Dermatologist Recommended Rosacea Treatment & Skincare Routine

Understand the Treatment Options and Products to Control Rosacea

For over 35 years, I've helped my patients find effective solutions for rosacea, a journey that has also been my own. In this comprehensive guide, I'll share my proven, holistic approach to controlling rosacea by combining my specific skincare routine, hand-selected products, and when needed, the right medical treatments. You'll learn the steps to soothe redness, calm flare-ups, and build a strong foundation for long-term skin health.

My patients have seen firsthand that my regimen and products focused on restoring the damaged skin barrier and fighting inflammation helps quiet flushing and stinging, making their skin less sensitive to rosacea triggers.

Complete Holistic Skincare Routine to Control Rosacea

Nope, you can't skip a step when you have rosacea! Rosacea control requires a holistic rosacea-friendly skin care routine that helps to restore the damaged skin barrier and fight inflammation.

Use only compatible rosacea-friendly products for each of the 4 essential steps of skin care:

1. CLEANSE - Cleansing your skin removes the buildup of skin microbes that can exacerbate rosacea.
2. CORRECT - This step is where you are trying to calm rosacea.
3. HYDRATE - Your damaged skin barrier won't heal without a good moisturizer.
4. PROTECT - Your rosacea will flare up with UV ray exposure.

All the compatible products you need for each step are in my Rosacea Therapy Kit.

Let’s go through the steps below. If you use prescription topical medicines or Rx cleansers, I’ll guide you on where to fit these into your regimen.

Once your rosacea is in remission, it is possible to exfoliate and/or use age-fighting products if you are careful. I explain how to do this later in this guide.

4 Step Rosacea Skincare Routine

1. Cleanse

• Morning: cleanse skin with a 2% pyrithione Calming Zinc fortified soap (from the Rosacea Therapy Kit).
• I developed this antimicrobial cleanser for my sensitive skin (see my important notes about treating sensitive skin below) rosacea patients because it's a gentle yet effective way to deliver treating ingredients.
• Alternatively, prescription Sodium Sulfacetamide Sulfur cleanser (a sulfa antibiotic and sulfur combination) can be highly effective when medical treatment of rosacea-prone skin is needed.
• Night: cleanse skin with pH balanced soapless Extremely Gentle Foaming Facial Cleanser (included in the Kit).
• In my experience, the best tolerated cleansers are pH balanced synthetic detergent cleansers such as this cleanser. Alternatively you can try Vanicream Cleansing Bar or Toleriane Cleanser.

Most rosacea-prone complexions have abnormally-sensitive facial skin due to compromised skin barrier strength. This means that any irritating products or treatments (such as anti-aging or acne treatments) may not be tolerated. - Dr. Bailey

2. Correct

• To correct out of balance skin inflammation, my patients apply the anti-inflammatory Green Tea Antioxidant Skin Therapy first, right after the cleansing and towel drying. It is part of the Rosacea treatment kit as well.
• This high concentration green tea antioxidant, caffeine, and hyaluronic acid formulation replenishes the skin's antioxidant reserve, which we know is depleted from chronic rosacea-induced inflammation.

• For oily pustular rosacea and inflammation, try applying Benzoyl Peroxide Cream 2 times a day to active areas. It can be irritating but can often be very uniquely appropriate and can possibly address mites. (see more below on treating oily skin)
• Facial dandruff often occurs with rosacea and needs to be addressed. The Calming Zinc Soap at the Cleansing step and Green Tea Antioxidant Skin Therapy is often sufficient to control both conditions. If not, I have my patients apply clotrimazole cream 2 times a day until their facial dandruff is under control.
• If topical medicines are being used, I have my patients layer those on top of the Green Tea cream.

Learn more about medical treatment options in my through guide: Rosacea Medical Treatments: Creams, Topical & Oral Medications, and Procedures

3. Hydrate

Moisturizers are key to heal and maintain the compromised skin barrier of rosacea. Your skin won't heal if it is not properly hydrated.

