensed aesthetician and cosmetology education manager.
0:01:23.7 MS: So Maggie, something interesting has been presenting itself really for about 18... For about a year and a half, ever since we came back from lockdown. And to me it's one of the most puzzling skin conditions. Do you have any guesses what that might be?
0:01:39.9 S4: I do have a pretty good guess, Ella, because I have my notes in front of me. But tell us. What are we gonna be talking about?
0:01:45.3 MS: Rosacea!
0:01:47.7 S4: It's a good topic. I'm excited to chat about this one.
0:01:49.8 MS: It is one of the most puzzling things for me for a few reasons. One of the reasons is it's really hard to understand where it comes from, right? But the other thing is that a lot of people, a lot of clients say they have it. And so after investigation or during the consultation, whatever you wanna call my full in-depth line of questioning, [chuckle] one thing that I've noticed is, I ask, "Oh you have rosacea? When were you diagnosed?" And a lot of it is a self-diagnosis or Google searching or understanding this is what they think they have. And that lends to another really interesting fact because they may or they may not have it, but did you know that rosacea was one of the most searched words in 2020?
0:02:37.1 S4: That's really interesting. And do you think this is like a COVID pandemic-related thing?
0:02:41.9 MS: I do. I've got to understand... I gotta ask myself, is it because there was a flare-up? Is it because they were at home or on Zoom calls and interested in their skin a little bit more? I'm not exactly sure, but I think in a time when we... I would love to see what else is on that list, really, but I'm sure it had to do with viruses, how to kill viruses, a lot of COVID-related things, but the fact that rosacea was also in there, I think is incredibly interesting. I also having done a few search engine investigative things myself, I realize there's a lot of misconceptions about rosacea, and I thought, you know what? Why don't we play a game called Fact Or Fiction Rosacea?
0:03:25.1 S4: I love games.
0:03:26.2 MS: I know. So let's start with one. You ready? Fact or fiction? Rosacea is a rare disorder.
0:03:33.0 S4: Fiction.
0:03:33.8 MS: It is, yes. Rosacea is actually a very common skin condition that affects an estimated 16 million Americans according to the Academy of Dermatology. And also according to the National Rosacea Society, rosacea typically begins between the ages of 30 and 60, but it doesn't always look the same on everyone.
0:03:56.5 S4: Really interesting.
0:03:57.7 MS: Mm-mmm.
0:04:00.4 S4: Fact or fiction? The types and stages of rosacea are all the same.
0:04:04.4 MS: Hmm... Fiction!
0:04:06.0 S4: Fiction, yes. So let's talk about some of these stages of rosacea. Stage one, pre-rosacea. I've never even heard of this before. What is pre-rosacea? This is when people are blushing easily and often, or experience frequent facial flushing, they maybe are vulnerable to rosacea, and this begins with a lot of different triggers that comes and goes over time. It can look a lot like a sunburn maybe, or erythema, a lot of you aestheticians know that word, and it appears as a consequence of excess blood flowing rapidly through blood vessels of the face and it enlarges and widens to cope with the various increased blood flow to the face. And the redness comes and goes, but when it takes hold and stays, it then becomes what?
0:04:51.3 MS: Stage two rosacea.
0:04:54.1 S4: Stage two rosacea. Yeah, this is mild rosacea, and this is probably what people picture or associate when we say the term rosacea. So the blood vessels that had enlarged to handle increased blood flow remain open. So redness is persistent, it's lasting longer than before, but potentially disappearing for an intermittent period, and the skin on the face becomes sensitive to applying topicals. Can be uncomfortable. You have that burning sensation. And then of course, we have stage three. This is moderate rosacea, and at this point of progression, the rosacea has persisted without disappearing for days or weeks.
0:05:31.0 S4: It has worsened. It becomes noticeable. It's permanent. There's structural damage of the blood vessels in the face, and most severely damaged blood vessels become chronically inflamed and they're showing up as telangiectasias. People may suffer from pimples or red bumps, pustules, they begin to appear. And then we move to our severe stage, stage four. This is intense flushing, swelling, burning sensation, facial pain, clusters of papules and pustules. Facial skin is deep red. There is damage to blood vessels and 50% of sufferers develop eye problems. Can you imagine rosacea in the eye?
