Hello Dr. Bailey, I only get rosacea and seborrhea dermatitis flare ups on my left cheeks. Can you tell me why I only get it on one side of my face? Also, my doctor prescribed for me Metrogel, Desonide lotion (corticosteroids), and Ketoconazole cream (antifungal). Can you please explain the order and give me the steps for applying all the above with the other products on your website that you recommend as the best skin care for rosacea and facial dandruff such as Calming Zinc, Green Tea Antioxidant Skin Therapy, Daily Moisturizing Face Cream and my zinc oxide sunscreen. Thanks, Mimi
It is possible to have unilateral rosacea, but it's unusual, so I always look for a different diagnosis that might be masquerading as rosacea. This is because we think of rosacea and seborrhea as being skin conditions that come from some as-yet-unknown internal predisposition. This means that we expect them to manifest on your skin bilaterally (on both sides of the body).
Ask your doctor about other possible rashes that might look like rosacea and facial dandruff, yet present unilaterally (on just one side of your face), such as an allergic contact dermatitis, tinea faciei, and demodex mites. Also, since here in the United States the left is the driver's side of a vehicle, sun exposure-induced rashes like photo-drug eruptions or polymorphous light eruption are in the list of possibilities too.
The tinea may be treated with the ketoconazole, but sometimes it is more tenacious and requires oral treatment. Demodex mites, on the other hand, need a completely different treatment. The other conditions require more medical sleuthing on the part of your dermatologist.
The application order of a skin care routine is always CLEANSE, CORRECT, HYDRATE, PROTECT. For your products, this is how I would do it in my practice:
CLEANSE: Wash with Calming Zinc
CORRECT: Apply Green Tea Antioxidant Skin Therapy to your entire face to help your skin stay clear. In my practice, I have patients wait a few seconds (e.g. comb their hair, put on deodorant, or take some other quick daily step) then apply Metrogel followed by ketoconazole. They then apply the mild cortisone ONLY if they are red, and for no longer than two weeks.
HYDRATE: Then they apply the Daily Moisturizing Cream
PROTECT: Zinc oxide sunscreen goes on top (daytime only). My top choice is a pure zinc oxide product such as Sheer Strength Pure Physical Invisible SPF 50+ Creme Sunscreen or Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen (this is my personal favorite!)
The first three products make such a popular skin care routine, with products that are essential for rosacea and seborrhea control, that I've bundled them in my Facial Flaking and Redness Solution Kit. Add one of the sunscreens and you're set.
I also want to acknowledge that the three medicines you are on create a lot of layers. When the rash is clear, I have my patients stop using the cortisone. In another month or so they can stop the ketoconazole too if the rash stays clear. At that point, the routine is much simpler.
Thanks for sending in a great question that demonstrates some important points about skin problems, namely diagnostic challenges and product layering.
Cynthia Bailey MD, Dermatologist
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