Derm Deep Dive: Rosacea Treatment

December 2023

What You Should Know About Rosacea and How to Best Treat It

We’re back with another Derm Deep Dive, a series where we provide expert advice from one of our board-certified dermatologists about common skin conditions or treatments. For this edition, we’re discussing rosacea treatment with Dr. Lori Schaen, MD, of our Milford, OH location, servicing the Cincinnati area. 

What is Rosacea and How Do You Know if You Have It?

I see a lot of patients who are experiencing symptoms of Rosacea but are unsure what it is or how to treat it. First and foremost, if you have any skin issue and you aren’t sure what it is, the best thing to do before any at-home treatment is to visit your dermatologist and get an official diagnosis. 

Rosacea in particular is a skin condition that requires a more specific treatment plan, so understanding what it is and how it manifests for you is most important for proper treatment. 

While some people think of Rosacea as facial redness, it is a bit more complicated than that. Rosacea is a chronic condition that can cause inflammation on the cheeks, nose, chin, forehead, or eyelids. This inflammation can also lead to redness, broken blood vessels, swelling, pimples, pustules, and sometimes ocular/ eye symptoms.

Rosacea is a fairly common condition, affecting about 16 million Americans. There is no known cause for Rosacea, and because it is a chronic condition, it can only be managed and controlled but not completely cured.  

How Can You Manage Your Rosacea?

Because there is no known cause – and no definitive cure – I work with patients to identify two important aspects of their Rosacea:

  1. What triggers seem to cause Rosacea flare-ups
  2. How those triggers can be managed or mitigated to reduce Rosacea flare-ups

Identifying Potential Triggers

Many individuals who have Rosacea are able to identify triggers that seem to bring on flare-ups. While these triggers vary naturally from person to person, there are some that are more common:

  • Sun exposure 
  • Hot or cold weather conditions, including humidity or indoor heat
  • Hot baths, showers, hot tubs, or saunas
  • Heavy exercise
  • Alcohol consumption, especially red wine
  • Harsh winds
  • Emotional stressors, such as anger, anxiety, embarrassment, or general stress
  • Certain foods, including spicy foods, aged cheeses, dairy products, and some chocolates
  • Hot drinks, including coffee and tea

I understand this list can seem pretty daunting and limiting – or simply hard to avoid, such as hot or cold weather conditions. However, the good news is that Rosacea can typically be brought under control, even if you can’t avoid your trigger or triggers 100 percent of the time. Here are some basic tips:

  • On hot, sunny days, seek out shade, wear protective clothing, and use sunscreen with an SPF of 30 or higher
  • Protect your face and neck from cold weather, especially harsh winds
  • Try to manage emotional stress through deep breathing exercises, meditation, or calming, relaxing activities like yoga or simply reading a book. 
  • Keep showers short to avoid overheating. If exercising, recognize when it’s time to take a break and drink water, and keep cold water on hand. 
  • Choose white wine instead of red if alcohol is a trigger, or try to avoid alcohol and opt for a mocktail or water. 

Products to Avoid that Can Aggravate Your Rosacea

Every individual’s skin is different, and not all skin care products work for everyone. If you have Rosacea, there are a handful of products that are best to avoid as they’ve been known to make symptoms worse or bring about flare-ups. 

  • Topical steroids on the face, especially if used for more than a few days. 
  • Cosmetics and hair sprays that contain alcohol, witch hazel, menthol, camphor, eucalyptus oil, propylene glycol, or fragrances. Instead of these products, I recommend L’Oreal alcohol-free hairspray.
  • Soaps, astringents, and alcohol-based toners. 
  • Chemical peels or acids, including glycolic acid and hydroxy acids, exfoliants, and dermabrasion. 
  • Sodium lauryl sulfate, which is a common skin irritant present in many shampoos, and chemical sunscreens.  

When it comes to sunscreens, mineral blockers zinc and titanium are often best tolerated by individuals with rosacea.

