Rosacea

A woman with a pink inflamed red face and may have rosacea

Rosacea is a type of sensitive skin characterized by a pink or red face that flushes.  If you have facial flushing, a red face,  stinging face after cleansing, or you notice that your face feels hot often- you probably have rosacea. 

Rosacea can coexist with the other 3 types of sensitive skin (acne, stinging and allergic), especially the Stinging and Burning Sensitive Skin Type.

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Rosacea Definition

Rosacea is a skin disorder in which capillaries in the face increase in size causing hot, red stinging skin known as facial flushing.  With time, the blood vessels stay large resulting in spider veins on the face called telangiectasias (meaning dilated blood vessels).

How to Diagnose Rosacea?

Your dermatologist can diagnose rosacea.  You can also take our quiz to see if you have Type 2 Rosacea Sensitive Skin.

 

Is Rosacea Dangerous?

Rosacea is progressive skin condition that gets worse if left untreated.  It should be diagnosed early and treated as soon as possible to prevent  an increase in severity.  Most people do not realize that they have rosacea until they have a very red face most of the time .  It is much better to start rosacea treatment early- when your face flushes from emotion, alcohol and exercise. There are many prescription medications for rosacea, but if you catch it early you can usually treat rosacea without a prescription using anti-inflammatory skincare ingredients.  While there is no cure for rosacea, it can be prevented by using a rosacea skin care routine at the earliest signs of rosacea on the face or rosacea on cheeks. 

How To Know If You Have Rosacea?

How do you know if you have rosacea? It is rare that for patient to ask me “Do I have rosacea?” because they usually do not suspect it unless the facial redness and pimples are moderate to severe.  Most patients think that they have sensitive skin and do not realize that they have rosacea. 

Look for these early signs that you are getting rosacea: 

  •  If your face gets red easily
  • Face flushes with emotion
  • Face gets hot, itchy and red during exercise
  • Alcohol, hot foods (temperature) or spicy foods make your face flush and feel hot

If you have these symptoms,  it’s likely that you have early rosacea.  It is hard for darker skin types to see the red face that is characteristic of rosacea so, if you have brown skin or black skin, you can tell if you have rosacea because your face will sting or feel hot even if it does not look pink.  Yes dark skin types can have rosacea!

It is best to catch rosacea early before the skin inflammation has caused damage. Inflammation can lead to uneven skin pigmentation and skin aging.

Get started on the best skin care for rosacea as soon as possible.  We recommend trying one of our dermatologist developed skin care routines  first and, if that does not work, consult one of our STS Approved medical providers to see if you need a rosacea prescription medication.

My face burns!

I often hear rosacea patients say, “My face burns when I put moisturizer on!” or, “Every moisturizer burns my face!” Rosacea skin tends to burn when it contacts low-pH skin care ingredients such as alpha-hydroxyacids (glycolic acid and lactic acid) and Vitamin C.  Sunscreen ingredients, such as avobenzone, can cause a burning sensation on face after applying cream which is a characteristic sign of early rosacea. Preservatives in skin care, such as benzoic acid, can cause the face to sting and give you a red face.  If you have rosacea, you need a personalized skin care routine to help calm and soothe your sensitive skin.

My face is red!

Rosacea is one of the most common causes of a red face that comes and goes. After years of facial flushing, you skin may turn permanently red.  If that happens, you can do laser treatments to remove the facial redness.

Rosacea Skin Care

Using the wrong skin care products can worsen rosacea!

The best skin care products for rosacea have anti-inflammatory ingredients to soothe and calm inflammation like:

 When choosing rosacea skin care, it is as important to know which skin care ingredients to avoid when you have rosacea as it is to find the best skin care products for rosacea.

 

Best Rosacea Skin Care Ingredients To Soothe and Calm Skin

The best ingredients in skin care to soothe rosacea prone skin have anti-inflammatory capabilities.

Polyphenols are an example of a type of ingredient that can calms rosacea skin. 