1. Hydrate your skin with Daily Moisturizing Face Cream (included in the Kit) applied over the products you used in the Correct step above. It is fortified with ceramides and squalane to support the skin barrier.
2. Add a few drops of the Omega Enriched Face Booster Oil (not included in the Kit) to the Moisturizing Face Cream in your palm, mixing them together then applying to your face.
• Your skin will benefit from the essential oils (such as sea buckthorn) and castor seed oil.
• This is especially helpful to dry complexions and in dry climates.
3. At night, you may even want to replace the Moisturizing Cream with the Omega Oil directly to your face.

Choose only non-irritating moisturizers based on your skin type. Avoid AHAs, BHAs, vitamin C, etc. See more about what to look for/avoid below.

Note for People with Papulopustular Type Rosacea

People with oily papulopustular rosacea may not want to use a moisturizer. Non-oil hydrating ingredients such as hyaluronic acid in the Green Tea Antioxidant Skin Therapy will help increase skin moisture and may provide sufficient hydration for oily skin, especially in the oily T-zone.

Further Your Knowledge

Understanding Rosacea - Symptoms, Types, Triggers & Treatment

4. Protect

Sun plays a role in triggering rosacea, especially the erythematotelangiectatic type. I prefer entirely mineral physical sunscreen ingredients (5% or more zinc oxide and titanium dioxide).

• Apply the non-irritating Sheer Strength Physical Matte Tinted SPF 50+ Sunscreen (included in the Kit) every day to prevent UV triggering of rosacea.
• It provides broad spectrum high SPF protection in hypoallergenic and non-irritating formulations that are ideal for sensitive skin such as rosacea-prone complexions.

Know that many sunscreens are a blend of mineral and chemical ingredients and may contain ‘brightening’ ingredients that can irritate sensitive skin.

For over 35 years, I've given my patients hand-written instructions for their skin care routine. I finally realized that this was always what I was writing down for my rosacea patients. We fit in their prescription topical medicines, but this has been the foundation routine. All compatible products you need are in this Kit.

Anti-Aging Skin Care Routine

Be cautious when incorporating anti-aging products into your skin care routine when you have rosacea. The most effective anti-aging products can be irritating to sensitive skin. I only introduce them when rosacea is in remission and the skin barrier had a chance to heal for at least a few months.

Your Step-by-Step Anti-Aging Skincare Guide

Here’s an overview of adding retinoids to your skincare treatment.

• Follow the rosacea skincare routine described above as your foundation.
• Apply retinoids at night; they break down on contact with light.
• I start at the lowest levels. My patients apply them only 1 or 2 times a week at bedtime then very slowly work up to a nightly application over 2 to 3 months.
• Retinol Anti-Wrinkle Night Cream is much easier to add and less irritating than tretinoin. It contains pharmaceutical grade green tea antioxidants to help calm skin.
• Dilute Retinol to lower strength by mixing it in your palm with the Moisturizing Face Cream (from the Rosacea Kit) before applying.
• My patients have done this for years and the technique allows you to start “low and slow” with this great age fighting ingredient.
• If any early dryness develops, I have them stop using the products until the skin has returned to normal; then, they resume the slow process.

For a detailed step-by-step guide, I walk you through a complete rosacea anti-aging skincare routine and explain your options and my recommendations here:

Retinol, Retin A & Tretinoin for Rosacea: Best Anti-Aging Treatment

Your Anti-Aging Rosacea Skincare Kit

For your foundational rosacea skincare treatment use the compatible products in my Rosacea Therapy Kit. Add in my Retinol Ultra-Intensive Anti-Wrinkle Night Cream by following the steps above.

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Using Tretinoin?

If your doctor prescribed tretinoin for you, you will find the steps along with helpful tips on how to layer it with other products in your skincare routine, in my guide here: How to Apply Tretinoin Cream: A Guide to Demystifying Its Use

Other Anti-Aging Skincare Products

The acid pH of many of the other anti-aging skin care products, such as vitamin C and AHAs (i.e. glycolic acid) products make them poorly tolerated by sensitive skin, especially the erythematotelangiectatic type of rosacea. Persons with papulopustular rosacea may, however, do surprisingly well with acid pH anti-aging products once their rosacea is controlled.

