Ep.10 - Rosacea Uncovered

Most traditional rosacea treatments are based on fear — babying the skin, avoiding exfoliation, and relying on thick moisturizers. But what if everything you’ve been told is reversed?
 In this eye-opening episode, esthetician Sam Bazile challenges everything you think you know about rosacea and sensitive skin. She reveals why rosacea isn't a sensitivity, but a skin condition rooted in oil, inflammation, and genetics — and why treating it requires a radical shift in approach.
 You'll discover:

• The real cause of rosacea subtypes and how they're all connected to excess oil and inflammation
• Why traditional “babying” treatments can actually worsen rosacea symptoms and how to avoid this common mistake
• The critical role of oil management, barrier strength, and tailored exfoliation in controlling the condition
• Why systemic treatments like oral medication may be necessary when topical approaches fall short
• How to identify triggers and educate your patients for lifelong management rather than short-term relief
   Sam shares her journey from misconceptions to proven strategies, backed by top dermatologists, that empower you to treat rosacea more effectively. Delve into the surprising evolution of rosacea treatment and learn how to prevent advanced disease and texture irregularities, all while improving your client's skin health.
   Perfect for estheticians, skincare professionals, and practitioners tired of outdated methods — this episode will help you redefine your approach so you can deliver real results. Because in the fight against rosacea, knowledge is your best weapon.
   Are you ready to help your clients conquer rosacea from within? Tune in now.