Ingredients To Avoid If You Have Rosacea

  • Avobenzone sunscreen
  • Benzoic acid
  • Alcohols  (fatty alcohols are OK to use)
  • Eucalyptus oil
  • Fragrances
  • Peppermint oil
  • Witch hazel

Ascorbic acid (Vitamin C) will irritate some rosacea prone skin types because it has a low pH that can cause the skin to sting. 

Hydroxyacids like glycolic acid should not be used on rosacea prone skin IF your skin is stinging and irritated. Rosacea skin that has been treated with the correct skin care routine and is calm and not irritated may be able to tolerate low strength retinoids and hydroxyacids.  however it is best if these are not added to the regimen at the same time.  rather, begin the retinol first and if you are tolerating it every night for 2 weeks, then you can add a hydroxyacids.  If you have oily skin, salicylic acid is ideal for rosacea because it has strong anti-inflammatory properties.

How To Wash Your Face If You Have Rosacea

If you have active rosacea, your face will sting when you wash your face- even if you only wash your face with water.  Stinging when you wash your face is characteristic of rosacea.

When your rosacea is flaring, it is ok to skip washing your face in the am.  However, you must wash your face at night.  Regardless of when you wash your face, you must do it gently!!! 

Rosacea Cleansers 

These should contain soothing and calming ingredients and should not have ingredients that irritate sensitive skin. Salicylic acid is a great choice for a rosacea cleanser for oily skin types because  it is in the aspirin family and is good at reducing inflammation in sensitive skin while clearing pores.

Many cleansers marketed to "sensitive skin" are not right for rosacea because there are 4 different types of sensitive skin.

Find our favorite rosacea cleansers here.

The way you apply rosacea skin care products is also important.  You should not use:

  • A loofa
  • Facial brush,
  • Rough wash cloth
  • Face Scrubs
  • Anything that causes friction on the skin’s surface. 

Friction worsens inflammation which causes the face to flush red. All skin care for rosacea should be applied gently, with your fingers, using slow gentle swirling movements.

The Best Soothing Cleansing Waters for Rosacea

Rosacea sufferers that live in cities with hard water such as New York City may get irritated from the calcium and magnesium in the water.  We suggest rinsing off your cleanser with a soothing thermal spa water. 

Rosacea Prescription Creams and Treatments for Dry Skin

While there are many prescription creams to treat rosacea, there are also many soothing anti-redness available without a prescription. Examples of prescription rosacea creams include Rhofade (oxymetazoline), Soolantra (ivermectin), and Azalea (azelaic acid) Cream.  Aczone (dapsone) is an acne treatment product that is often used as a rosacea cream off label.

If you want to try a skincare products that target skin redness and does not require a prescription, here are some choices:

Rosacea Creams and Moisturizers for Dry Skin

Soothing moisturizers help control inflammation and can be used alone or with a prescription rosacea cream when you have mild to moderate rosacea. Here are our thoughts on skin calming moisturizers for rosacea.

You can find our dermatologists recommended  moisturizers for rosacea sufferers with dry skin here:

Rosacea Oils for Dry Sensitive Skin

I am often asked “Which essential oils are best for rosacea?”. The answer is none of them!  Essential oils  do not contain soothing fatty acids- they are mostly fragrance which can irritate sensitive rosacea prone skin. Never use essential oils on a red face!! 

Oils (not essential oils) have fatty acids with moisturizing and soothing activities that help rosacea.  Choose oils with fatty acids like linoleic acid that soothe and calm the skin. Oils that target inflammation are wonderful for rosacea.   Argan oil is the best oil for rosacea. Do not use coconut oil for rosacea because it can cause acne. Jojoba oil is also an option, but jojoba oil is not as good as argan oil as a rosacea treatment.  Avoid using olive oil for rosacea because it can impair the skin barrier. The best oils to use to soothe and calm the skin are:

How To Use A Rosacea Prescription Cream or Serum- Before or After a Moisturizer?