My favorite over the counter anti-aging products are retinol and Glycolic Acid Anti-Wrinkle Cream. I always recommend starting AHA, vitamin C, or retinoid products with the lowest strength 1 or 2 times a week and working up to daily use of the highest strength tolerated.

Treating Highly Sensitive Skin from Rosacea

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. Example:

I am a 59-year-old woman with diagnosed rosacea for 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.

When someone talks about sensitivity sufficient enough to cause widespread product intolerance and dryness, I start looking for a confounding diagnosis along with the rosacea. My approach is to make sure that IF there are confounding factors causing skin barrier issues, we address those too. This requires accurate diagnosis and a multi-staged customized treatment plan, and even then, it's tricky.  In my experience, a skincare routine specifically developed for sensitive skin can offer significant help.

Some common conditions other than rosacea that cause facial redness and skin sensitivity are allergic or irritant contact dermatitis, photosensitivity conditions such as a medicine causing sun sensitivity, facial dandruff (seborrheic dermatitis), severe skin inflammation from demodex mites.

Rosacea Cool Down Before Treatment

If the barrier weakness is due solely to rosacea, I do 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.

Before starting the rosacea treatment, we need to do the cool down for 2 months to restore skin barrier integrity - several weeks for each of the key stages in the healing process: eliminate the inflammation, replace damaged epidermal layer of living cells, replace damaged stratum corneum layer of dead cells, and then the rosacea treatment begins.

After the cool down my patients follow the 4 rosacea treatment steps I outlined above. All the products you will need for this routine are included in the Rosacea Therapy Kit.

Here are the cool down steps I have my patients follow when treating sensitive skin from rosacea:

1. Cleanse with Extremely Gentle Facial Cleanser. It is pH balanced hypoallergenic. Alternate with Calming Zinc Bar Soap at night.

2. Replenishes exhausted skin with Green Tea Antioxidant Skin Therapy after towel drying.

3. Choose a moisturizer to apply immediately after the Green Tea

• Apply a very thin layer of bland oil as a "safe" moisturizer.
• This is a crucial step because dry skin struggles to regain its barrier strength.
• Choose an oil that doesn't sting, such as canola, extra virgin olive, or extra virgin coconut oil. My top choice is jojoba oil as it is hypoallergenic and very similar to your skin's natural sebum.
• The oil must be pure and free of any additives.
• If the skin is really inflamed, in place of the oil, I try to use the most tolerable non-halogenated cortisone that I know, which is Locoid Ointment.
• Locoid Ointment can sting some people's skin though and occasionally I need to have hydrocortisone compounded in a 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 dependency can be a problem for rosacea.
• Treatment should be guided by a physician who understands the importance of “non-halogenated”.

4. Sometimes antibiotics are needed, like oral tetracycline (which is not available in the US right now, hello Washington, anyone going to address that!) or doxycycline for a few months.

5. I have my patients strictly avoid the sun by wearing sun protection hats and using my mineral zinc oxide Matte Tinted Sunscreen.

6. Pure mineral makeup powder 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. See more about using makeup when you have rosacea below.

7. Avoid things that trigger rosacea.

8. Eat a diet that does not fuel inflammation and make lifestyle changes. Learn all about these in my guide: Food & Lifestyle Choices That Can Trigger or Help Reduce Rosacea

Oily Skin and Rosacea

It's common to have a combination of oily skin, blackheads, clogged pores and rosacea! However, treatment can be tricky since the first-choice products we use to treat blackheads and oily skin can aggravate rosacea.

Skin Care Regimen for Rosacea and Oily-Skin Types

1. Begin with a "Rosacea Cool Down" - This won’t worsen blackheads or clogged pores, but will treat your currently inflamed rosacea. Follow the cool down skincare steps described above.

All of the products you’ll need come in my Rosacea Therapy Kit.

