Rosacea: New Treatment Ideas and Scientific Developments

Demodex mites in rosacea - it's trending scientific information! Anyone with rosacea knows how frustrating it is and how few good treatment options there are to sustain a remission. I’ve long been treating my rosacea patients with medicines and skin care recommendations that are more art than science out of necessity. 

I've been treating facial demodex mites in rosacea patients for years.

I developed my recommendations based on what worked for my many rosacea patients and observations I made under the microscope on skin biopsies.  Recent scientific studies are giving us some interesting information that supports my art-based treatment methods and I'm thrilled. As scientists learn more about rosacea, I'll be able to build on their findings and refine my treatment recommendations even further.

Rosacea is a common, frustrating and often disfiguring inflammatory facial rash. In spite of years of excellent scientific studies, the cause of rosacea remains elusive.  In the entire 30 years that I've practiced dermatology, the standard rosacea therapies have relied on oral and topical antibiotics.  Many of my patients are unwilling to use antibiotics long term so I’ve worked hard to find alternative treatments to help them.

My rosacea skin care treatment always starts with the routine to calm rosacea that can be found in my Rosacea Therapy Skin Care Kit. It covers all the bases and we build up from there. 

What's new is that scientists are starting to rethink the significance of mites in rosacea!

• We've always known that every person has Demodex mites in their skin pores (yes, it's unsavory but true).
• We’ve also always known that people with rosacea have even more mites in their pores than normal.

Because everybody has Demodex mites doctors have ignored their presence.  I haven’t. I'd see mite stuffed pores under the microscope as an incidental finding on skin biopsies. I'd noted that it often correlated with run-away rosacea. I’ve been treating Demodex mites for years and found that my rosacea patient’s skin improves when I do!

Results of recent scientific papers suggest a significant role for Demodex mites in driving rosacea in both facial skin and eyes.  Even more interestingly, one of the papers suggests that it’s not just the mites, it’s a protein on a bacteria that the mites carry that causes some of the inflammation of rosacea - wow, this could be why antibiotics have helped all these years!

What are my current skin care recommendations for rosacea?

I teach my patients to build a Dr. Bailey Complete Skin Care Routine™ made of compatible products aimed at healing rosacea and supporting remission. This always yields the best results, especially in a temperamental skin problem such as rosacea.

Complete Skin Care involves the 4 essential steps of: CLEANSE, CORRECT, HYDRATE, PROTECT. With rosacea the hydrate is important because barrier integrity is weak in rosacea-prone skin. Skin won't heal if it is not properly hydrated. Protect is important because UV exposure can trigger rosacea flares. I created my Rosacea Therapy Kit to take the guess work out of building a healing skin care routine for those suffering from rosacea. 

Here is what a rosacea skin care routine often looks like in my practice:

CLEANSE skin twice daily. Perhaps mites can be washed off if they are outside of the pores. If possible, use a Clarisonic Sonic Brush system or other sonic skin cleansing system like the Foreo to pulse cleanser into the pores to help the mites dislodged and out.

At least once daily use a 2% pyrithione zinc fortified soap to help balance a skin yeast germ called Pityrosporum that also grows abundantly on rosacea-prone complexions. If necessary, I may choose a cleanser with sulfa drugs in it for non-allergic patients.

If skin is dry or irritated, a pH balanced soapless cleanser such as Extremely Gentle Foaming Cleanser may be soothing. Always rinse skin really well after cleansing because retained cleanser will irritate skin and continue to pull skin lipids out of skin layers. Many of my patients alternate Calming Zinc with Extremely Gentle Cleanser.

If large pores are a problem, I use my Naturally Hydrating Pore Minimizing Toner made with organic witch hazel as a second cleansing step to unclog pores so demodex can't hide behind debris. 

CORRECT out of balance skin inflammation with Green Tea Antioxidant Skin Therapy. I always have my patients apply this first, right after toweling skin dry. The pharmaceutically pure and stable green tea polyphenols are equivalent to what is extracted in 500 cups of green tea. 

This popular topical product loads the skin's antioxidant reserve to help fight skin stressors - perhaps from the living conditions of what is going on in the pores?! If topical medicines such as Metrogel, Finacea or Soolantra (which specifically kills demodex mites) are being used I have my patients layer those on top.

(Pro-tip: I prescribe the very economical permethrin cream to my rosacea patients and have them use it on their face and neck twice a day for a week and then several days a month to control demodex. Ask your dermatologist if this might be right for you.)

Benzoyl Peroxide  can also possibly address mites. It can be irritating but can often also be very uniquely appropriate for oily pustular rosacea.  

HYDRATE skin with Daily Face Cream for Normal to Oily or Normal to Dry skin. I created a kit with the most popular product combination which includes Calming Zinc Soap, Green Tea Antioxidant Skin Therapy and Daily Face Cream for Normal to Oily skin. I call it my Facial Flaking and Redness Solution Kit - because it is!

PROTECT with a mineral zinc oxide broad spectrum sunscreen. My top choice for daily sun protection forrosacea prone complexions include or Sheer Strength Physical Matte Tinted SPF 30+ Sunscreen. This non-irritating sunscreen is lightly tinted with iron oxide to help hide complexion flaws.

The iron oxide also helps filter visible and blue screen light known to cause skin damage. It blends in well to all complexion skin tones, including really fair skin. Men love it too because it does NOT look like makeup. The matte texture also helps hide oily shine. This is my top sunscreen recommendation for rosacea. 

What is the best complete skin care routine to help heal your rosacea-prone complexion?

I put the routine together for you in my Rosacea Therapy Skin Care Kit and select the Sheer Strength Pure Physical Invisible Sunscreen and you select the right facial Daily Moisturizing Face Cream for your skin oil type. Add the Naturally Hydrating Pore Minimizing Toner if you have clogged and large pores. 

The bottom line with mites and rosacea:

The new research results are exciting and I expect that soon we’ll have more treatment medicines for facial Demodex mites, and that these medicines will help to control rosacea.

If you would like more info on Rosacea please see my Advice Page and scroll down to the Glossary where you will find a listing of my most popular rosacea articles

References

Zhao YE, Wu LP et. al., Retrospective analysis of the association between Demodex infestation and rosacea,  Arch Dermatol. 2010 Aug;146(8):896-902

Elston DM, Demodex mites: facts and controversies, Clin Dermatol. 2010 Sept-Oct;28(5):502-4

Li J, O’Reilly N, et. al., Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea, Ophthalmology. 2010 May;117(5):870-877

Gao YY, Di Pascuale MA, In vitro and in vivo killing of ocular Demodex by tea tree oil, Br J Ophthalmol 2005 Nov;89(11);1468-73

Author: Dr. Cynthia Bailey M.D. is a Board Certified dermatologist practicing dermatology since 1987. She has done well over 200,000 skin exams during her career and authors the longest running physician written skin health blog in the world.