Treatment Options for Rosacea

Avoiding triggers is a critical way to manage your Rosacea, but I also work with patients to identify treatment options that can help manage or mitigate flare-ups altogether. It’s important to note that there are different types of Rosacea, and treatment options differ depending on the type and severity of your Rosacea. 

Some treatment options can include:

  • Antibiotics (typically Doxycycline): If Doxycycline is prescribed, be aware of common side effects and closely follow the recommendations for taking this medication.
  • Oracea: Oracea is a lower dose of Doxycycline that acts as an anti-inflammatory rather than an antibiotic. This helps minimize the risks associated with the antibiotic dosing of doxycyline and is a safer long-term choice for rosacea. 
  • Topical medications: I help my patients understand which topical treatment is best for their Rosacea. 
  • Laser treatment: Typically, laser treatments are used in conjunction with one of the above treatment regimens and depends entirely on your specific type and severity of Rosacea.  Laser treatment for rosacea are not covered by insurance.

What Can You Do to Manage Your Rosacea at Home?

After you have seen your dermatologist and identified the best treatment plan for your Rosacea, there are other steps you can take at home to adjust your skin care routine for better Rosacea management. 

Simplify, simplify, simplify. Keep your skin care routine simple. The more products you’re using on your face, the more irritated your skin can become, which can trigger Rosacea symptoms. 

Wash your face. A gentle wash with lukewarm water and a soap-free unscented cleanser is perfect for your face. Don’t scrub or rub your skin. My favorite products include:

  • CeraVe Hydrating Cleanser
  • Cetaphil Gentle Cleanser
  • Neutrogena Ultra Gentle Hydrating Cleanser
  • Vanicream Gentle Facial Cleanser
  • Avene Antirougeurs Clean 

Establish a regimen. Any prescription medications should be applied prior to any other products. 

Tackle dry skin right away. Apply thicker moisturizers to dry skin, such as CeraVe, Cetaphil, or Vanicream Moisturizing Skin Cream to mitigate dry skin before it becomes worse. 

Protect your skin! Apply a sunblock every morning with an SPF of at least 30. As I mentioned, physical sunblocks containing Zinc Oxide and/or Titanium Dioxide over chemical sunscreens are recommended for sensitive skin and are typically better tolerated by individuals with Rosacea. My favorite sunscreens include:

  • La Roche-Posay Anthelios Mineral Tinted or Un-tinted SPF 50
  • Cetaphil or CeraVe Mineral SPF
  • Elta MD UV Elements 44 (Tinted in moisturizing base with antioxidants)

Switch up your makeup. Tinted SPF or mineral-based makeup is recommended for individuals with Rosacea as the minerals sit on the surface of the skin rather than being absorbed. You should avoid:

  • Liquid makeups, which contain emulsifiers which can irritate the skin
  • Mineral makeup that contains bismuth oxychloride, a common skin irritant that can cause facial redness and rash
  • Oil-based and/or waterproof makeup

I recommend using makeup made by Neutrogena Mineral, Clinique Mineral, and Jane Iredale. 

When Should You Schedule a Visit With Your Dermatologist?

I recommend that you schedule a visit with your dermatologist as soon as you begin experiencing Rosacea symptoms. Because it is a chronic condition with no known cause or cure, it’s best to speak with a professional rather than try and treat it at home.

When you schedule an appointment with me, I first listen to your symptoms and concerns, perform an examination of the affected skin, and work with you to establish a treatment plan. You can expect to see improvements within the first few weeks of treatment, with ideal and more noticeable improvement occurring between eight and 12 weeks. 

I know Rosacea, like any skin condition, can be difficult to manage and frustrating to live with. However, the best way to manage it and get back to your life is to work with a dermatologist to establish the best treatment plan for your specific situation. 

I’d love to meet with you to start a conversation about treating your Rosacea. Schedule an appointment with me at Optima Dermatology’s Milford, OH practice for an initial consultation and to get started on a path to healthier, happier skin.