How to treat highly sensitive skin from rosacea is a question I am often asked by rosacea sufferers who are desperate to find relief from this horrible skin problem. I received this exact question from a reader and know that my answer will be of interest to other people who can't quite unlock their skin from this horrible cycle or sensitivity and irritation.
Hello Dr. Bailey, I saw your replies and information on the Rosacea Forum and am inquiring about your product recommendations for myself. I am a 59-year-old woman with diagnosed rosacea for the past 20 years. My skin is highly sensitive and I am unable to tolerate any sunscreens and moisturizers. Currently the only thing I can use is Aquanil to wash my face (which I am now reacting to) and I pat on a little concealer. My skin is also very dry.
- What of your products would you recommend?
- With your experience with older rosacea patients with highly sensitive, dry skin - what have you found to be successful?
I look forward to hearing about your product recommendations. Thank you, Linda
Hello Linda, What you describe is very severe. We know that people suffering from rosacea have a very weakened skin barrier. I wonder, however, if you may have even more reasons for an exquisitely sensitive skin barrier such as a confounding diagnosis adding to the rosacea skin sensitivity.
Some of the more common skin conditions other than rosacea that cause facial redness and skin sensitivity are:
- An allergic or irritant contact dermatitis from some remote product (hair care products that manage to get on to the facial skin, airborne allergens like room fresheners, etc.)
- A photosensitivity condition, such as a medicine causing sun sensitivity (even thru windows) such as NSAIDS, antibiotics used to treat rosacea etc. You can find a list of photosensitizing medicines here.
- Facial dandruff (seborrheic dermatitis), which causes redness and scale (possibly interpreted as dryness) along the brows, on and around the nose and chin.
- Severe skin inflammation from demodex mites
When I hear someone talk about sensitivity sufficient enough to cause widespread product intolerance along with dryness, I start looking for a confounding diagnosis along with the rosacea. My approach is to always make sure that IF there are confounding factors causing skin barrier issues that we address those too.
Issues with weakened skin barrier happen with underlying rashes as well as with rosacea. They cause skin inflammation and increased skin "porosity" such that even mild products get through the skin barrier too easily and cause inflammation, irritation, sting, and redness.
Healing skin barrier is critical for skin care product tolerance.
If the barrier weakness is due solely to rosacea, we do what I call a "rosacea cool down". This will also help heal skin inflammation from many of the conditions I mentioned above once the cause has been identified and eliminated.
We usually need to do the cool down for two months before we can begin rosacea treatments. This is because it takes 2 months to restore skin barrier integrity - several weeks for each of the 3 key stages in the healing process: 1. eliminating the inflammation, 2. replacing damaged epidermal layer of living cells, 3. replacing damaged stratum corneum layer of dead cells. And, that's in a best-case scenario!
Again, the aim is to quiet inflammation to allow the skin barrier to heal. Exactly how I do this cool down varies from patient to patient. In general, my "Rosacea Cool Down" looks like this,
Dr. Cynthia Bailey's Rosacea Cool Down Treatment
- I usually have my patients cleanse their skin with a pH balanced hypoallergenic skin cleanser such as VaniCream Cleansing Bar, Aquanil Cleanser (which you are using), or Toleriane Cleanser twice a day. I recommend washing with tepid to cool water which helps constrict skin capillaries to shunt inflammatory mediators away from the red and sensitive skin. This is a general dermatologic principle in reducing skin inflammation from a variety of causes.
- They then apply Green Tea Antioxidant Skin Therapy right after towel drying their skin. The pharmaceutical pure and stable EGCG polyphenol antioxidants help replenish exhausted skin antioxidant reserve squandered in the rampant inflammation. Combined with caffeine, this combination is key to healing redness. The product is hypoallergenic and soothing to all skin types. The antioxidants are equivalent to those found in 500 cups of brewed green tea per ounce of cream and I consider this product therapeutic.
- I then have them apply a very thin layer of bland oil as a "safe" moisturizer immediately after washing and the Green Tea. We pick this oil depending on what does not sting their particular skin. Options for "safe" oils include canola oil, extra virgin olive oil, extra virgin coconut oil, or jojoba oil. This is important because dry skin just doesn't easily regain its barrier strength and skin lipids (oils) are a key component of skin barrier. My top choice is the jojoba oil which is very similar to skin sebum and very hypoallergenic. The oil must be pure and contain no additives.
- If the skin is really inflamed, I try to use the most tolerable non-halogenated cortisone that I know, which is Locoid Ointment. We use this in place of the oil because the ointment base will act as a moisturizer. Locoid Ointment can sting some people's skin though and occasionally I need to have hydrocortisone compounded in whatever topical ointment or cream they know their skin will tolerate. Cortisone application is often key to quieting inflammation but it's a short-term solution since cortisones dependency can be a problem for rosacea. Please note that the term 'non-halogenated' is very important and this treatment should be guided by a physician that knows what that means!
- We sometimes also need to use oral tetracycline (which is not available in the US right now, hello Washington, anyone going to address that!) or doxycycline for a few months. These antibiotics may be working because of their anti-inflammatory properties, not their antimicrobial, we don't know, but they do help rosacea so we use them.
- I have my patients strictly avoid the sun by wearing hats and ideally using a pure mineral zinc oxide sunscreen too because sun can trigger rosacea. I've had pretty good tolerance with my most sensitive skin patients to my hypoallergenic and pure zinc sunscreen Sheer Strength Pure Physical Spray SPF 50+ Sunscreen. The added benefit of this product is that it won't accentuate any facial flaking because it is entirely clear.
- Mineral makeup or my Sheer Strength SPF Refresh Powder Sunscreen can be applied on top to help soften the redness. I don't recommend liquid makeup until the skin barrier is repaired - and even then, I prefer mineral makeup powders for sensitive rosacea-prone complexions.
- I have them avoid things that trigger their rosacea (foods, temperatures, etc.).
- I recommend they eat a diet that does not fuel inflammation, meaning a veggie-heavy diet, and take probiotics or eat probiotic-rich foods.
You can find links to the products I mentioned highlighted in the text above. They are the tools in my toolbox and I have them on my site because, in my experience, they are the best for treating sensitive skin from rosacea.
When a patient comes back for examination of their skin in two months, we see how their skin looks and then try to craft a more sustainable skin care regimen to treat and suppress their rosacea.
I have created my Dermatologist's Rosacea Therapy Skin Care Kit with the top products that I use to create a Complete Skin Care Routine to help control rosacea long term.
To learn more about rosacea click here for my article on rosacea.
I also have a popular 5 part article series on rosacea which you can find here. It includes some of my natural remedies for rosacea, including diet suggestions. Here in the Northern California Wine Country, people are interested in natural remedies for health problems and I've learned a lot of really good tricks from my patients over the years as they've experimented with natural remedies for rosacea.
Your question is excellent and I've given you a thorough - though complex answer to your question. The most important point is that the sort of exquisitely sensitive skin that you describe requires accurate diagnosis of any confounding problems and then a multi-staged customized approach, and even then, it's a tricky situation.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.