Dear Dr. Bailey,
I suffer from rosacea and acne, and I’m not sure which to treat.
Acne medications and regimes irritate my sensitive skin. On the other hand, rosacea treatments burn or clog pores. I’m at a loss. I have seen numerous dermatologists and they all prescribe the same thing, my face only gets worse. It’s really embarrassing.
Thank you,
Jenn
Hello Jenn,
Acne vulgaris and rosacea can coexist, unfortunately. My usual approach is to treat the rosacea, which is trickier, and to aim my acne vulgaris treatments very precisely at what I think the biggest driver of the acne is for a particular patient.
One of my favorite regimens for this combination of skin problems is the product combo in my Facial Redness Kit.
This skin care kit included Calming Zinc ® soap which has an ingredient that helps to decrease a skin yeast that causes a form of acne called pityrosporium folliculitis, and that’s also overgrows the pores in rosacea. The other product in the kit is either Replenix CF or Power of Three Cream. These products are very soothing for rosacea. They also act to moisturize acne prone skin WITHOUT pore clogging oils. They have one more benefit and that is to help relieve the redness from acne lesions.
If the acne is mostly due to clogged pores and blackheads (comedones) then I try to sneak in a little tretinoin, which is a fantastic prescription medicine for comedonal acne. When we use the Facial Redness Relief products I find that the rosacea is usually so well controlled that we can get the tretinoin into the skin care regimen without irritating the rosacea. I typically stick with the lowest strength of tretinoin, and I start with it just twice a week. I have many rosacea patients who successfully use tretinoin, so it is possible. I’ve included a link below to a post that explains my tretinoin use tricks.
If hormonal factors are driving the acne then I may try hormone regulating treatments such as birth control pills, but this is usually a last resort in my practice. I always look for a bacterial infection too because bacteria may be ‘dog-piling’ on a case of mild acne or rosacea and really making big, tender, inflamed pustules out of what would otherwise be little ones. The goal is to trying to figure out why the acne lesions are present and then very precisely address the cause while at the same time providing a supportive skin care regimen to calm the rosacea.
I know that is not a simple answer but I hope it gives you some idea of how I approach a patient with your combination of skin problems. It’s actually a fairly common combination in my dermatology practice.
Warm Regards,
Cynthia Bailey MD, Dermatologist
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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.
Thank you Dr. Bailey for answering my question. Any advice or recommendation on how to choose which of the Replenix products (Replenix CF or Power of Three Cream)?
Either is perfect. The Power of Three has the addition of Resveratrol from grapes, which is one of the newer botanical antioxidant ingredients. It also had a non-paraben preservative system which matters to some people but not others. (It doesn’t matter to me personally but I like to give people choices.) The key ingredients are equally present in both the CF and Power of Three so they work equally well in my experience. The CF is slightly less expensive, I’ve used it in my practice for years and love it.
J JohnsonDecember 15, 2011 at 10:21 pm#
I have mild rosacea and I use the zinc soap, power of three,and Glycolix ultra lite daily. By the time I put on make-up my face seems dry and flaky (in spots) and I end of taking the makeup off. Is there another product I should add, for a softer, more moisturized complexion?
Thank you!
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Rosacea often coexists with seborrheic dermatitis. Seb derm, called dandruff, causes scale along and between the brows, along the sides of the nose, mouth and chin. On the other hand, dry skin often causes scale on the sides of the cheeks near the jaw line. These are the two most common causes of facial scale that I see.
When the scale more resembles the distribution of facial dandruff then I spot treat as needed with lotrimin and sometimes even a day or two. I have other tricks in my facial dandruff post http://www.drbaileyskincare.com/blog/tips-for-facial-seborrheic-dermatitis-control/
There is no cure for facial dandruff and so long term management of the complexion problems (like scale) is important. I have this most annoying problem myself and so get to live with the management ‘challenges’. When the embarrassing scale wants to join me for the day I use Replenix Scrub to very gently exfoliate it so that I don’t have to wear it in front of the world with every person I interact with.
If dry skin is the more likely explanation for a person’s facial scale then I usually have them use the zinc soap once a day alternating w/ Toleriane Cleanser and use the Glycolix Fortified instead of the Ultra Lite on the dryer areas.
I hope that helps.
Warm Regards,
Cynthia Bailey MD
Thank you Dr. Bailey for all your help and recommendations. I am using the zinc soap and Replenix, which has helped tremendously. I have always struggled with how to determine if I have more oily or dry skin. Having acne forever I always assumed my skin was oily. Since the Rosacea I have no idea, my skin often feels dry and now feels dry after I apply the Replenix. I am concerned that a moisturizer for dry skin will clog my pores and cause more breakouts, however when my skin is drier this is a trigger for a rosacea flare up. I looked but I didn’t find a post on how to tell if you have more oily or dry skin when you have a condition like Rosacea that can misrepresent what your skin needs. Any thoughts or advice would be so appreciated. Thank you again.
Thanks for the inspiration Jenn, I’ve put your idea on my list of topics and will write a post with my medical thoughts, observations and patient experiences. Happy New Year!