Ideal Moisturizers for Rosacea: Drugstore vs. Department Store

1960s Drugstore Vaseline

Whether drugstore, department store or other moisturizers are more effective for rosacea is a perennial patient concern.

There are effective moisturising products to be found everywhere, however I believe the cosmetic finish and overall performance of more expensive products has typically been superior.

Dermatologists are taught that vaseline (petrolatum) is the most effective moisturiser (because it can stop all water from evaporating from the skin), and it is inexpensive, yet it is an unpleasant and unattractive product for general facial use.

The gap between drugstore/department store/other products has narrowed as drugstore products for everyday skin care have become more sophisticated (and expensive).

Vaseline Gauze Dressings

Effective skin care products for sensitive skin available through the drugstore are predicated on relatively few key ingredients, particularly niacinamide, glycerin, panthenol, colloidal oatmeal, feverfew and soy, which are a fraction of the ingredients available in the marketplace at large.

Other antioxidant and anti-inflammatory ingredients are only included in negligible amounts, if at all.

If skin is extremely allergic the allergies should be identified and specific products recommended or the allergenic ingredients always avoided.

All-natural moisturising options for extremely sensitive and allergic skin include natural oils (jojoba, rose hip, avocado, macadamia, cherry seed) and butters like shea, olive and mango butters.

Further information and references: http://rosacea.riverderm.org/Creams-Moisturizers/

Rosacea Moisturisers (Australia): http://www.rosacea-treatment-clinic.com.au/Moisturize.html

The History and Story of Vaseline: http://mentalfloss.com/article/25556/vaseline-miracle-jelly-turns-140 and  http://www.damninteresting.com/story-of-vaseline/.

Rosacea Resources

Concise list of respectable rosacea resources including the Mayo Clinic. 

Rosacea Treatment Clinic Products – Pharmacy Skin Care Range

Rosacea Treatment Clinic – An environment dedicated to rosacea.

The Rosacea Treatment Clinic, founded in Australia in 1996, is a specialist practice which produces skin care products available in (obviously) Australia, the US, UK and some regions of Europe.

Typically, skin care products for rosacea are simply “sensitive skin care” products branded as suitable for rosacea and there is no technical reason why they should be superior to other alternatives available at the drug store, department store or beauty salon.

Examples of such ranges are Pevonia’s RS2 and Topix Replenix products, which exist under 100s of different labels.

You may have noticed in the small print of advertisements that major cosmetic brands such as Clinique and Estee Lauder often launch products on the basis of general satisfaction by very small groups of women. As few as 10 will be used to rationalise a percentage claim for a product – for example, “90% of women felt their skin looked less wrinkled.”

Conversely, Rosacea Treatment Clinic products have a long history of development and refinement, including formula revisions, based on actual clinical experience with rosacea patients, and are not mass-produced.

The products are made to order by the clinic’s pharmacy, a consideration which has allowed them to use ingredients with shorter shelf-lives and at higher concentrations, typically without preservatives and other potential irritants. Products are generally packaged hermetically and/or in amber glass.

Rosacea Treatment Clinic also produces products for “professional use” intended for use by medical professionals, and broadening into helping treat skin care concerns other than those of rosacea, such as aging and hyperpigmentation, without provoking rosacea symptoms.

If you’ve found your skin care to be problematic despite having tried many brands, or have had to settle with bland products to avoid symptoms (e.g. Cetaphil, Neutrogena), but would like to do more for your skin, these extremely niche, and similar products, such as Avene’s preservative-free Tolerance Extreme products, are worth considering.

Unfortunately, this category of skin care is relatively expensive. Although the price of more rudimentary products such as facial cleansers is reasonable and in-line with other professional products dispensed by dermatologists and plastic surgeons, more specific products, such as serums, and the products for professional use, are over $100.00.

The effort which goes into producing the products justifies their price somewhat, as does their high concentration of beneficial ingredients (realistically, most cosmetic companies are putting essentially zero “active ingredients” into their products), but there is no getting around the fact that the Clinic doesn’t have a complete skin care solution for those with little to spend.