Transcript

SPEAKER_00 0:07

Hey y'all, welcome to the Skintrovert. I'm your host, Sam Bazeal, and we are in the month of April, and April is National Rosacea Awareness Month. So, you know, I gotta cover rosacea, but I'm not gonna cover it in the way that you think. So, welcome to the Skintrovert. I have been an aesthetician for a really long time, and I'll tell you when I started my career as an aesthetician, I was so afraid to treat patients with rosacea because um the instructor that I had, the teaching that I had when I was in school was oh, if they're rosacea, you know, just moisturize, don't do anything else because you're gonna cause them to have a flair. They're so sensitive. Their skin type is sensitive. So I was just so worried to like make things worse or fuel the fire. So I was misguided, which caused me to mistreat and not be helpful. So I want to take a little bit of a different approach with this information on rosacea. So first, let's talk a little bit about what rosacea is. So, rosacea is a chronic skin condition that there is no cure for. So, in my opinion, I think because there is no cure, providers that are able to diagnose, because as an aesthetician, I'm not allowed to diagnose. I can only say you have something that is indicative of a rosacea and you should see a dermatologist. Like that's that's my job. So those providers that are able to diagnose, I think they might be a little bit hesitant to because you know you have that R-word on you forever. But in my opinion, I feel like the sooner that we diagnose, the sooner that we actually treat. And because there is no cure, there are ways to treat the symptoms before they become more advanced in the in the disease. So that would be my encouragement to you guys to really learn rosacea, understand rosacea, formulate your own opinion. As a provider, you are qualified to be here and your knowledge means something. So learn everything that you can and then decide your approach, how you want to treat your patients with rosacea. And maybe some of the information that you learned today will help you figure out your course of action. So back to what rosacea is. So no cure for it. Um, it usually gets diagnosed between the ages of 30 and 50, and it starts as facial redness. So you start to see that redness in the midface. Um, I've had some people come up to me and say, Well, I flush when I exercise, but I don't have rosacea. Or I flush when I drink wine, I don't have rosacea. Babe. Having that kind of vascular response is not a normal skin response, so you likely have rosacea. All right, so we've heard a little bit about what it is. Now, I'm gonna give you a little bit of controversial approach. I want to encourage, because remember, I was always told, baby them, moisturize, moisturize, moisturize. They're so, so sensitive. I learned something from Dr. Obaji um later on in my career that completely challenged everything that I know about rosacea. And then I attended a class with Dr. Rachel Eccl, who is a dermatologist out of Trinidad, Tobago, and holy crap, like everything that I thought I knew, done. Everything I thought I knew was challenged. It completely changed how I felt about rosacea, how I felt about skin being sensitive. And it really allowed me to see true results because I was so scared to like do anything. I was so scared to touch them or make things worse that I just stayed away. But challenging what I knew challenged me to take it my treatment a step further. So I'm very grateful to both of those uh world-renowned dermatologists that they're brilliant. Both of them are brilliant. And if you ever have an opportunity to learn from them, I would encourage you to take advantage. Even if you don't carry the skincare brand that they represent, I still think learning from dermatologists that have contributed to this industry is always helpful. It helps you to formulate how you want to feel um about treatment. So, all right, so I want to compare some of the things that are subtypes of rosacea and why I challenge you to go outside of the sensitive realm. And the reason why I'm challenging you to go outside of the sensitive realm is because I do not feel that they are sensitive. I said it. I don't even think sensitive is to be acknowledged as a skin type. I don't. You are not born sensitive, your skin has become sensitized due to the disease of the skin, the environment, what you're doing to the skin. You're not a sensitive skin type. You know, when I was an esthetician, I would have patients come in and they would immediately put on their intake form that their skin was sensitive. And if you have that on your intake form, I would encourage you to do a little bit of a discovery and go a step further. So what do I mean by that? Um, when they say I am sensitive, I would encourage you to ask, when you put sensitive, does that mean that at this moment, while you're sitting here talking to me, does your skin feel tight? Does it feel itchy? Does it burn? Is it irritated? No? Okay, then does sensitive to you mean when you put on certain products, you become reactive? Most of the time, when they put they're sensitive, that's what they mean. They not they mean that they're reactive. And they're scared, they're putting sensitive because they're kind of apprehensive about what you're gonna do or what you're gonna put them on, or if you're gonna sell them too many products. So if they tell you, oh, I'm sensitive, she's gonna kind of go easy and not be all, you know, over the over the over