Rosacea treatment: facial redness, triggers and IPL

Triggers that matter on the Costa del Sol

Ultraviolet light is involved in almost every aspect of rosacea: inflammation, new vessels, visible vessels and thickening of the skin ^[4]. Air pollution, smoking and stress can also worsen it ^[4]. On the coast, the sun is strong well beyond the summer months.

Food and drink matter too. The most often reported triggers are alcohol, spicy food, hot drinks and foods rich in histamine, such as aged cheese, wine and processed meats ^[3]. Alcohol worsens flushing in particular. Many people also notice that heat in general, from a hot terrace to a sauna, has the same effect.

Triggers vary from person to person, and there is no diet that suits everyone with rosacea ^[3]. A simple diary over a few weeks usually shows your own pattern better than any list.

Skin care basics

Daily sunscreen, a moisturiser and a mild cleanser are a core part of keeping rosacea under control, together with avoiding your triggers ^[2]. In practice:

• Use a broad-spectrum sunscreen every day, all year. A tinted one can also soften visible redness ^[4].
• Wash with lukewarm water and a gentle, non-foaming cleanser. Pat dry.
• Choose simple products without fragrance, alcohol or menthol.
• Avoid scrubs, strong acids and anything that stings.
• Add a hat and shade on bright days.

Medical treatment comes first for bumps and inflammation

When there are bumps, pustules or active inflammation, the first step is medical treatment. A doctor may prescribe creams or gels, sometimes an oral treatment, depending on your features. For bumps and pustules, several of these treatments are backed by high-certainty evidence ^[5].

The aim is not only improvement. The consensus recommends aiming for skin as clear as possible, with regular follow-up ^[1]. When the skin is thickened or the eyes are involved, referral to a dermatologist or an ophthalmologist is recommended ^[2].

IPL and vascular lasers for redness and visible vessels

Intense pulsed light (IPL) and vascular lasers, such as the pulsed-dye laser, target the red pigment in blood vessels. The light heats the small dilated vessels until they close, while the surrounding skin is spared.

In a large review of rosacea treatments, laser and IPL reduced persistent redness and, above all, visible vessels, with low-to-moderate certainty evidence ^[5]. In a meta-analysis of 141 people, IPL and pulsed-dye laser reduced redness to a similar degree. IPL was a little more uncomfortable, while slightly more people reached a high level of clearance with it ^[6].

How many sessions you need

Treatment is a course of several sessions, a few weeks apart. In a randomised trial, patients had three IPL sessions four weeks apart after their inflammation had been treated. Two in three achieved at least 90% clearance of visible vessels, and the effect was followed for two years ^[7].

Rosacea is a long-term condition, so redness and vessels can return with time and sun. Many people keep their result with an occasional maintenance session. You can read more about how light works on the skin in our guide to IPL for sun spots and pigmentation.

What light treatment does not do

IPL and lasers act on vessels and redness. They are not the treatment for bumps and pustules, which need medical treatment first. Treating active inflammation with light alone tends to disappoint.

Nor do they cure rosacea, prevent flares on their own or replace sunscreen. Thickened skin and eye symptoms need their own specialist care.

Risks, and who it is not for

After IPL, temporary redness and mild swelling are common. In the randomised trial above, these effects settled within a week, and darker patches of pigment appeared in 1.9% and faded within three months ^[7]. Blisters, small crusts or pigment changes are less common, and are more likely on tanned or darker skin.

IPL is not suitable on recently tanned skin, during pregnancy, with active infection or inflammation in the area, or with some medicines that make the skin sensitive to light. Tell the doctor about everything you take, including supplements.

When to see a dermatologist or an ophthalmologist

Eye involvement is easy to miss. In studies that looked for it, 44% of people with skin rosacea had some eye involvement, and 10% had a diagnosis of eye rosacea ^[8]. Typical signs are dry or gritty eyes, a feeling of something in the eye and discomfort in bright light ^[8]. If your eyes are affected, an ophthalmologist should see you.

A dermatologist is the right specialist if the skin is thickening, if the diagnosis is unclear or if medical treatment has not worked.

How we approach it at Rejuvelook

At our clinic in Fuengirola, rosacea starts with a medical consultation. The doctor identifies your features and your triggers. If there are bumps or inflammation, the doctor may prescribe treatment or refer you to a dermatologist first. If your eyes are involved, we will advise you to see an ophthalmologist.

When persistent redness or visible vessels remain, IPL is part of our facial treatments. We plan the sessions around the season and your skin, and review the result. If another technique, such as a vascular laser, would suit you better, we will tell you. We see patients in English or Spanish.