Hello Dr. Bailey,
I just love your newsletter and blog posts; I have learned so very much from you.
I have had rosacea for at least 15 years. I have been on the sulfacetamide lotion, Metrogel, and Finacea gel. I had stopped using the sulfacetamide lotion for 2 years. I thought my rosacea was getting better. This year I was diagnosed with seborrheic dermatitis (facial dandruff) on my face out of the clear blue. My dermatologist put me on Noble Zinc Soap, sulfacetamide lotion (night & morning), ketoconazole cream at night, and Finacea Gel in the morning.
Since reading your blog I now use the Replenix Power of 3 Cream. What a beautiful cream and what a difference it has made in my skin. I also bought the eye cream because of your review on it, and what an anti-aging difference that has made.
My questions is, I think that the Finacea is slightly drying my face, I use it first before the Replenix because I like to use the Replenix as my moisturizer. Do you think I should stop using the Finacea? Is it bad for my seb dermatitis, because I still see the dry skin around my nose area a bit. Could the Finacea be preventing a total clear up of the facial dandruff? I was just thinking of using the zinc soap, the sulfacetamide lotion and the Replenix cream.
Thank you very much for your help!
Laura B.
Hello Laura,
Thank you for your kind words about my blog and newsletter; I’m glad you’ve found helpful information here. I can give you general information about how I handle this combination of skin problems in my practice. You can discuss this information with your dermatologist.
Both rosacea and facial dandruff (seborrheic dermatitis) can cause rashes that result in red flaking facial skin, but the facial dandruff is more likely to cause flaking in the creases of the nose. What’s really important to know is that the rashes from both facial dandruff and rosacea cause a compromise to your skin barrier integrity. This means that the involved skin is very easily irritated by harsh products. It’s also more sensitive to harsh climactic conditions or strong skin cleansers.
Seborrheic dermatitis (facial dandruff) and rosacea often coexist, as you have experienced. They can flare up together or one at a time. I tell my patients who suffer from this frustrating combination of skin problems, when either of these conditions has become persistent then we need to protect the involved skin from everything that is irritating. This allows the rash to subside so that the skin barrier integrity can be repaired. The process requires applying only non-irritating products to the skin so it can recover. I call this a Rosacea or Seborrheic Dermatitis Cool-Down.
This “cool-down” skincare routine is important because applying irritating products to barrier-compromised skin is like squeezing lemon juice on a cut, meaning it prolongs inflammation and slows healing. Healing of the compromised skin barrier is supported by the using only bland moisturizers and soothing products. Unfortunately, Finacea can be irritating to some skin types. There is individual variation in terms of product tolerance and I always ask patients what products their skin tolerates and what products it doesn’t. For the “cool down” we use only products their skin tolerates well.
Rosacea or Facial Dandruff Cool-Down Skin Care Routine for my dermatology patients:
Twice daily, cleanse facial skin with one of the following cleansers (they can be alternated depending on skin tolerance and need):
- Toleriane Cleanser (the least irritating option)
- Sodium Sulfacetamide Prescription Cleanser
The latter two products can dry or irritate some people so the question of skin tolerance is important in picking which cleansers we use for the cool down.
After cleansing, I have my patients apply in this order:
- Green Tea Antioxidant Skin Therapy/Replenix Power of Three or Replenix CF Cream because the skin’s antioxidant reserve is stressed by inflammation. I believe the antioxidant replenishment is one of the main reasons that the Green Tea Antioxidant Therapy/Replenix Power of Three makes such a big difference for healing facial dandruff and rosacea.
- Clotrimazole cream to calm seborrheic dermatitis where it has been flaring up.
- A soothing moisturizer to all of the facial skin that feels like it needs a richer moisturize. Good options include my Daily Facial Moisturizing Skin Creams matched to your skin type.
My Seborrhea and Rosacea Cool-Down Skin Care Routines also may include:
- Prescription medicaments that are non-irritating to treat rosacea or seb derm, if necessary (e.g. Cleocin Lotion, Sodium Sulfacetamide Lotion, Metrogel, or Metro Cream and occasionally permethrin cream, all according to their dosage requirements). I usually have my patients apply these after the Green Tea because products with lighter bases are often better applied before those with heavier bases.
- A very mild cortisone cream such as 1% hydrocortisone cream. I have them use this only where the rash is red, and for usually no more than 2 weeks. I, as my patient’s treating physician, always supervise the use of this because there are side effects. I only use “non-halogenated” (a term a doctor will understand) cortisone products on the face.