the board. So anyway, make sure you do some discovery because sensitive is, in my opinion, not exactly where we need to like diagnose. It's more of what's causing that. Why is your skin sensitized? So when you have these patients that present that way and you're so scared to do anything, we're really not helpful. And when it comes to rosacea, you can become more advanced in the disease. And that's when you start to see the textural abnormalities, the lumpy bumps. The skin becomes more vascular, more textured. And we could be proactive in treatment and we can get ahead of that game. So the only way you're gonna do that is if, like me, you become wise to what it actually is, and you get outside of that little sensitive, ooh, ouchy bubble, and you really start taking it seriously. So here's how I want to challenge it. If you think about all of the subtypes of rosacea, what do they all have in common? And I'm gonna tell you, in my opinion, it's oil. Don't shoot the messenger. I'm telling you, and you're probably thinking, girl, please, I can visualize a rosacea patient in my head, and their skin is flaky, their skin is sensitive, their skin is inflamed, everything hurts. How on earth does that relate to oil? Well, I'm gonna tell you. So let's talk about these subtypes of rosacea, and I'm gonna tell you how I think they actually relate to oil. So the first subtype of rosacea is gonna be that facial redness. It's also gonna also gonna have to do with the vascular. So you'll see usually in the mid face is where it starts. So nose, cheek, maybe forehead, sometimes chin, you're gonna see that redness. When the redness goes untreated, that's when things start getting a little crazy. You start to see the raised redness. We start to see maybe some like of the distended capillaries, the telangictasia, which is those little red veins. And that usually is a vascular issue from holding heat in the mid face. It starts to distend capillaries and it starts to cause all of that facial redness and that facial flushing. Well, how would that relate to oil? Hear me out. So here's my take on it after learning from Dr. Abaji and Dr. Eccle. Oil, aka sebum, is a highly inflammatory substance. But what does that have to do with facial redness? Well, think about someone who has rosacea. And look, he's probably gonna kill me, but I'm gonna do it. I'm gonna talk about my daddy, okay? So Chuck is his name. We're gonna talk about Chuck today. You can walk up to Chuck at any given moment and literally pull flakes from Chuck's skin. Chuck has the gnarliest case of rosacea that you will ever see, okay? He is in full-fledged, lumpy bumpies, bulbous nose, uh raised uh facial redness in the midface here, um, flaky, everything hurts. Like he could just put on a moisturizer and it hurts. Like he is just in the throes of it. Well, what you're seeing on the surface is that flaky, you know, dry skin. But I want you to challenge not only seeing what's on the surface. I challenge you to really truly go deep and discover why the epidermal tissue looks that way. What on this top layer is causing it to be so sensitized, so weak, so dry. If you would look outside of that, you would see oil glands that are overproducing oil. It's like the faucet turned all the way on, and you just have this oil spewing out. Here's why the top is so dry and flaky and irritated and inflamed. Oil itself is very thick and it's sticky, it's waxy, it's kind of like glue. So if you think about that, skin should naturally shed, right? We should be naturally exfoliating cells. But when you have lots of oil that's really thick and sticky like glue, those cells cannot naturally exfoliate. They just start to become more impacted and they stick and they stick and they stick and they stick and they stick. And guess what's on the top? You have all of those dead flaky skin cells. And why the redness and the inflammation? Because oil is a highly inflammatory substance. So it's causing all of this chronic inflammation. What happens when you have chronic inflammation? Redness. You have swelling, you have irritation, barriers weak, you have all of this ouchy, everything hurts, putting on moisturizers, all that hurts. Uh-huh. You see where I'm going with this? All right, what's another subtype of rosacea? Papules and pustules. Well, how does that relate to oil, Sam? Well, come on. You have all of this oil, and then when you're not, you know, flaking away, you start to get impactions and congested. Those hair follicles become congested. And what happens when the hair follicles become congested? You start to see papules and then pustules because pustules contain pus, they contain bacteria. And when you have all of this congestion, that's a perfect feeding ground for that acne bacteria. So it starts to thrive. So, yes, those little papilles, pustules, and acne can also relate to rosacea, which is rooted in, say it with me now, oil. Okay, what's another subtype of rosacea? Phytamus rosacea. That's the thickening of the skin, the rhythophymas. So remember how I said Chuck? Poor baby. And look, I did I got it. I got rosacea too. He handed it down to me, and I'm gonna fight this till the day I leave this earth because I do not want this, we call it the bazile nose. I do not want the bazil nose to continue to spread and spread and spread. And bless it, Chuck has it. Okay, Chuck has got the bulbous nose because of the skin thickening, and it is spreading and spreading and spreading. And he's got the textural abnormalities, the lumpy