2. Next tackle your clogged pores and blackheads

• Best method: use a sonic skin cleansing system such as the Foreo or Clarisonic.
• Note: there is no guarantee that the rosacea-prone areas of the cheeks or forehead will react well to sonic cleansing, which is why I start slowly and carefully using the lowest settings with the Delicate Brush for extra-sensitive skin.
• For blackheads: use a retinoid such as Retinol Night Cream.
• Note: it is tricky to use a retinoid with rosacea-prone skin but it is possible for certain areas of the face. I explain how to properly apply retinol under the “Directions” tab on the Retinol Night Cream page.
• Another option to get rid of blackheads in rosacea-prone skin is my alcohol-free Benzoyl Peroxide Acne Treatment Cream. Apply only to the blackhead-prone areas: nose, chin, and between the brows. This method is only a test since it may cause a rosacea flare-up, so start the application gingerly.

Natural Treatment for Rosacea

For naturally treating rosacea, it's essential to understand that rosacea-prone skin is sensitive and has a weakened barrier, which makes it easy to irritate. A natural treatment plan, therefore, focuses on nurturing the skin from the inside out and the outside in. This includes making rosacea conscious diet and lifestyle changes, which a dermatologist can advise on, and using specific skincare strategies to control redness and acne.

Key points of a natural approach include:

• Adopt a rosacea-friendly diet that avoids common triggers.
• Make lifestyle adjustments to reduce inflammation.
• Use herbal and other botanical skincare products that are gentle on sensitive skin.
• My Rosacea Skincare Kit allows your skin to heal naturally and resist rosacea flare ups.

For a full guide on a natural rosacea treatment, read more here: Dermatologist’s Natural Treatment of Acne Rosacea

Selecting the Right Skincare Products for Rosacea

The best skin care routine for your rosacea-prone complexion targets the known driving factors behind rosacea. These include products that,

• help to heal the fragile skin barrier
• calm inflammation
• address the Pityrosporum yeast that often over-grows on rosacea-prone complexions
• protect facial skin from UV rays that can trigger rosacea

Ingredients to Look for and What to Avoid

With rosacea, you need to be ultra-cautious with your skin care choices. Common categories of rosacea-unfriendly products include:

• acne products
• anti-aging products
• "natural" products stuffed with high concentrations of essential oils - like citrus
• chemical sunscreens

To help you understand how to build a rosacea skin care routine, here is how I do it.

Cleansers

• Use a pH balanced type cleanser called a synthetic detergent cleanser (Syndet). My top choice is Extremely Gentle Facial Cleanser (which is what I use and is in my Rosacea Therapy Skincare Kit) or VaniCream Cleansing Bar.
• I alternate the pH balanced cleanser with a cleanser that contains ingredients aimed at the facial microbe population that impacts rosacea. My top choices:
• Calming Zinc Bar for rosacea (included in the Kit) is fortified with 2% pyrithione zinc
• prescription sodium sulfacetamide/sulfur cleansers
• note that both of these will also address seborrhea

• Oily skin suffering from papulopustular rosacea may respond nicely to benzoyl peroxide cleansers such as my Foaming Benzoyl Peroxide Acne Treatment Cleanser.
• I avoid facial toners for all but the oiliest rosacea complexions. If I do use them I stick with alcohol free/gentle products only such as my Naturally Hydrating Pore Minimizing Rose Tone.
• I avoid harsh cleansers or cleansers with acid ingredients such as AHA cleansers, except for only the oiliest papulopustular rosacea.
• Avoid scrubbing or exfoliation unless your rosacea inflammation is entirely controlled and your skin tolerates it.

For Correcting Rosacea Complexion

Use products that help reduce inflammation and capillary blood flow and flushing, both of which drive the symptoms of rosacea. Medicines that reduce skin microbes can also treat rosacea.

