Medical Cosmetology and the Rosacea Management

Doctor Romain Foucourt

Dr Romain Foucourt is an aesthetic physician trained at leading French universities. He completed his basic training in physics at the Massachusetts Institute of Technology (MIT), and in regenerative medicine and cellular therapies at the University of Montpellier. His integrative approach lies at the crossroads of basic science, skin biology and contemporary medical aesthetics.

A specialist in medical cosmetology, he structures his expertise around skin quality, combining the science of active ingredients, functional nutrition and targeted medical aesthetic procedures. He designs personalised protocols that combine topical treatments, oral supplements and medical aesthetic procedures. This global strategy aims to restore the skin's essential functions and optimise its integrity, texture and radiance for prevention and lasting regeneration. His approach is based on a detailed understanding of the skin's mechanisms and a constant focus on natural, measurable and harmonious results.

Alongside his clinical practice, Dr. Foucourt coordinates the teaching of the Diplôme Universitaire des Assistantes en Médecine Esthétique (DUAME) and is a regular speaker at national and international conferences, where he shares his work at the crossroad of aesthetic medicine, medical cosmetics and regenerative medicine.

Committed to a dynamic of transmission and innovation, he upholds a demanding practice founded on scientific rigor, therapeutic personalization and the quest for subtle, long-lasting and physiologically coherent results.

Introduction

In recent years, medical cosmetology has seen unprecedented growth. Positioned at the crossroads of dermatology and aesthetic medicine, it has emerged as a distinct discipline, driven by increasing demand for non-invasive, evidence-based, and highly personalized skin care solutions. While managing the visible signs of ageing remains a significant concern, patients increasingly seek a more foundational goal: improving overall skin quality.

This shift reflects a broader emphasis on prevention, prompting individuals to pursue long-term, safe, and tailored solutions to common dermatological conditions such as melasma, acne, and rosacea. The latter affects approximately 10% of adult patients seeking aesthetic care and exemplifies the complex nature of chronic inflammatory skin disorders—conditions shaped by immunological, vascular, microbial, and environmental factors. Effective treatment goes far beyond prescribing a topical medication; it requires an integrative, cosmetological approach grounded in a detailed understanding of the skin barrier, microbiome, and topical active ingredients

A Thoughtful, Rigorous, and Personalized Cosmetic Strategy

Rosacea management relies heavily on carefully selected formulations aimed at reducing inflammation, restoring barrier function, and improving skin tone and texture.

 
• Cleansing should be limited to once daily, using soap-free products that respect the skin’s physiological pH. Milk or balm-based cleansers are ideal for minimising irritation.
 
• Antioxidant serums, particularly those containing L-ascorbic acid (vitamin C), may be introduced cautiously, with attention to formulation pH and concentration to avoid intolerance.
 
• Moisturisers should incorporate biomimetic ingredients such as ceramides, hyaluronic acid, or natural moisturising factors. Green-tinted formulations can help visually neutralise facial erythema. In the evening, occlusive treatments that support skin regeneration and reduce trans epidermal water loss—such as Eucerin Aquaphor Balm—are often recommended, especially following topical antibiotic therapy.
 
• Photoprotection is a cornerstone of rosacea care. Mineral-based sunscreens containing zinc oxide or nano-form titanium dioxide are preferred, particularly in moderate to severe cases. The galenic formulation is critical to ensure patient compliance. Likewise, cosmetic camouflage should be discussed openly, as visible skin symptoms can contribute to stress and worsen inflammatory responses.
 

Despite meticulous selection, rosacea-prone skin remains highly sensitive. Products containing alcohol (especially those listed early in the INCI), menthol, eucalyptus oil, sodium lauryl sulfate, synthetic fragrance, and exfoliating acids (AHA/BHA) should be strictly avoided. Waterproof cosmetics are also discouraged due to their occlusive nature and difficult removal.

Topical Therapeutics and Cosmeceutical Transition Strategies

Among the most validated topical pharmacological agents are metronidazole (0.75–1%) and azelaic acid (15–20%), both known for their anti-inflammatory and sebum-regulating properties. Ivermectin (1%) is often indicated in moderate to severe cases. However, the long-term use of these medications is generally not advisable.

Cosmeceutical alternatives may serve as effective adjuncts or transition therapies. Retinaldehyde (0.01–0.02%), polyhydroxy acids (PHAs), lipohydroxy acids (LHAs), and copper peptides (1–2%), such as those found in Nooance formulations, often promising anti-inflammatory and regenerative effects. Although evidence supporting these agents is somewhat dated, they merit consideration within a comprehensive care protocol.

The Gut-Skin Axis: A Systemic Dimension of Care

Emerging research underscores the importance of the gut-skin axis in rosacea pathogenesis. Intestinal dysbiosis—particularly involving Helicobacter pylorior Bacillus oleronius—may amplify cutaneous inflammation. Concurrently, an imbalance in the skin microbiota, often associated with Demodex folliculorumovergrowth, further aggravates the inflammatory environment.

Restoring microbial balance includes the use of prebiotic-based skincare, especially formulations with fructo-oligosaccharides. Additionally, targeted micro nutritional support —including zinc, omega-3 fatty acids, vitamin D, magnesium, L-glutamine, and specific probiotics (e.g., Lactobacillus rhamnosus GG, Bifidobacterium longum) — has shown promise in reducing flare-up frequency and improving overall quality of life. These adjuncts reflect a holistic, systems-based approach to dermatological care.

Toward a Sustainable, Educational, and Adaptive Care Model

The effectiveness of any dermo-cosmetic regimen should be assessed after a minimum of 10 to 12 weeks. Tolerance remains the primary endpoint—often more relevant than perceived short-term efficacy —when building a sustainable skincare routine. This regimen must be adapted to seasonal changes, periods of emotional or physiological stress, and hormonal fluctuations (e.g., menstrual cycle, pregnancy, menopause), all of which can impact skin reactivity and disease course.

Once a well-tolerated routine is in place, adjuvant aesthetic procedures may be considered. Vascular lasers (KTP, Nd:YAG), intense pulsed light (IPL), and photobiomodulation using red and near-infrared wavelengths represent validated therapeutic options. Their integration should be individualised based on rosacea subtype, skin sensitivity, and the patient's expectations.