0:06:07.6 MS: It's horrible. And I think the best way to think about rosacea and the stages, so there's stages and types. And the stages of rosacea is kind of like a balloon that gets blown up. You blow up a balloon and then you let all the air out and then what's happened to that balloon? It's a little bit wider or a little bit looser.
0:06:25.0 S4: Stretched.
0:06:25.4 MS: Stretched out. And the same thing happens. You blow it up again, it's more stretched out. This is the same thing that's happening to the blood vessels. Rosacea's actually a vascular condition. It's not a skin condition, it just shows up in the skin, and so each time you're having a flare up, the blood vessels are larger and larger and that's why there's more and more redness. So the stages of rosacea is equitable to the types of rosacea. So there's four different types of rosacea and each type can go through these four stages. Should we go over the types of them?
0:06:57.0 S4: Let's do it.
0:06:57.2 MS: Okay. You want me to take the first one?
0:07:00.2 S4: Do it. Yeah.
0:07:00.2 MS: The first one is a tongue twister to say. It's erythematotelangiectatic rosacea, and it's persistent redness on the face. It's small blood vessels beneath the skin and they have become enlarged and visible. The symptoms flare up, but they also disappear. Without treatment of this tongue twisting type, redness can get more and more persistent and spread and become permanent.
0:07:25.5 S4: There's then papulopustular rosacea or white head pustules, puss filled blemishes, red, swollen bumps that can appear with more advanced stage of rosacea, and it typically appears on cheeks, chin, forehead. It's frequently misidentified as acne because it looks like, of course, acne. There's flushing and redness may appear. Severe papulopustular rosacea can cause 40 plus blemishes that take a long time to heal. Can you imagine having that irritation from rosacea plus dealing with acne-type breakouts?
0:08:01.2 MS: Ouch. That's all I can say, ouch. Hot, right? So that's something, how do you wrangle it?
0:08:06.5 S4: Yeah.
0:08:07.8 MS: The next type is phymatous rosacea or phymatous rosacea. This is the one that reminds me of garden gnomes. Have you seen the nose thickens up and they get that cute little... They might not think it's that cute, but that cute little bumpy nose?
0:08:21.9 S4: I love Garden gnomes.
0:08:22.7 MS: And have you ever seen Pimple Popper? Dr. Pimple Popper?
0:08:26.8 S4: Yeah.
0:08:27.2 MS: Yeah, so this one comes up a lot where they end up using a tool that actually electronically blades the skin off, but this is where skin thickens and scars, making it bumpy, swollen, and discolored sometimes, usually like a pink or purple. It's rare but treatable, and most affects the nose, that bulbous garden gnome. And it happens more frequently in men than in women.
0:08:53.9 S4: And then of course, as we said before, ocular rosacea or rosacea of the eye, causing them to look watery, blood shot. A lot of the symptoms that you might see with conjunctivitis or pink eye, so persistent dryness, sensitivity, cysts may form along the eyelids. May be more common than previously thought because of the connection between skin and eyes and can be easily overlooked.
0:09:20.3 MS: Yeah, just like Maggie said, this could be taken for pink eye. Mistaken for pink eye.
0:09:26.2 S4: Hey, guys, stop. Let's take a quick break.
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0:10:06.2 S4: Let's get back to the conversation.
0:10:09.2 MS: Alright, let's talk fact or fiction. Rosacea only affects lighter skin tones and those of European descent.
0:10:17.2 S4: I wanna say fact, but I think it's probably fiction.
0:10:19.6 MS: It is fiction, but it was taught as fact for a long time. It was thought that it could only present itself in Northern Europeans. Specifically, we learned probably together that it was Ireland and Scottish, those of Irish and Scottish descent, right? But really, people with skin of color can get rosacea, it's just that they're missing that stage one diagnostic part of that flushing. Studies show that when people of color develop rosacea, the early signs like flushing can be missed or mistaken for another condition such as an allergic reaction.
0:10:52.5 MS: Signs of rosacea in skin of color include that warm feeling, that rush of blood to the skin as we learned is a vascular disorder. Also dry, swollen skin and patches of darker skin, so that's one indication in the higher Fitzpatrick skin tones that can lead to part of this rosacea diagnosis. Also a dusky brown discoloration of the skin, acne-like breakouts that acne treatment won't clear. Also a yellowish brown, hard bumps around the mouth, eyes or both, and a burning or stinging when you apply skin care products. Swelling and thickening of skin on the nose, cheeks, chin, and forehead can also be an indication.