bumpies. That's because the skin starts to thicken due to the impaction of cells upon cells, upon cells. It starts to distort the texture, things start to become lumpy bumpy. It's all related to the oil. That is where it roots. Next, another subtype of rosacea, ocular rosacea. We don't always talk about this in the treatment room. I'm sure dermatology practices do all the time, but in med spas, plastics, it's not always something that we ask when we have a patient come in and present with symptoms of rosacea. And it should be, it should be something that we ask. You should ask the patient do you suffer with things like dry eyes? When you blink, does it feel like there's sand in there? Um, do you have any irritation? Are you constantly rubbing and itching the eyes? Watery eyelids, and then do you get cysts? Do you get those styes around your eye? And if they say yes, chances are they're dealing with ocular rosacea. And where is ocular rosacea rooted from? It's rooted from trapped oil, guys. So you start to get trapped oil in that eyelash area, right on that eyelash line, and that's what starts to lead all of these symptoms of ocular rosacea. So I've just related all of the subtypes of rosacea to oil. Now imagine, okay, we've got Chuck in our brain right now, so let's just go with it. Think of Chuck's condition. Now, looking at it, having all that flaky, like dry skin, and you seeing all that, and then you seeing how inflamed and ouchy and hurt he is. Most providers would say, Vaseline that dude up. Give him some Vaseline on that barrier. He needs some Vaseline. And while I do understand that moisture can be helpful for that superficial tissue, right? For all that initial dryness. Imagine if I would Vaseline that dude up. Just think about that. Think about all the flakes upon flakes upon flakes upon flakes upon flakes. And here I come with this super thick moisturizer, and I just slap it on every day, morning and night. Just slap it on. What is that gonna do? It is going to throw him further into the disease. Okay. So then what do we do? What do we do, Sam? What does he need? If it's not moisture, what does he need? Think about it. What do you think he needs? If you thought exfoliation, hell to the yes, you are correct. He needs exfoliation, he needs oil control, he needs barrier support, he needs all the things. And I get it. A lot of you will say, Well, Sam, he can't tolerate exfoliation right now. There's way too much inflammation, everything hurts. Putting a moisturizer hurts. So surely more aggressive acids or retinoids is gonna throw him over the edge. Abso freaking lutely, it will. So, what's the plan of action? What do we do? Well, in my opinion, we need to love on the barrier first. We need to get his skin in a stronger state. So whenever you hear that skin is truly sensitized, not reactive, okay, I'm talking about sensitize. The barrier, it means when you hear the word sensitize, I want you to replace that with weak. So instead of saying a sensitized barrier, it is a weak barrier. And if someone has a weak barrier, what's the opposite of that? Strong. So that would mean we need to make the barrier strong. So that's what I would focus on. I would take all of your tools that you carry in your practice, figure out what tools you have that are designed to strengthen the barrier. And that is what I would do. I would work on strengthening the barrier, get him a good six to 12 weeks of that. Then when the barrier is strong and we know he can tolerate, then I'm coming in guns ablazing. We are getting rid of all of that impacted tissue, that thickening skin. We have got to get that under control if we want to get it better. Because remember, I can't cure him of these conditions as much as I want to. I can't. I can only treat the signs and symptoms. And I am here to report that Chuck is doing the things and his skin is looking so much better. We went years with him not wanting to do anything. And now, this is what he did. My poor daddy. When I would say, like, what do you do for your skin? Well, I mean, I go in the shower and I take my wash rag with my soap and I just scrub, scrub, scrub, scrub my face, and then that's it. That's all I do. So we're going from that to like a full-on six-step regimen. I am so proud of him. Okay, so there is hope in this. There's no cure, but there's hope, and I will take that. All right. So you've got all of these comparisons to oil, and treating it like baby skin is just not always the right answer. You know, and I'm gonna have a lot of people that disagree with me and they're gonna be like, no, she's crazy. Rosacea is so sensitive, it's so vascular, it's all these things. But I would just, if you don't believe me, or if you think I'm just talking out of my behind, I would challenge you to try it. I would challenge you to, because you can't call me a liar if you've never done it, right? You have to do it to be able to say she then what you're talking about, she's a liar, right? Okay, let's just go with that. All right. So I feel strongly about this because of the statistics. Besides the relation that I'm making to every subtype of rosacea, 25% of patients suffer with sebarrac dermatitis. 25% of them. And you know what sebarrake dermatitis is rooted in? Oil. Excessive amounts of oil. Okay, so another relation there. Another little fun fact: rosacea patients have five to ten times more demodex mites per square inch on the face than normal skin. You wanna know why that is? You want to know why we're all nasty with mites?

