It’s really common to fall into the trap of thinking that actives to treat premature aging aren’t for you when you have rosacea. But it doesn’t have to be the case. And in many ways, they’re much needed in the typical rosacea patient with light skin who’s very much at risk of premature ageing, with fine lines, uneven skin tone and texture and loss of elasticity. 


I have lots of patients who are pleasantly surprised by how far beyond simple rosacea treatment we can go. And let's face it, its human nature. Once you solve one issue, we so often find ourselves moving on to the next! 


And when it comes to my own skin journey, I’ve learnt to anchor my maintenance routine on a few really key ingredients whilst still respecting my skin’s desire to redden unpredictably and I’ll share my favourites as we go. 


So let's go through the routine step by step.


The morning routine. 

So this step is all about protecting you against environmental aggressors and again, this is even truer for rosacea sufferers because UV is a major trigger for disease.


So we want that simple base structure for the routine that we covered last week:


Cleanser - a simple, single unfussy cleanse is ideal.

Moisturiser  - barrier repair properties, soothing occlusives and non-clogging works well.

SPF - All-mineral is often best with good UVA protection and a tint will help mask fixed redness.

So lets consider first antioxidants - the most helpful is vitamin C. This adds an extra layer of support to your daily SPF against provoking UVA. It’s also anti-inflammatory, so may help with reducing redness. And of course, we know it improves collagen assembly and hyperpigmentation, so it’s great for tackling the signs of sun damage. 


Whilst l-ascorbic acid in  strengths from 5-20% are great, rosacea-prone complexions may find this quite challenging as the low pH need for absorption may irritate. So definitely start with a lower strength from 5-10%. If that proves too challenging, then look for a vitamin C ester, like ascorbyl glucoside (in Flawless Brightly Serum) or Magnesium Ascorbyl 


Given that daytime skincare is always about protecting against environmental aggressors, Niacinamide also makes sense. It helps bolster collagen production and again evens out skin-tone but it’s also anti-inflammatory and boosts barrier function. Another balanced active that is equally good for sun damage and rosacea. 

As far as acids use goes, I have little use for either AHAs or BHAs in rosacea. Neither especially helpful at treating the signs of the disease or make a significant impact on photo-ageing and they take up room in your routine. We can do better. Check out next week’s vide for  more on my favourite acid for rosacea. 


The night-time routine 


So night-time is all about regeneration and repair. So the question really is why wouldn’t you use a retinoid. In principle, retinoids are thought to be helpful in treating the vascular component of rosacea. But there is a but. Retinoids can aggravate some of the primary symptoms and signs of rosacea, especially at the beginning. So I think what’s imperative is two-fold. 


1) Introduce them at the right time. In clinic, they’re only added once the acute inflammatory flare is controlled.

2) Introduce them at the right strength. If you’re doing this at home, start non-prescription. I’d highly recommend Granactive retinoid, as I’ve used in Flawless Nightly Serum for being extremely efficacious and gentle. Or consider retinaldehyde (at 0.05%) which is also quite gentle. 


I’ll often ensure my patients are well-stabilised on azelaic acid or Soolantra for 4-6 weeks without flaring before switching over to using a retinoid, and I’d always suggest starting use at 2-3 times a week only, initially. Buffering with moisturiser is always a good idea until you see how your skin reacts. 


Final Thoughts


Realistically, you may experience flares of rosacea from time to time. That’s ok. Just cycle back to the strategy that brought it under control originally. And then once calm re-establishes, you can gradually phase your 2nd wave of actives in. Slowly slowly. That’s the way with rosacea. But with time, you’ll get into a rhythm and progress will be made. 

Isn’t that heartening?