They do however point out that their products are usually compatible (and never harmful) when combined with those from other sources.

Such if you already have a suitable cleanser, you could continue using that, in conjunction with one of the specialty products, or vice versa.

In Australia:
http://www.rosacea-treatment-clinic.com.au/

USA/Internationally:
http://www.rosacea-treatment-clinic.org/

Other speciality dermatology products for rosacea are available from your dermatologist, sometimes requiring prescription, and are available from dermatology supply companies such as Delasco:
http://www.delasco.com/pcat/3/welcome.php

Questions/Facebook for Rosacea Treatment Clinic products:
https://www.facebook.com/RosaceaTreatmentClinic

Sunscreens for Rosacea – An Expert Guide

The outcome of a successful rosacea treatment and management regimen is usually control rather than eradication of the disease and to that end sunscreen is now seen as crucial.

Apart from advising patients to avoid those stimuli that tend to exacerbate their rosacea, such as exposure to extremes of heat and cold, excessive sunlight, ingestion of hot liquids, alcohol, and spicy foods, a sunscreen suitable for rosacea should be used.

But what exactly does “a sunscreen for rosacea” mean?

We used to think it was a zinc or titanium dioxide sunscreen.

I was recommended this addition to Yahoo’s rosacea category which sheds new light on the use of sunscreens in rosacea, and that chemical sunscreens should be the rosacea patient’s friend, not foe.

Melbourne CBD Medical Health and Beauty Resources

Glycolic Acid (an AHA) in Treatment and Management of Rosacea

Glycolic Acid is an alpha hydroxy acid (AHA) with a variety of cosmetic uses, including potential utility in the treatment and management of rosacea symptoms.

Typically, glycolic acid has most  often been used to help ameliorate the appearance of acne, rough skin texture, fine wrinkling of the skin, keratosis pilaris and purportedly to stimulate the production of collagen and elastin, diminished in aging, as an anti-aging intervention.

Glycolic acid formulations vary greatly in concentration (from less than 1% to 70%) and in pH (from a pH of less than 1, which is extremely acidic, to 7, which is neutral). Concentration and pH impact the effectiveness of the formula. The ingredients contained alongside the glycolic acid also impact the effect of the formula.

High concentrations of glycolic acid at low pH render the greatest changes in the skin, however can be irritating and associated with side effects such as scarring and hyperpigmentation (darkening of the skin).

As a general rule, I do not believe that substantially effective glycolic acid formulations are available on the mass market. Most glycolic acid products, including those marketed as effective for rosacea (such as Jan Marini Bioclear Cream) do not declare their pH or the actual availability of “free acid” in the product. A claim that the product contains 20% glycolic acid (as in the pictured example), does not mean that the product contains 20% glycolic acid available to the skin – the bioavailable content is likely negligible.

Effective formulations may however be found through specialist dermatologists and plastic surgeons. These specialists possess the skills and experience to prescribe appropriate glycolic acid use and will typically make use of the ingredient in chemical peels (brief applications of high concentrations of low pH glycolic acid under controlled circumstances). For an example, see http://www.rosacea-treatment-clinic.com.au/News/May-2011/Glycolic-Acid-Treatment.html.

Studies have shown that glycolic acid can reduce rosacea symptoms of papules and pustules, however it has not been proven that the ingredient has anti-inflammatory effects, and common complaints among rosacea patients using glycolic acid products are burning, stinging and redness of the skin – precisely the symptoms of the disease.

As to whether or not glycolic acid is useful in the treatment and management of rosacea, you may find the above link useful.

The FDA and Sunscreens for Rosacea

The FDA has for some time been considering the problem of determining and labeling the efficacy of sunscreens we recommend for rosacea against UVA rays.

In August of 2007, the FDA proposed the development of a new sunscreen rating system which would take into account the protection of a sunscreen against UVA based on a four-star rating system.

This is necessary because, as most rosacea patients are still unaware, a sunscreen’s “SPF” rating only pertains to it’s ability to protect against UVB rays, and by “protection” all that is meant is the product will prevent the skin from burning, not tanning, or sustaining any other damage, such as free radical damage, not outwardly evident to the human eye.