0:11:32.2 S4: That's really interesting, and I think what's important to point out here is that estheticians who maybe are listening to this are thinking how do I know that my client has rosacea regardless of skin type, but especially those that are skin of color? And I think it's important to say that it's not up to the esthetician to diagnose that, and if they're having that consultation with their client and the client is maybe expressing some of these conditions, that's where the esthetician then says, "It's important that you go and see your dermatologist to have that discussion with the doctor and determine is this rosacea?"
0:12:11.2 MS: Maggie touches on an excellent point here. We as aesthetic professionals often find that I feel like there's a lot that I can help with, and we can definitely help with some of the symptoms here that have been listed out, but as far as the diagnosis, we need to make sure that that comes from a medical professional that we see within our scope of practice.
0:12:34.2 S4: 100%.
0:12:35.0 MS: Right.
0:12:37.2 S4: Yeah. So fact or fiction. Currently, there is a cure for rosacea.
0:12:41.3 MS: Fiction. Can you believe it? There is no cure, but even more than that, the cause of rosacea is really unknown. And for that, we can look at... As aesthetic professionals and even some medical professionals, they can look at rosacea and they can look at inflammation, or even our clients, and one will assume I have rosacea even though it's inflammation, or vice versa, I have inflammation, but it may be rosacea. So let's talk about that. Rosacea and inflammation are the same thing, fact or fiction?
0:13:12.9 S4: Fiction.
0:13:13.6 MS: Fiction.
0:13:14.3 S4: Yeah, there is a difference between rosacea and inflammation, and for that matter, there's a difference between rosacea and erythema, I think we should point that out as well. But rosacea is chronic, inflammation is acute. And Ella, explain to us what's the difference between chronic and acute.
0:13:34.1 MS: So chronic is going to be long-lasting, acute is just for a little bit, or a point of time.
0:13:40.3 S4: Yeah, exactly.
0:13:41.0 MS: So we're looking at chronic rosacea, this is more than a day, more than a week, this is long-term. Or inflammation is acute. Now, inflammation can turn into other things, but inflammation is for a shorter period of time.
0:13:52.9 S4: Yeah, exactly, so inflammation and rosacea, they present very similarly for both the patient or the client and the practitioner, and the goal is the same in both circumstances and often addressed with the same approach. So rosacea is easily triggered, but most triggers are internal and not topical, except for things like weather, for instance. So you wanna address those acute skin symptoms, manage chronic ongoing conditions and rebuild or fortify the skin's barrier. And I think that's really important because whether it's inflammation or it is rosacea, oftentimes, there are issues with that barrier function. And then of course, balance sebaceous activity, calm and sooth skin redness without using steroids that thin the skin, and exfoliating without using over-active chemicals and peptides and enzymes, are often preferred.
0:14:43.1 MS: Yep. You know what I think is also another interesting thing, is that we associate... I say we, I'm gonna say clients, practitioners, we associate or have associated topically applied products with rosacea flare ups, 'cause that's... It's probably because that's the street we're driving down, right? But fact or fiction, the biggest contributor to a rosacea flare up is topical skincare?
0:15:08.1 S4: Fiction.
0:15:09.4 MS: It sure is. You know what's interesting, is in a 2016 study that surveyed over 2600 patients who were diagnosed with different types, different stages of rosacea, they were asked to log what induced a flare up, guess what was top of the list?
0:15:24.5 S4: I have no idea.
0:15:25.7 MS: Food and drink.
0:15:28.2 S4: That's really interesting.
0:15:29.3 MS: Yeah.
0:15:31.4 S4: So it's internal?
0:15:31.5 MS: It's internal.
0:15:31.6 S4: It's a gut health issue.
0:15:33.9 MS: Could be. Very well could be. Of course, they don't know yet, but they're leaning that way. So alcohol, spicy foods, hot drinks, hot foods. And if you think about it, like I have a glass of red wine, I get a little flush, I get a little blushy. I love spicy food, but the same thing. And it somehow must induce a response, but with that stretched out balloon is wreaking havoc. Guess what came next?
