Hello Dr. Bailey,
I saw your replies and information on the Rosacea Forum and am inquiring about your product recommendations for myself. I am a 59-year-old woman with diagnosed rosacea for the past 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.
What of your products would you recommend? With your experience with older rosacea patients with highly sensitive, dry skin – what have you found to be successful?
I look forward to hearing about your product recommendations.
What you describe is very severe and I wonder if there might not be a confounding diagnosis. Some of the more common ones that come to my mind are:
- an allergic or irritant contact dermatitis from some remote product (hair care products that manage to get on to the facial skin, airborne allergens like room fresheners, etc.)
- a photosensitivity condition, such as a medicine causing sun sensitivity (even thru windows)
- facial dandruff (seborrheic dermatitis)
- demodex mite inflammation
My approach is to always make sure that IF there are confounding factors causing skin barrier issues that we address those too. Barrier issues in these cases happen when the underlying rash (or rashes) causes skin inflammation and increased skin “porosity” so even mild products get in too easily, sting, and increase the inflammation. When I hear someone talk about sensitivity sufficient enough to cause widespread product intolerance along with dryness, I start looking for a confounding diagnosis along with the rosacea.
That said, if skin is exquisitely sensitive solely due to barrier issues associated with rosacea, then I do a “rosacea cool down” to quiet inflammation and improve skin barrier strength. Only then can we move on with topical rosacea skin care treatments. (See my more usual treatment approaches for rosacea in my 5-post series on rosacea.)
We usually need to do the cool down for two months before we can begin rosacea treatments. Again, the aim is to quiet inflammation to allow the skin barrier to heal. Exactly how I do this cool down varies from patient to patient.
In general, my “Rosacea Cool Down” looks like this:
- I usually have my patients cleanse their skin with Toleriane Cleanser twice a day.
- They then apply Replenix CF Cream.
- Unless their skin is really oily, I usually have them apply a very thin layer of bland oil as a “safe” moisturizer immediately after washing and applying Replenix CF Cream. We pick this oil depending on what does not sting their particular skin. Options for “safe” oils include canola oil, extra virgin olive oil, extra virgin coconut oil, or jojoba oil. This is important because dry skin just doesn’t easily regain its barrier strength.
- If the skin is really inflamed, I try to use the most tolerable non-halogenated cortisone that I know, which is Locoid Ointment. We use this in place of the oil because the ointment base will act as a moisturizer. Locoid Ointment can sting some people’s skin though and occasionally I need to have hydrocortisone compounded in whatever 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 cortisones dependency can be a problem for rosacea.
- We sometimes also need to use oral tetracycline (which is not available in the US right now, hello Washington, anyone going to address that!) or doxycycline for a few months. These antibiotics may be working because of their anti-inflammatory properties, not their antimicrobial, we don’t know, but they do help rosacea so we use them.
- I have my patients strictly avoid the sun by wearing hats and ideally using a pure mineral zinc oxide sunscreen too because sun can trigger rosacea. I’ve had pretty good tolerance with my most sensitive skin patients to a pure zinc sunscreen called Glycolix Elite Sunscreen.
- I have them avoid things that trigger their rosacea (foods, temperatures, etc.).
- I recommend they eat a diet that does not fuel inflammation, meaning a veggie-heavy diet, and take probiotics or eat probiotic-rich foods.
You can find links to the products I mentioned highlighted in the text above. They are the tools in my toolbox and I have them on my site because, in my experience, they are the best for treating sensitive skin from rosacea.
When a patient comes back for examination of their skin in two months, we see how their skin looks and then try to craft a more sustainable skin care regimen to treat and suppress their rosacea. You can see what that looks like in my Rosacea Article Series: Skin Care Tips For Rosacea and Medical Treatments for Rosacea. You can also see my diet recommendations and ideas for a more natural approach in that series too. Here in the Northern California Wine Country, people are interested in natural remedies for health problems and I’ve learned a lot of really good tricks from my patients over the years as they’ve experimented with natural remedies for rosacea.
So, it’s a complex answer to your question. The most important point is that the sort of exquisitely sensitive skin that you describe requires accurate diagnosis of any confounding problems and then a multi-staged customized approach, and even then, it’s a tricky situation.
Cynthia Bailey MD, Dermatologist
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.