The Redness That Will Not Go Away
It started with occasional flushing – after a glass of wine, in a warm room, during a stressful moment. But over time, the redness became permanent. Visible blood vessels appeared on your cheeks and nose. Small bumps and pustules emerged. Your skin burns and stings, and you have become increasingly self-conscious about your appearance. This is rosacea – and it is far more than just a cosmetic concern.
At our practice in Zürich Seefeld, I treat rosacea as a systemic condition with multiple contributing factors, not just a superficial skin problem.
What Is Rosacea?
Rosacea is a chronic inflammatory skin condition primarily affecting the central face – cheeks, nose, chin, and forehead. It affects an estimated 5-10% of the population and is more common in fair-skinned individuals, though it occurs in all skin types. There are four subtypes: erythematotelangiectatic (redness and visible vessels), papulopustular (bumps and pustules), phymatous (thickened skin, rhinophyma), and ocular (eye involvement).
What Drives Rosacea?
Immune dysregulation: Rosacea involves overactivation of the innate immune system, with elevated levels of antimicrobial peptides (cathelicidins) and increased inflammatory signalling in the skin.
Neurovascular dysfunction: The blood vessels in rosacea-affected skin are hypersensitive and dilate excessively in response to triggers. Over time, this leads to persistent redness and visible vessels (telangiectasia).
Demodex mites: These microscopic mites normally live on human skin, but patients with rosacea typically have significantly higher densities. The inflammatory response to Demodex and their associated bacteria contributes to pustular rosacea.
Gut connection: There is a strong association between rosacea and gut conditions. H. pylori infection, SIBO, and inflammatory bowel disease are all more common in rosacea patients. Treating gut conditions often improves skin symptoms.
Skin barrier dysfunction: The skin barrier in rosacea is compromised, leading to increased sensitivity, transepidermal water loss, and susceptibility to environmental irritants.
Common Triggers
Trigger identification is crucial for management. Common triggers include sun exposure, temperature extremes, hot beverages, spicy food, alcohol (particularly red wine), emotional stress, vigorous exercise, certain skincare products, and hot showers or baths. Triggers vary between individuals – I help patients identify their personal pattern.
Our Diagnostic and Treatment Approach
I assess for gut involvement (H. pylori testing, SIBO breath test), screen for Demodex overcolonisation when indicated, and evaluate potential contributing factors including food triggers, hormonal influences, and medication effects.
What We Do: Calming the Fire
Trigger identification and avoidance: A structured approach to identifying your personal triggers through diary-keeping and systematic observation.
Gut health restoration: Treating H. pylori, addressing SIBO, and optimising the microbiome. Many patients experience significant improvement in skin symptoms after gut treatment.
Gentle skincare protocol: Barrier-repairing products, mineral sunscreen (essential in rosacea), and avoidance of common irritants. I provide specific product recommendations.
Topical treatments: Metronidazole, azelaic acid, ivermectin (which targets Demodex), and other evidence-based topical options.
Anti-inflammatory support: Omega-3 fatty acids, zinc, and dietary anti-inflammatory strategies to reduce the systemic inflammatory component.
Advanced treatments: When indicated, low-dose oral antibiotics (for their anti-inflammatory properties), or referral for laser/IPL treatment for persistent redness and telangiectasia.
Conclusion
Rosacea is a treatable condition that benefits enormously from a comprehensive approach addressing both skin and systemic factors. If rosacea is affecting your confidence and comfort, I welcome you to our practice in Zürich Seefeld for a thorough evaluation and personalised treatment plan.