0:16:00.0 S4: I don't know. How about exerting yourself?
0:16:01.2 MS: Yes, [laughter] exactly, activities. Exercise or heavy exertion, and that definition may vary from each person [laughter] of what heavy exert... I had to tie my shoes today, [laughter] that was a little... They're far down there.
0:16:15.2 S4: I mean, that flight of stairs, it was tough. Yeah.
0:16:18.3 MS: Oh, I know, right? But hot baths or hot saunas also have that similar response. So heavy exercise or heavy kind of exertion, lifting up a boulder in your front yard, I don't know. Next, this is... Number three on the list was weather, extreme changes in weather, from hot to cold, humid to dry, from windy to sunlight, these can all initiate a rosacea flare up.
0:16:42.0 S4: And that makes sense to me. I mean, if you think about being out hiking or on the ski slopes or something like that, the sun burns you, the wind whips you, and that affects rosacea. But is this also indicating that just walking to get your mail could potentially cause a rosacea flare up?
0:17:03.1 MS: I guess it would depend on how far away your mailbox would be.
0:17:06.3 S4: Yeah.
0:17:06.7 MS: And how fast you're walking.
0:17:08.8 S4: If you're exerting yourself to get that mail, you could cause a rosacea flare up.
0:17:12.7 MS: Yeah, especially if it's windy.
0:17:15.0 S4: Okay.
0:17:16.4 MS: So let's talk about another interesting effect or flare-up was emotions. You think of stress and anxiety, like the cartoons when we were growing up, you'd see the guy turn red and his eyes start to pop out or a sudden change in emotion like being so embarrassed that you blush... So again, here's that vascular activity in the cheeks and the nose primarily that causes that stretching or that pulling of those stretched out capillaries. Other medical conditions were menopause, a chronic cough, and caffeine withdrawal, and then at the very, very bottom of the list, lumped in 8%-12% were other triggers, and in other triggers were medications such as topical steroids, some blood pressure drugs, some opiate pain killers and skincare products.
0:18:05.5 S4: Interesting, that's at the very bottom of the list.
0:18:08.4 MS: Lumped in with these other things at the very bottom of the list.
0:18:11.6 S4: Alright, fact or fiction, estheticians can diagnose and treat rosacea.
0:18:17.9 MS: Girl, fiction.
0:18:18.8 S4: Yes, fiction.
0:18:20.0 MS: Absolutely not. We can only address the symptoms just as Maggie was saying before.
0:18:25.2 S4: Yeah, exactly.
0:18:26.6 MS: And so we're addressing those symptoms the same way we would do inflammation. Would you agree?
0:18:31.5 S4: Yes.
0:18:31.6 MS: And so that means avoiding things that are going to cause heat in the skin. Chemical peels would be a challenge finding the right one, that's why enzymes would be preferred. But also steam, I would avoid steam on an inflamed client... Well, I avoid steam altogether, but...
0:18:46.0 S4: Yeah, I agree, because that's going to distend those capillaries and you already have that inflammation.
0:18:49.3 MS: Yeah, and the extractions, not to go too crazy on the extractions, but also with what is in our scope of practice, even though we learned that it's... Topical application is a small contributor to rosacea flare up, we know that topical products with good ingredients can strengthen. So we're looking at anti-inflammatories to limit inflammation, we're looking at antioxidants to strengthen, as Maggie mentioned, the skin barrier, and of course, SPF for those environmental triggers. So let's talk fact or fiction, intense exfoliation and aggressive treatment protocols are great for those with rosacea?
0:19:29.6 S4: Fiction.
0:19:29.7 MS: Fiction. Sensitive treatments, hydrating facials, avoiding steam. Now, listeners, we still wanna hear from you too. What is your experience with rosacea? What is your favorite protocol? What are your favorite products? Let us know, reach out and comment on our social media posts on Instagram and Facebook or by emailing firstname.lastname@example.org. We want to know all the details. In the meantime, thank you for listening to ASCP Esty Talk. For more information on this episode or for ways to connect with Maggie or myself, or to learn more about ASCP, check out the show notes and stay tuned for the next episode of ASCP Esty Talk.
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