You should apply a rosacea cream treatment product twice a day, even if you do not wash your face in the morning. Apply the rosacea treatment before a moisturizer, as the moisturizer helps push the the rosacea cream or serum into the skin to get better results.  The best skin care products for rosacea have ingredients to soothe inflammation like argan oil, niacinamide, fever few and green tea. Look for rosacea moisturizers that do not use benzoic acid as a preservative.  

Rosacea Serums and Gels are Better for Oily Skin

There are many prescription rosacea treatment serums and gels. Prescription rosacea serums and gels include MetroGel (metronidazole), Mirvaso (brimonidine) and Finacea (azelaic acid). These rosacea serums and gels can be used on dry skin before a hydrating moisturizer or on oily skin before an anti-inflammatory moisturizer or a rosacea safe sunscreen. Nonprescription soothing serums that have been used to treat rosacea contain ingredients like caffeine, green tea and resveratrol.

How To Use A Rosacea Serum

Use rosacea treatment serums twice a day. If you wash your face in the morning, apply the rosacea serum after cleansing.  If you do not wash you face in the AM, you still should apply the rosacea treatment serum. Follow with a moisturizer that is appropriate for your Baumann Skin Type® and a rosacea friendly sunscreen.

Rosacea Toners

Toners are not the best skin care product for rosacea because they often have alcohol in them which can cause facial flushing and result in a red face. Witch hazel, which I found in many toners for sensitive skin, has some anti-inflammatory activity. However, most people with rosacea get a burning face or  stinging face when they use skin care products containing witch hazel.  If you insist on using a toner for rosacea, choose a gentle toner, to  be applied before a rosacea cream or a rosacea serum. An essence is another word for a facial mist toner. Essences will not be as effective as rosacea serums and rosacea creams.

Rosacea Sunscreens

Rosacea sufferers often get a burning face or a stinging face when they use chemical sunscreens.  The sunscreen ingredient avobenzone (also called Parsol) is the biggest culprit.  However, oxybenzone, cinnamates like octinoxate (also called octyl methoxycinnamate or ethyl hexyl methoxycinnamate) and dibenzoylmethanes can also cause stinging. The bottom line: choose a mineral sunscreen (also called a physical sunscreen) if you have rosacea.  The other problem with using sunscreen when you have rosacea is how to get sunscreen off without irritating your skin.  Choose a gentle makeup remover to remove your sunscreen if you have rosacea.

Best Mineral Sunscreens for Rosacea

These are our favorite physical mineral sunscreens for rosacea with a tint to hide facial redness:

Best Gentle Makeup Remover for Rosacea

Getting sunscreen off when you have rosacea is not easy because you cannot scrub vigorously, use strong detergents or use scrubs.  So how do you remove sunscreen when you have rosacea?  We recommend a gentle makeup remover to use prior to cleaning the face with a rosacea cleanser.

Rosacea Facials

Your aesthetician can design a rosacea facial for you based on your Baumann Skin Type®. Rosacea facials should not include scrubs.  An enzyme exfoliator is a better choice to exfoliate rosacea prone skin.  A scrub and microdermabrasion should not be used in a rosacea facial because the friction can cause inflammation.  Your aesthetician should use rosacea creams and serums and a rosacea friendly toner. Rosacea facials are tricky.  We recommend that you find a STS Approved medical provider with a well-trained aesthetician here. 

Rosacea can be difficult to treat.  You can usually keep it under control if you use the best skin care products for rosacea and your skin type.  It all begins with knowing and shopping with your Baumann Skin Type®.  Use your Baumann Skin Type to get educational advice that is right for YOU and read reviews from others with the same Baumann Skin Type,. You will get customized skin care routines for your skin type, and you can shop for products that match your Baumann Skin Type. 

 

Hear what others with rosacea have to say about their skin and how learning their Baumann Skin type helped their rosacea.

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