• The single best product for rosacea skin care is high concentration green tea ECGC polyphenol antioxidants combined with caffeine.
• Every rosacea patient in my practice uses Green Tea Antioxidant Therapy Cream (included in the Rosacea Kit) fortified with resveratrol because it works so well. It’s made with pharmaceutical grade EGCG polyphenol antioxidants extracted from 500 cups of brewed green tea per ounce of cream.
• Papulopustular rosacea with clogged pores may benefit from a salicylic acid alcohol-free product applied where the pores are clogged.
• Avoid anti-aging products with AHAs (called alpha hydroxyl acids including glycolic acid and lactic acid among others), BHAs (most notably salicylic acid), vitamin C (which needs to have a very acid pH) and retinoids (retinol and prescription tretinoin). Of these, the retinoids are the ones I can often coax a rosacea complexion to tolerate once I have it entirely controlled with my Rosacea Therapy Kit routine (see the routine above).

The Green Tea Antioxidant Skin Therapy helps to calm my red rosacea prone complexion like nothing else. MKR

Moisturizers

Your moisturizer should prevent transepidermal water loss (TEWL), replenish skin barrier components such as ceramides, phospholipids and squalane, and contain humectants such as glycerin and hyaluronic acid.

• Keep product ingredients simple to lower the risk of accidentally using a product with something that irritates rosacea.
• My rosacea patients do really well with my Daily Moisturizing Face Cream (included in the Rosacea Therapy Kit).
• It’s lightweight for even the most oily papulopustular type 2 rosacea yet barrier replenishing enough for type 1 rosacea because it contains ceramides and squalane.
• Good ingredients to look for are hypoallergenic oils such as jojoba, glycerin, hyaluronic acid, squalane, dimethicone and ceramides.

• Avoid botanical ingredients such as tea tree, camphor, citrus and rosemary oil, especially in higher concentrations.

• Avoid taunting ingredients such as AHAs, BHAs, vitamin C and even niacinamide. I have seen all of these cause redness and irritation in my rosacea patients.

After years of using high-end French and German skincare products, I finally found the best moisturizer of all and also for half the cost. It's light but highly effective and with zero fragrance. Thanks so much, Dr. Bailey. Frances

• A botanical natural moisturizer option is my Natural Face, Hand and Body Lotion.

Sun Protection

UV rays have been proven to trigger rosacea, especially the erythematotelangiectatic type.

• Mineral sunscreen is tolerated the best.
• Avoid any white cast by selecting a tinted product that contains iron oxide.
• Yes, this is important; iron oxide helps block some of the visible and digital screen light that also damages skin. The tinting technology in my pure mineral Matte Tinted Sunscreen blends into all skin tones to become invisible (it doesn’t look like you are wearing a tinted product)
• The matte base absorbs oil on the sebaceous complexions of papulopustular rosacea, works really well on a man's textured facial hair bearing skin, great under makeup, and the tinting softens complexion flaws.
• I do not recommend chemical sunscreen ingredients. They can sting and irritate sensitive rosacea skin, and also generate a slight amount of heat as they block UV rays.
• Avoid sunscreens with 'anti-aging' ingredients because they are usually irritating.

Over the years I have become very particular about sunscreen formulations because not all products work well, especially for my sensitive skin patients like those with rosacea. I have created a small collection of pure mineral sunscreen products that I trust for my rosacea patients.

Overwhelmed with the Intricacies of Your Complexion and Rosacea-Prone Skin?

Try my Rosacea Skincare Therapy Kit for a good skin care routine that's been proven successful by my many thousands of rosacea patients. This is what I use on my own tricky rosacea-prone face.

Just start with the Calming Zinc soap bar once a day alternating with the Extremely Gentle Cleanser. Apply the Green Tea and Daily Face Cream twice a day. Apply the Sunscreen during the day. See how it goes. You can add more later once you see how your complexion responds.

What if Rosacea Flares Up?

Rosacea-prone skin is sensitive and has weakened barrier strength, meaning it's easy to irritate. Facial acid peels, massage, or mechanical stimulation such as microdermabrasion and dermaplaning may trigger rosacea flare-ups. Many of the products used in facials targeted for acne or anti-aging concerns will include rosacea taunting ingredients.