- Pure mineral zinc oxide sun protection, because both of these skin conditions can flare-up from sun exposure. Pure mineral zinc oxide sunscreens that are non-irritating and perfect for sensitive (aka barrier compromised) skin include Suntegrity 5 in 1 BB Cream, Glycolix Elite Sunscreen, or Suntegrity Baby Sunscreen.
I have my patients do this Cool-Down Skin Care Routine for 2 months, which is what is necessary to settle down skin inflammation. Stopping too soon results in relapse. It takes a month or more for the skin barrier to heal AFTER the inflammation has subsided so it is important to be patient and not to add irritating products back too soon.
I hope that helps. Thanks for a really good question that I know other people share.
Warm Regards,
Cynthia Bailey MD
Reference: Why is Rosacea Considered to Be an inflammatory Disorder? The Primary Role, Clinical Relevance, and Therapeutic Correlations of Abnormal Innate Immune Response in Rosacea-Prone Skin. Del Rosso J Q et. al., J Drugs Dermatol. 2012;11(6):694-700.
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.
I was hoping this would answer the question I have in my head, and it didn’t quite – so I’ll just piggyback. My understanding is that skin cell turnover is the point of products like Retin A. I don’t feel that my skin is irritated, but it is constantly shedding that top layer, which is irritating to ME. I feel like my make-up never goes on smooth and catches those particularly flakey spots. I use the Power of Three, the Toleriane cleanser, the sensitive Clarisonic, etc… Is there a good way to better exfoliate? Sometimes I get frustrated and go at it with a wash cloth, but of course that is always a bad idea!
Lillie,
After the initial break in period of the retinoid dermatitis induced by Retin A, the exfoliation becomes microscopic and is typically not visible as a daily molt. Everyone is different, but this is the norm. When there is scale over the long term it’s usually the retin a bringing up an underlying skin problem like dandruff. That said, it’s always possible to gently but definitively exfoliate with a pure physical exfoliant like Replenix Scrub. That product is not for everyone but those that love it LOVE it – me included. It’s better than a wash cloth which requires too much pressure.
Thanks for explaining that. I really like understanding how things work.
Hi Dr. Bailey,
I love this post as I skin that gets flaky and red and it sounds like it can be helped by trying out some of these products. I definitely have dandruff on my scalp and it sounds like I probably have it on my face, too. Thank you for this information because it actually seems of quality.
I was wondering if you could answer a question for me. I have dandruff, but on top I have a really oily scalp. My hair gets greasy right away–I definitely have to wash my hair every day, because if I skip I look so greasy it is embarrassing. Lately it has gotten even worse, to the point where my hair looks greasy at the end of the day if I showered in the morning. Worse, if I showered the night before instead of that morning, my hair looks greasy by the afternoon. I can’t figure out what to do about it and have tried a lot of different shampoos. Do you have any ideas or suggestions?
Terry
Hello Dr. Bailey,
I’m very glad to find your website recently days and learned much about acne , seborrheic dermatitis and rosacea.I’m a female from China and 30 yeas old now.
I’m the very unlucky person who have the double, triple, quadrupedal whammy of facial skin issues. I have acne from my junior high school .That time, the acne I have is the big pimple .From my senior high school, I have not the big pimple in whole my face ( only several pimples before my menses) ,but my pores began to bigger and bigger ,redder and redder . I have many red pores on my nose, side two block of my nose ,between my eyebrows everyday ,sometime it is red whole face until now . It has been almost 10 years. I have tried many product and method and only salicylic acid 2% liquid is effective ( only liquid, if it is salicylic acid 2% gel ,it will be sensitive…) But I do not know why it is only sometimes effective. My skin became more and more sensitive . Almost every product will cause my pore redder ,bigger ,clogged pores, even the red face,so I only use the cleanser to wash my face and use nothing then everyday . Last month ,I used the salicylic acid 2% liquid again. unexcepted my face became very very dry and scaling immediatly. I have been diagnosed as Seborrhei dermatitis then. Since reading your website, I know Green Tea Antioxidant Skin Therapy/Replenix Power of Three or Replenix CF Cream are both products for Seborrhei dermatitis. I want to know which one is more suitable for my skin. Which sunscreens on your website is the best for Seborrhei dermatitis? (I do not know why every sunscreens I used before caused acne , the pore more bigger and redder.I tried almost well-known and unknown brand , but failed .I need the cut-oil , no sensitive sunscreens.) And I also need a body lotion , which one on your website is better for Seborrhei dermatitis?
I also want to know whether many red and big pores on my nose, side two block of my nose ,between my eyebrows, the very sensitive skin (no scaling before ) is the symptoms of Seborrhei dermatitis or it is only the ance. If it is no scaling in the future , only red and big pores, whether I need to continue to use the product of Seborrhei dermatitis or the salicylic acid again.
