Anyone with rosacea knows how frustrating it is and how few good treatment options there are to sustain a remission. I’ve long been treating my rosacea patients with medicines and skin care recommendations that are more art than science out of necessity. I developed my recommendations based on what worked for my many rosacea patients. Recent scientific studies are giving us some interesting information that supports my art-based treatment methods and I’m thrilled. As scientists learn more about rosacea, I’ll be able to build on their findings and refine my treatment recommendations even further.
Rosacea is a common, frustrating and often disfiguring inflammatory facial rash. In spite of years of excellent scientific studies, the cause of rosacea remains elusive. In the entire 25 years that I’ve practiced dermatology, the standard rosacea therapies have relied on oral and topical antibiotics. Many of my patients are unwilling to use antibiotics long term so I’ve worked hard to find alternative treatments to help them.
What’s new is that scientists are starting to rethink the significance of mites in rosacea.
- We’ve always known that every person has Demodex mites in their skin pores (yes, it’s unsavory but true).
- We’ve also always known that people with rosacea have even more mites in their pores than normal.
Because everybody has Demodex mites doctors have ignored their presence. I haven’t. I’d see mite stuffed pores under the microscope as an incidental finding on skin biopsies. I’d noted that it often correlated with run-away rosacea. So I’ve been treating Demodex mites for years and found that my rosacea patient’s skin improves when I do!
Results of recent scientific papers suggest a significant role for Demodex mites in driving rosacea in both facial skin and eyes. Even more interestingly, one of the papers suggests that it’s not just the mites, it’s a protein on a bacteria that the mites carry that causes some of the inflammation of rosacea – wow, this could be why antibiotics have helped all these years!
So, what are my current skin care recommendations for my patients with rosacea?
Building a complete skin care routine made of compatible products always yields the best results. Complete skin care involves the 4 essential steps of: cleanse, correct, hydrate, protect. With rosacea the hydrate is important because barrier integrity is weak in rosacea-prone skin. Skin won’t heal if it is not properly hydrated. Protect is important because UV exposure can trigger rosacea flares. Here is what a rosacea skin care routine often looks like in my practice:
Cleanse twice daily. Perhaps mites can be washed off if they are outside of the pores. If possible use a Clarisonic Sonic Brush system to pulse cleanser into the pores to help them get out. At least once daily use Calming Zinc Soap fortefied with a full 2% pyrithione zinc to help balance a skin yeast germ called pityrosporum that also grows abundantly on rosacea-prone complexions. If necessary, I may chose a cleanser with sulfa drugs in it for non-allergic patients. If skin is dry or irritated, a soapless cleanser such as Toleriane Cleanser or Extremely Gentle Foaming Cleanser may be soothing. Always rinse skin really well after cleansing because retained cleanser will irritate skin and continue to pull skin lipids out of skin layers.
Correct out of balance skin inflammation with Green Tea Antioxidant Skin Therapy. I always have my patients apply this first, right after toweling skin dry. The pharmaceutically pure and stable green tea polyphenols are equivalent to what is extracted in 500 cups of green tea. This topical product loads the skin’s antioxidant reserve to help fight skin stressors – perhaps from the living conditions of what is going on in the pores?! If topical medicines such as Metrogel, Finacea or Soolantra (which specifically kills demodex mites) are being used we layer those on top. Benzoyl Peroxide 2.5% can also possibly address mites. It can be irritating but can often also be very uniquely appropriate for only oily pustular rosacea.
Protect with a mineral zinc oxide broad spectrum sunscreen. My top choices for rosacea prone complexions include EltaMD Daily, EltaMD Clear, Suntegrity 5 in 1 BB Cream or Sheer Strength Mineral Matte or Spray Sunscreen.
The new research results are exciting and I expect that soon we’ll have new treatment medicines for facial Demodex mites, and that these medicines will help to control rosacea.
If you would like more info on Rosacea please see my Advice Pages with complete rosacea information from my dermatology practice, or download my free Ebook on Rosacea.
Zhao YE, Wu LP et. al., Retrospective analysis of the association between Demodex infestation and rosacea, Arch Dermatol. 2010 Aug;146(8):896-902
Elston DM, Demodex mites: facts and controversies, Clin Dermatol. 2010 Sept-Oct;28(5):502-4
Li J, O’Reilly N, et. al., Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea, Ophthalmology. 2010 May;117(5):870-877
Gao YY, Di Pascuale MA, In vitro and in vivo killing of ocular Demodex by tea tree oil, Br J Ophthalmol 2005 Nov;89(11);1468-73