unknown 17:50

It's the oil.

SPEAKER_00 17:52

It's the oil. You want to know why? Because demodex mites feed on oil. So if you have lots of oil, you're gonna have more mites per square inch because you're feeding them, they're getting all the munchies on your face. And here's the weird thing like, this is how the demodex situation gets out of control. And let me tell you this. If you have not Googled Demodex mites, it is quite frankly the most terrifying thing on the planet. Go look at them. These little nasty things look like, oh God, they look like little nasty aliens. They're so disgusting. Okay. And to know that they are living and thriving all over my skin is very terrifying. But I have to know what's going on. Like, you know me, I gotta dig. I gotta figure out what the heck is going on. And the reason why I'm probably never gonna be able to completely get rid of all of these demodex mites is because number one, everybody on the planet has them. Number two, I produce a lot of oil genetically. That's the thing about rosacea. People are like, where does it come from? How do you get it? Well, there's a lot that we still don't know, but we can bank on the majority of people that have rosacea, it is genetically predisposed. So I Chuck had it, Sam has it. Like it's just it gets passed down in generations. I couldn't have gotten generational wealth, I got rosacea and acne. I love that for me. So, yes, genetics is a huge part of that. Um, another thing, it can be flared through environmental concerns, it can be flared through hormonal fluctuations. You know, the thing about rosacea is you really need to have a conversation with patients. They need to know that as a provider, it's my job to guide you with topicals. It's my guide, my job to educate you. Your job is to actually put the key in the ignition and put the foot to the floor. Like you have to actually do the things. And because there's no cure for rosacea, you have to avoid triggers. Okay, you have to avoid flares. And if you don't, if you want to live life, because believe me, y'all know me, one life, live it. You have to understand that flares are gonna happen and it's not your provider's fault and it's not the product's fault. It's it's you, boo. You want to do it. And what are flares for rosacea? Anything heat related. So heat, humidity, spicy foods, alcohol, um, ex um excessive exercise, like intense exercising. What else? I actually wrote them down so I wouldn't forget to tell y'all. Humidity, spicy foods, hot water, and then the extreme, the other extreme, cold water, um, wind, that'll do it. Stress. Stress will also make flares. Okay, so basically, if you want to have a good time, you're probably gonna have a flare. So you just gotta deal with it, okay? Just part of the deal. So, anyway, you got all these internal things, you got these genetics, you've got environment, but what about these demodex mites? So, here's the thing that's super gross about demodex mites. They are having this little like weird ecosystem like on your skin. So, they are feeding and munching on all of that oil. Okay, so they're thriving. We're giving them all this food, so they're just eating, they are having sex, they're making babies, they're dying, they're pooping. And here's the thing: like, no one's taking those little shells of the Demodex mites and like hauling them off in a hearst and like burying them somewhere. No, no, they're just dying, and just all that shell is just staying on your skin while they're just mating and making more babies, and oh god, it's so gross. And then that leads to the inflammation. That's what causes the inflammation. You have all these little munchy invaders, and your skin is like your body's like, no, this isn't supposed to be here. And then what do our bodies do when something's not supposed to be there? It produces inflammation as a way to ward it off. But when you constantly have all this oil and you constantly have all these mites, you're never gonna get it, you're never gonna heal from that stimulus. So you're just gonna stay in this chronic stage of inflammation. It is such a sad, sad story for rosacea patients. So, and look, I I have rosacea, so I understand, I get it. All right. So here's what I want to highlight. Since I feel that there is no such thing as sensitive skin, since I feel like Rosacea shouldn't be babied, I think it is important as a provider that you customize an approach for every single patient. Because here's the thing we can't stop it. It's going to come. Not all of us are presenting the same. Like not every rosacea patient is presenting with all five subtypes of rosacea. Maybe they just have, you know, the facial redness. Or maybe they're just dealing with the inflammation. Or maybe it's just mild, maybe just a few papillas pustules. So their journey to skin health is not always going to be the same. So what I would challenge you to do is really meet the patient where they're at. Just like with Chuck, right? He's so inflamed. He's so dry. Let's meet him where we're at. Let's first start by getting the barrier healthy, loving on the barrier, nourishing the barrier, making a sensitized barrier a strong barrier, working on that weak barrier. Once we have strength, then we can come in with our heavy hitters and really start promoting exfoliation, getting that skin out of the way so we can really see true change. And then in some cases, and look, some people are not going to agree with this, but in some cases, you might need to control oil systemically. You might need to get in there from within. Because not always topical is going to stop it. Matter of fact, topical won't stop it. It's produced internally, all that oil. So just what you're putting on topically is not going to stop it. It may kind of plug up the hole, but it's not going to stop it. So you may need to use oral treatment to help get that oil under control. And what are some options for that? Oral isotretinoin, otherwise known as Accutane. Accutane will shut that valve completely off. Okay. If that is too extreme for you, or you are not a candidate, or you are not a provider that is able to prescribe Accutane, there are other medications out there like aldactone, spirinolactone. Those don't necessarily shut the valve all the way off. It's more of like a halfway. So you still have some kind of oil produced, but maybe that's just enough to get the symptoms of the disease under control. And then if you are a provider that takes more of a holistic approach, there are other ways, supplements that can help kind of curve that so it's not as excessive. There's also ways that you can truly get to the root. Okay. Right. We can't cure it, but we can try to get to the roots to get that oil controlled. So as providers, you see what I mean? Like you have so many ways, so many roads that you can take to help your patient get to that end that end goal. It's just, we all don't take the same road. And it doesn't make anybody wrong or incorrect. As long as you are a qualified provider, you're licensed, you're you're you're supposed to be here. That check. Okay. You educate yourself, you further your knowledge, you don't stay in your little educated box, you go kind of outside of that. All of those things help you grow as a provider, excuse me, and help you decide how you want to treat your patients. So providers disagree all the time. It doesn't mean that you're wrong, okay? Sometimes you can be wrong, yes. But disagreeing on science-backed, clinically backed, there's no wrong there, right? We're all just taking different paths because that's how we align, that's how we decide to treat. So that's what I would encourage you to do today. I would encourage you to do like I did. I didn't accept what I learned in aesthetic school to be fact about rosacea. I took what I had, that good base knowledge, and I continued to educate myself. I aligned and soaked up all the knowledge from board-certified, world-renowned dermatologists like Dr. Obaji, like Dr. Rachel Eccle. And then I was able to formulate my own thoughts and my own opinions about treating rosacea. And it was so helpful for me in the treaty treatment room. And I sure hope that it's helpful for you. All right, guys, I'm out of here. Happy National Rosacea Awareness Month. Y'all get out there, control that oil, help your patients with rosacea, educate them so they know why they're dealing with this. And let's get ahead of the game. Early diagnosis, start that treatment early so you can get ahead of those advanced signs and symptoms. All right, guys, have a wonderful day. Take care. Bye, y'all. Think of the Skintrovert as your aesthetics roundtable, not a training manual. This podcast is for professional education and discussion. It's not medical advice. Your scope of practice matters, regulations vary, and your license always leads. To continue the conversation, follow the Skintrovert on Apple, Spotify, or any platform that you listen to your podcast.