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.
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.
Cynthia Bailey MD, Dermatologist
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