Dear Dr. Bailey,
I read your blog series on rosacea and I have a question. I have been diagnosed with rosacea. I mainly have it on the apples of my checks and my forehead (right in the middle). My problem is that I have an oily t-zone and I have blackheads and other break outs on my chin. I would love to know what products will work. I want something gentle as to not upset my rosacea but I need oil and blackhead control for my chin and nose as well.
I was going to buy the Calming Zinc Soap along with the Green Tea Cream. Will these control my clogged pores?
This is a great question. To best answer this, I’m going to share with you some general information from my dermatology practice.
First off, you’re not alone. It’s really common to have a combination of oily skin, blackheads, clogged pores and rosacea! However, treatment can be tricky since the products that we use to treat blackheads, and our first choice products for oily skin, may aggravate rosacea.
When working with my dermatology patients, I begin with a “rosacea cool down” regimen. This regimen involves doing whatever it takes to quiet down the inflammation that drives the rosacea.
To calm the inflammation of rosacea I advise my patients to,
1. Stop all irritating skin care products or procedures.
2. Use soothing products that calm the inflammation driving rosacea including:
- Calming Zinc Soap (usually twice a day, but the small potential to dry some skin types may cause us to switch to only once a day, alternating with Toleriane Cleanser).
- Green Tea Antioxidant Skin Therapy with an ultra concentrated amount of green tea polyphenol antioxidants and the resveratrol from grapes. My patients use this twice a day right after washing and before applying anything else.
The two key products to calm rosacea (Calming Zinc and Green Tea Cream) are included in my Redness Relief Kit.
We use these products on the entire face. Although neither of these products will make blackheads or clogged pores worse, they, unfortunately, don’t treat them either. They are, however, essential to the overall strategy for unclogging the pores since they help soothe the rosacea, allowing us to work on the competing pore and oily skin problems.
During the rosacea cool down, if the rosacea is really flaring up, I would also prescribe topical (and possibly oral) medicines until we control the rosacea. Some of my prescription approaches to rosacea are outlined in my post Prescription Medicine and Cosmetic Procedures to Treat Rosacea
It’s also important that rosacea-prone skin stay well hydrated if it’s going to heal.
Rosacea-prone complexions have weakened barrier integrity and must remain well hydrated – even when skin is oily. For this, I typically recommend a soothing facial moisturizer such as Daily Moisturizing Face Cream for Oily to Normal Skin, which is perfect for oily skin. It also contains squalane, an important lipid component of skin, and glycerin to bind water for optimal skin hydration.
Sun exposure will also aggravate the inflammation of rosacea.
This means that daily wearing of a broad spectrum sunscreen on facial skin is essential as part of our rosacea cool down. I always recommend sun protection with mineral zinc oxide sunscreen. The most loved mineral zinc oxide sunscreens by my oily complexion patients are,
EltaMD UV Clear (tinted or untinted)
Sheer Strength Matte Tinted Sunscreen, which has an ultra light texture on the skin.
Sheer Strength Pure Mineral Spray Sunscreen with untinted, light weight and non-oily product feel on the skin. It’s also great for hairy skin such as the top of the scalp!
After the inflammation of rosacea has subsided from the “rosacea cool down”, we’re ready to tackle clogged pores.
I have found that the best way to unclog pores for rosacea-prone complexions is with the Clarisonic Sonic Brush System.
We work gingerly, but deliberately with the complexion and the Clarisonic. We start with once daily use. The sonic brush oscillation help to deliver cleanser deep into the pores to help remove pore clogging oil and debris. There are a variety of brush heads to fit every complexion.
This well-loved sonic skin-cleansing system usually can be used by most rosacea patients at least on the nose and chin (where clogged pores are the worst). It also helps the other treatment products, including the Calming Zinc and the Green Tea Cream to penetrate skin better. However, it is important to note that there is no guarantee that the rosacea-prone areas of the cheeks or forehead will react well to sonic cleansing, which is why it is always something we start slowly and carefully using the lowest settings with the Delicate Brush for extra-sensitive skin.
The other methods to unclog clogged pores and remove blackheads varies according to a person’s skin type and skin tolerance (which mostly means how sensitive it is to friction and oil removing or irritating products).
To treat blackheads in rosacea-prone complexions the prescription medicine tretinoin (Retin A) is my usual first treatment choice.
I can usually coax a person’s rosacea-prone skin into letting me use this great medicine on certain parts of the face. (It is a prescription, so its application needs to be supervised by an experienced treating physician.) I start with 0.025% cream on the blackhead-prone facial areas like the nose, chin and possibly between the brows. Proper application is really important and I’ve shared how I do that in a prior blog post titled How To Correctly Use Retin A for Acne and Anti-aging Skin Care. It’s tricky to use tretinoin if you’re prone to rosacea. However, it is possible and tretinoin is a great medicine to fight blackheads and to provide anti-aging bonus benefits.
Another good treatment option to get rid of blackheads in rosacea-prone skin is benzoyl peroxide, believe it or not!
In fact, some people with rosacea find that benzoyl peroxide helps their rosacea, but others find that it makes their rosacea worse, which makes its use tricky! Again, this potentially irritating medicine is applied only to the blackhead-prone areas, which are usually the nose, chin and between the brows. The benzoyl peroxide needs to be formulated in a water-based product without alcohol like my Benzoyl Peroxide Acne Treatment Cream 2.5%. Typically, it’s used once or twice a day, but since it can provoke rosacea in some people, it should be started gingerly, and only once the rosacea is quiet. Remember, this is a test and your skin may complain!
Of course rosacea, being a capricious gremlin, will resurface from time to time even if you’re being “nice” to your skin. Flare-ups always happen when they’re most inconvenient. When a flare-up occurs, it’s an “all stop” on the products that could rev 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.
Phew, it sure will be nice when we have a cure for rosacea. It’s such a cranky skin problem and requires patience, delicate care and stewardship.
Thanks for a great question. This is a combination of skin problems that I see every day in my dermatology practice and that I’m sure tons of readers can relate to your experience.
Cynthia Bailey MD, Dermatologist
If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.
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.