Rosacea is a multifactorial chronic inflammatory skin barrier disorder involving a combination of immune, genetic, microorganisms, nutrition, UV and various other environmental factors. Those presenting with the rosacea skin innately do not make a competent skin barrier defence, which in turn, triggers cellular inflammation as a result of continual activate of the underlying innate/adaptive immune systems.

Rosacea is characterised by various skin manifestations including erythema (redness), papules/pustules, watery vesicles, telangiectasia (vascular damage) along with temperamental flushing. When it comes to this skin barrier disorder, we need to understand the skin has lost the first three lines of skin barrier defence. Let’s take a look at these defence systems and why they are so important to be preserved and nurtured in the barrier disordered skin.

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Acid mantle/microbiome 

Did you know that your skin contains an invisible and protective hydrolipidic film (composed of oil/water) that resides on the surface of the skin? Yes! This film can be considered as a natural moisturising lubricant that functions to slow down the evaporation of trans-epidermal water loss (TEWL) from the skin, while also acting as an antiseptic in helping to prevent the growth of pathogenic bacteria. The acid mantle is also a transporter of antioxidants as the oil secretions that make your acid mantle, demonstrate strong antioxidant capabilities. Antioxidants fight free radicals (unstable molecules) in order to defend and protect you as you move forward in life.

Sadly, those presenting with rosacea, have an impaired acid mantle which means they are less protected from the damaging free radicals within the environment, rendering their skin barrier disorder even more compromised.

Did you know this film also contains an ecosystem of unique bacterial bugs that colonise to defence and protect you? Yes! This is known as your skin’s microbiome. In fact, we are more bugs than human cells which means these microbial creatures make up a very large percentage of our immune system, and when compromised, decrease our immunity and pave the way for the invasion of pathogenic allergens and bacteria.

Our skin microbiome is also directly linked to a communication pathway between our gut’s microbiome. This statement really reiterates the importance of intestinal gut health via nutrition, and how the skin has the ability to reflect changes in other cells and systems of the body. Think of the skin like a mirror. No, not like the mirror in Snow White, but more so a mirror that can show you potentially what is going on within your system.

Never think of the skin without thinking of the health of the gut, because in retrospect, the gut microbiome contributes to around 70% of your immune system!

Let’s now explore the role of the protective stratum corneum and the multi-lamellar lipid structure that support the skin’s homeostasis (balance).

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Stratum corneum/multi-lamellar lipids 

The stratum corneum is a thin layer of tissue that is comprised of multiple living layers of corneocytes (skin cells) that make up the outermost layer of the skin. These cells are surrounded by a protective envelope that give structural support and provide external defence, while other defence systems such as the multi-lamellar lipids, encase the cell envelope of the corneocyte to provide even further barrier protection. The multi-lamellar lipids are composed of important oil-soluble molecules such as ceramides, cholesterol and free fatty acids.

For a very simplified analogy of this statement, picture in your mind a brick wall that is embedded within layers of mortar. The bricks represent the corneocytes and the mortar represents the multi-lamellar lipids that encase the corneocytes to provide effective physical and water barrier functions within the skin. In other words, the brick wall is sturdy and will not allow for the entry of foreign materials into the deeper layers of the skin.

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Sadly, in the rosacea skin, the stratum corneum and the multi-lamellar lipids struggle to form correctly which results in a compromised “brick wall.” This, in turn, allows for the entry of microorganisms, foreign materials and substances into the skin, triggering an immune system response and resulting in cellular inflammation.

The corneocyte is the first cell to have contact with the outside environment, it is the physical defence of the body and when it fails to form correctly, will result in inflammation.  I want you to picture healthy skins cells like hydrophobic (water-repelling) grains of rice. They are strong, sturdy and are doing their job correctly in order to defend and protect. Now, let’s take a look at the rice bubble. What we are seeing is a poorly formed stratum corneum and barrier defence systems, resulting in cellular inflammation via activation of the underlying innate immune system.

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This IS the rosacea prone skin and must be treated as a barrier disorder. It is so fundamentally important to preserve the integrity of the skin at all times in order to prevent unnecessary activation of the underlying immune system. When you have rosacea, you are innately incapable of making a fully competent skin barrier defence. This means your skin demands even more greater respect as you move forward in life. Let’s now take a look at some of the leading triggers that can be associated with aggravating the rosacea skin.

Triggers associated with worsening rosacea symptoms:

• Emotional stress

• Hot OR cold weather, wind and sun exposure

• Exercise

• Hot showers/baths

• Hot drinks

• Spicy foods

• Alcohol consumption

• Dairy products

• Certain skin care products/cosmetics

• Over exfoliation

• Medications e.g., topical steroids, niacin (vasodilator), beta blockers (blood pressure)

The quantity and quality of the trigger factors that induce facial redness vary from person to person, so take note of what aggravates you! Unfortunately, there is no cure for rosacea and all you can do is manage the condition both externally and internally.