Having rosacea means that you have to be cautious, patient and ‘sneak up’ on your skin when it is entirely controlled. This means:

1. Testing them on a small part of your skin for several weeks
2. Trying them only when your rosacea is controlled
3. Choosing lower strengths and/or starting with less frequent applications.

When a flare-up occurs, it's an "all stop" on the products that could wake up the beast, and back to the rosacea cool down regimen. When the inflammatory phase is once again quiet, then resumption of the blackhead and clogged-pore treatment can be gingerly restarted.

Learn more about rosacea causes in triggers and how to prevent flare-ups.

IF you think your skin will tolerate it, consider re-trying a potentially irritating product, but using it less frequently and on the less sensitive parts of your face. Remember, a serious flare up of rosacea can leave lasting marks on your skin.

If your rosacea is really flaring up, consult a dermatologist to determine if a prescription is necessary. Some of my prescription approaches to rosacea are outlined in my post Prescription Medicine and Cosmetic Procedures to Treat Rosacea.

Medical Treatments and Procedures

Topical & Oral Medications

Dermatologists use a range of prescription and "off-label" topical treatments, which must be carefully integrated into your skincare routine. I typically advise my patients to apply medicated treatments after a calming Green Tea Cream but before moisturizers or sunscreen. While some topical medicines can be very effective, they can also be irritating.

My personal preference for addressing facial mites is an "off-label" use of permethrin cream due to its cost-effectiveness and proven effectiveness. I do not use tacrolimus or pimecrolimus for rosacea.

Procedures & Devices

Laser and light treatments can also be beneficial. I have used Intense Pulsed Light (IPL) for years to help reduce facial redness. Other laser and light technologies are also available.

Important Considerations

Relying solely on prescriptions often leads to frustration. Rosacea is a chronic problem with many treatment options, but every prescription and procedure carries potential pros and cons that must be weighed against possible side effects.

My thorough cosmetics procedures and medical rosacea treatments guide walks you through the options and considerations.

Disclaimer: Only your treating doctor or skincare professional can determine if a treatment is safe for you. All treatments have risks, and this information is intended solely to help you start a conversation with your healthcare provider.

Makeup and Rosacea Prone Skin

What’s the Best Makeup for Rosacea?

Pure mineral makeup powder is tolerated best due to its ingredient simplicity and provides additional sun protection when applied on top of sunscreen.

My oil-free Pressed Mineral Makeup Powder, Baked Mineral Makeup Powder, and Loose Mineral Makeup Blush are elegant, natural and ideal for rosacea-prone skin, plus, they provide long lasting coverage with a fine natural finish. My mineral makeup is well-priced and high quality.

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Further Your Knowledge

• Makeup Tips & Healthy Skin Care Best Practices

Final Considerations

The bottom line with treating your rosacea-prone complexion and understanding the symptoms, types and triggers:

Whether your rosacea is active or in remission, your skin is still sensitive and has a more porous barrier strength than normal skin. That’s why you need carefully-selected skin care products and a holistic rosacea-friendly skin care routine to prevent rosacea flare-ups.

And, it's why I created my Rosacea Therapy Kit - I take the guesswork out of a rosacea-healing skin care routine.

My Kit is built from the many routines that I customized for my rosacea patients over 35 years of practice. It’s also the same routine that I use to control my own rosacea. Give my Rosacea Kit a try and let me know how it worked for you.

References

1. Mikkelsen, Carsten Sauer et al. “Rosacea: a Clinical Review.” Dermatology reports vol. 8,1 6387. 23 Jun. 2016, doi:10.4081/dr.2016.6387
2. Rainer, Barbara M et al. “Rosacea: Epidemiology, pathogenesis, and treatment.” Dermato-endocrinology vol. 9,1 e1361574. 4 Oct. 2017, doi:10.1080/19381980.2017.1361574
3. Andrew F. Alexis, MD, MPH, Valerie D. Callender, MD, Hilary E. Baldwin, MD, Seemal R. Desai, MD, Marta I. Rendon, MD, Susan C. Taylor, MD.
   "Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience", JAAD Sep. 2-18