The FDA’s proposal entailed that those sunscreens we use in rosacea which provide no protection against UVA would have no stars on their labels and bare the phrase “no UVA protection.”

In practice, I do not know of any sunscreens which provide absolutely no UVA protection to rosacea patients, however there are likely some specialty tanning products available through beauty salons and tanning parlours which provide such minimal protection.

Some rosacea sunscreens which I recommend and further information about protection are available at: http://www.rosacea-treatment-clinic.com.au/Rosacea-Sunscreens.html

The proposal has not yet been adopted. The FDA’s reluctance to improve sunscreen labeling, like their reluctance and tardiness with allowing new and superior sunscreen chemicals onto the market, is baffling.

Changes in Follicular Keratinization and Visibly Open Pores

The process of keratinization at the skin’s surface is fundamentally identical to the process occurring in the lower sections of the follicular infundibulum, however irregularities in the lower section can mark the beginning of visibly open pores.

“Open pores” are a clinical rather than pathological manifestation (reference: http://www.treatment-skincare.com/January-2008/Weiner-L.html), nevertheless causing distress and annoyance to patients whatever their technical classification may be.

The maturing of the skin’s keratinocyctes, and their subsequent exfoliation/desquamation into the pores, begins the process of visibly open pore formation, with or without the formation of classically distinguished comedones.

In acne patients, keratinocyte cells have a tendency to adhere to one another, blocking the pores, extending their openings.

Once the contents of the pores oxidizes, both the contents and the pore itself become more visible.

If the pore is open, the result is called a blackhead or open comedone.

If the pore is closed with debris, the result is called a whitehead or closed comedone.

The pores, particularly when closed, provide an environment in which Propionibacterium acne can thrive.

The skin’s immune system recognizes the presence of Propionibacterium acne, creating inflammation, which serves to further enhance the open appearance of the pores.

Bacteria digesting sebum also release substances which create inflammation.

Accordingly, a treatment for open pores releases and prevents recurrence of excess debris from the pores while removing Propionibacterium acne bacteria and interfering with arachidonic acid cascades to curb inflammation.

For further information, the best information I have found for patients can be found at Melbourne Dermatology: http://www.treatment-skincare.com/Open-Pores.html

Treatments for open pores are detailed @ http://www.treatment-skincare.com/MD-Rx/Open-Pores-Solution.html and http://www.treatment-skincare.com/August-2006/Open-Pores.html.

Granulomatous Rosacea

The National Rosacea Society Expert Committee currently only recognises one form (or variant) of rosacea. That form is “granulomatous rosacea.”

Other forms or variants previously thought to be a part of rosacea such as pyoderma faciale (also known as rosacea fulminans), rosacea induced by steroids and perioral dermatitis, are no longer considered to be forms of rosacea and are exempt from classification as variants.

Granulomatous rosacea is a form of rosacea which is visually as yellow as it is red and formed from nodules, papules and (less commonly) pustules.

Granulomatous rosacea usually appears on the malar and periorificial areas of the face.

When compared with the papulopustular form of rosacea, granulomatous rosacea’s papules and nodules appear to be less inflamed.

This variant can present on its own and is sufficient for a diagnosis of rosacea.

For a review of modern rosacea treatment, see http://www.rosacea-treatment-clinic.com.au/News/November-2012/Research-Grants.html

Foods Which Commonly Trigger Rosacea

Foods are a common cause of rosacea flare-ups.

The list of foods which can trigger rosacea symptoms of flushing and burning (the pre-requistites of more advanced and severe symptoms) is long and varies from patient to patient, however these are the most prevalent, worth avoiding if you are prone to inflammation after eating them: 

• Hot (temperature) foods

• Spicy foods

• Soy sauce

• Vinegar

• Chocolate

• Beans (broad-leaf) and pods

• Avocados

• Spinach

• Yoghurt

• Tomatoes

• Bananas

• Liver

• Vanilla and alcoholic flavour extracts

• Cinnamon

• Plumps

• Figs

• Raisins

• Cheese

2013.