Those with rosacea tend to have sensitive skin, so you should look for gentle, fragrance-free cleansers that help to maintain your skin’s pH. Avoid bar soaps (especially deodorant soaps) which can strip your skin of its natural oils. Instead, choose a liquid or creamy cleanser such as Cetaphil Gentle Skin Cleanser, Purpose Gentle Cleansing Wash, or Clinique Comforting Cream Cleanser. Wet your face first, then gently massage a small amount onto your skin with your fingertips, working it into a lather. Rinse off with warm (not hot) water, and pat dry with a soft towel. Avoid washcloths and scrubs, which can irritate sensitive skin, leading to more redness and broken capillaries. A gentle cleanser may not be enough to remove heavier makeup, so if you wear foundation or eye makeup, you might need to use a makeup remover before washing your face. It’s especially important to clean your eyelids thoroughly if you have ocular rosacea, since studies have shown that bacteria and yeast build-up along the eyelids can trigger or aggravate rosacea in that area. Look for soothing, natural anti-inflammatory ingredients like aloe vera, cucumber, and green tea, which can help calm irritated skin. Try Almay Makeup Remover Towelettes or Kiehl’s Supremely Gentle Eye Makeup Remover. If your doctor has prescribed a topical medication for your rosacea, wait 5 to10 minutes after washing before applying the medication to your face. After it dries, you can apply moisturizer if needed. One of my favorite drugstore moisturizers is Aveeno Ultra-Calming Daily Moisturizer with soothing feverfew extract, which has been shown to reduce the redness and irritation associated with rosacea. Q2. The cold winter weather is making my rosacea much worse. Is there anything I can do to protect myself? Cold, windy weather combined with dry indoor heat can really aggravate rosacea. Normally, the outer layers of your skin form a natural barrier to help to keep moisture in and irritating substances out. Studies have shown that those with rosacea have a disruption in these outer layers of skin, forming microscopic cracks. As a result, water escapes more quickly and your skin dries out, making it more sensitive to topical products such as cosmetics, cleansers, and even plain water. When the humidity drops, the skin’s natural barrier is even more disrupted, leading to redness, itching, and increased sensitivity. To protect yourself this winter, look for gentle cleansers and moisturizers that contain natural soothing ingredients. One of my favorites is CeraVe Hydrating Cleanser, which contains ceramide lipids to help repair your skin’s outer layers. I also recommend the Aveeno Ultra-Calming products with feverfew extract, and the Eucerin Redness Relief line with licorice extract, both of which have been shown to reduce redness associated with rosacea. In addition, studies have shown that adding essential fats such as omega-3 (found in salmon and other fish) and omega-6 (found in evening primrose oil) to your diet may help replenish your skin’s natural oils. To replace moisture in the air, invest in a humidifier, and turn it on every time you turn on the heat, especially at night. This will help alleviate dry skin and dry eyes (especially important if you suffer from ocular rosacea). Lastly, don’t forget to wear sunscreen on clear, sunny days, regardless of the temperature. Even if it’s cold outside, the winter sun can still be bright, and UV rays are a common trigger factor for rosacea. In addition, snow and ice can reflect up to 80 percent of the sun’s rays, so be sure to use sunscreen on exposed areas: face, neck, ears, and the back of your hands. This is especially important if you live at a high altitude or participate in winter sports. Q3. I have severe rosacea that won’t go away. I have seen two dermatologists but have not made much headway in controlling the problem. What should I do? If your rosacea seems especially stubborn and resistant to treatment, the first step is to make sure you have the correct diagnosis. There are several rosacea “impostors” that can mimic the signs and symptoms of rosacea, but don’t respond to the usual rosacea treatments. Many patients who are referred to my office for “rosacea” actually have seborrheic dermatitis (also known as seborrhea). Both conditions are associated with red patches on the cheeks and nose. However, seborrheic dermatitis produces dry, flaky skin, whereas those with rosacea tend to have oily skin with pimples and whiteheads. Also, unlike rosacea, seborrhea tends to affect the eyebrows, ears, and scalp, where it produces dandruff. Treatments for seborrhea include antifungal creams and mild cortisone creams. Eczema (atopic dermatitis) and allergic reactions can also produce red patches on the face that look like rosacea. However, these conditions typically itch, and there is often a history of previous rashes or allergies elsewhere on the body. Lupus is a systemic autoimmune condition that can produce a red “butterfly” rash on the nose and cheeks, especially after sun exposure. This can be diagnosed with a blood test and skin biopsy. If these other skin conditions are ruled out, and conventional rosacea treatments aren’t working, it’s possible that something in your environment is aggravating your skin. Rosacea is often worsened by environmental factors, so try to avoid known triggers such as heat, sun, hot and spicy food and drinks, and alcohol. It helps to keep a diary of what you eat and do throughout the day. One of my patients was frustrated by a sudden flare- up of her rosacea that wasn’t responding to her usual medications. I asked her to keep a diary for two weeks, and when we reviewed it at her next visit, I noticed that her symptoms coincided with using the new steam shower she installed in her bathroom, which she used for an hour every night. When she cut back to 10 minutes three times a week, her rosacea subsided without my having to change her medications. As a last resort, some cases of severe rosacea can be controlled with Accutane. This is an oral medication that was originally developed to treat severe acne. In low doses, it can help some patients who have rosacea that is unresponsive to topical creams and antibiotic pills. Accutane has serious potential side effects including liver damage, elevated blood triglycerides, and severe birth defects, so it should only be prescribed by a doctor who is experienced with the drug and can monitor you closely with regular office visits and blood tests. Since some private dermatologists do not prescribe Accutane, you may want to consider making an appointment at the dermatology clinic associated with your local medical school. Also, university physicians may be able to recommend new or experimental rosacea treatments that your previous doctors have not prescribed. Good luck, and don’t give up!
