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Rosacea and nitric oxide: the difference between hypothesis and fact.

Rosacea skin is characterized by dysregulated inflammatory (perivascular or pilosebaceous infiltrate), vascular dilation, lymphatic dilation, glandular hyperplasia, and fibrotic processes, a mixture of symptoms that reflects the complexity of the underlying mechanisms. What is going on? We all prefer simple answers, especially for very complex situations. 

A simple answer for rosacea has been proposed. Nitric oxide is a gas produced naturally in nearly all of the body’s cells and is used as a signal by the nervous, immune and cardiovascular systems. Because nitric oxide is known to make blood vessels dilate, it was hypothesized that it might play a role in rosacea.

But, so far, and despite intense research on this subject, there is no evidence that nitric oxide is a relevant factor in rosacea. Maybe some evidence will be found in the future, and there may be inhibitors of nitric oxide production that could be used to control rosacea. Maybe.

In the meantime?

Rosacea seems to originate from the dysregulation of inflammatory processes.

Genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the immune system, both innate and adaptive. Trigger factors may lead to the release of various mediators from keratinocytes (cathelicidin, vascular endothelial growth factor, and endothelin-1), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (T H1) and T H17 cells. Additionally, trigger factors can directly communicate to the cutaneous nervous system and, by neurovascular and neuro-immune active neuropeptides, lead to the manifestation of rosacea lesions. That’s complicated.

What you can do

I know that it’s silly to suggest that you avoid emotional stress, but some triggers can be avoided, like sun exposure, hot steam, spicy food, wind, and alcohol consumption. You can control Demodex infestation, which happens in some rosacea patients. Demodex eradication seems to alleviate rosacea symptoms probably by preventing the formation of pro-inflammatory cytokines

What can Skin Actives do for you?

Try soothing actives, like licorice, or green tea with caffeine, which would work as a vasoconstrictor. Centella asiatica and horse chestnut extracts are well known for their capillary strengthening properties. Many clients have found relief using 4-ethoxybenzaldehyde mixed with a base cream. Azeloyl glycine and magnesium ascorbyl phosphate are other options. You could also try our glycan-7 booster, which may help with strengthening the skin barrier and enhancing the immune response against Demodex. Our clients have also reported excellent results with sea kelp bioferment used on its own.

Strontium spritz may block the instant reaction that rosacea serum shows when you enter a hot, smoky place. Epidermal growth factor seems to help with rosacea. There are many actives that help with inflammation. Until we get some better answers on how rosacea happens, we may have to make so with products that help ameliorate the problem. Here are four products from Skin Actives worth trying.

Redness reduction serum

Skin soothing serum

Ultra calming cream



Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7:F1000 Faculty Rev-1885. Published 2018 Dec 3. doi:10.12688/f1000research.16537.1

For more on Rosacea, see this post.

DISCLAIMER: These claims have not been evaluated by the FDA and are not intended to diagnose, cure, treat or prevent any disease.