Sorry for my pore English , I want you can understand what I said above.
Thank you very much for your help!
Regards,
Chris
Dear Dr Bailey, I’m sorry to bother you with this question but I’m not sure where else to ask. I have the glycolix elite ultra light moisturizer that I got based on your recommendation. Unfortunately I accidentally left the lid off of it over night!! Is it still good? I’m hoping it is b/c it’s practically still full! Thanks for your time.
Hello Gail,
In general a product like that should be ok but of course there is no way I can know.
Hello Terry,
Some hair care products leave residual product on your hair that might make it start out already coated with something. Oil production compounds product buildup. You may want to find a products with less residue but I don’t know any by name. Ingredients like dimethicone coat hair so looking for products without dimethicone might be a start. Using a strong foaming shampoo and a scalp scrubber to clean down to the base would be good. Adding the Foaming Zinc Cleanser as a second lather will help as it foams well to remove oil, treats dandruff and works well with the scalp scrubber. Considering a dry shampoo later in the day is another thought.
With all the science behind how to manipulate your skin, is there any suggestions on how to store these products given as the examples? I get to be in charge of making the bathroom look clean and curious where I should be placing our products so they don’t get destroyed similar to the question above about leaving a bottle open overnight.
Hello Chris,
Your skin issues are complex and require individual care by a treating dermatologist in your community. I give only general educational information on my web site. General products that I like for seborrhea/acne and oily prone skin include Elta Clear Sunscreen which is oil free and has niacinamide to help fight inflammation and redness. http://www.drbaileyskincare.com/eltamd-uv-clear-spf-46-sunscreen.shtml My new All Natural Body Lotion is a great body lotion. It has oil in it so it’s not the product for an oily face. I have people use the Daily Moisturizing Face Cream for Oily to Normal Skin as a good all purpose facial moisturizer for oily/acne prone skin http://www.drbaileyskincare.com/daily-moisturizing-face-cream-oily-to-normal-skin.shtml
Warm Regards,
Cynthia Bailey MD
Hello Brandon,
It is recommended to store products at moderate temperatures and with the lids closed to minimize air contact and germ or other contamination. If bottles are see through, the products are usually also best stored out of the direct sunlight. Bathroom cabinets and drawers are usually ideal locations as long as the bathroom temperature remains in the moderate range.
Dear Dr Bailey,thank you for your reply!
I only get rosacea and seborrhea dematitis flare ups on my left cheeks only. Can you tell me why I only get it on one side of my face? My doctor prescribed me Metrogel, Desonide lotion (corticosteroids), and Ketoconazole cream (antifungal).
Can you please give me the steps on applying all the above with other products on your website such as…
Calming Zinc
Replenix Power of Three Cream (should I apply this all over face or just the problem area)
Daily Moisturizing Face Cream for Dry to Normal Skin
Thanks,
Mimi
I also forgot to included your
Glycolix Elite SPF 30 Sunscreen in my last email.
Hello 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 conditions that come from some internal predisposition and thus they manifest bilaterally (on both sides of the body). Ask you doctor about an allergic rash, tinea faciei and demodex mites. Also, here in the US the left is the driver’s side and so sun exposure induced rashes like photo-drug eruptions or polymorphous light eruption are in the list of possibilities too.
The tinea should be treated with the ketoconazole but sometimes it is more tenacious. Demodex, on the other hand need a completely different treatment. The other conditions require more sleuthing.
The application order of the skin care routine based on your products: Wash w/ Calming Zinc the apply Green Tea Antioxidant Therapy/Power of Three. I have patients wait a few seconds (ie. comb your hair, put on deodorant or some other quick daily step) then apply metrogel then ketoconazole. They apply the mild cortisone ONLY if they are red, and max 2 weeks. Then they apply the Daily Moisturizing Cream, Glycolix Sunscreen. The three medicines make it a lot of layers, but when the rash is clear they stop 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.
Your question is so good that I don’t want it to get lost as a comment so I’m going to make an Ask Dr. Bailey post out of it. Thanks for sending it in!
Thank you so much for the reply. May I ask one more question?
Can I apply the products in the following steps?
1) Calming Zinc
2) Replenix (should I apply this all over face or just the problem area)
3) Metrogel
4)Ketoconazole cream (antifungal)
5)Desonide lotion (corticosteroids)
6)Daily Moisturizing Face Cream
7)Glycolix Elite SPF 30 Sunscreen
Thanks,
Mimi