Rosacea is an inflammatory condition of the face that is divided into four different subgroups. Two of the common subgroups, erythematotelangiectatic (type 1) and papulopustular (type 2), are associated with dry and sensitive facial skin. Researchers have taken a deeper look at the reasons why this occurs.
The Barrier Function of the Skin Is Impaired in Rosacea
One of the skin’s important functions is to serve as a barrier. Normally we think of a barrier as a way of keeping toxins and irritating substances from getting in. However, the skin barrier is a two-way street and also helps prevent loss of healthy substances. A healthy and normally working barrier will help hold in water so that water is not lost too quickly through the skin.
In type 1 and type 2 rosacea, the skin barrier does not work correctly.[1,2] There are two main reasons for this:
- The skin oils are not quite right: The skin’s oil glands (also known as sebaceous glands) normally make oils that help the skin barrier function properly. In rosacea, these oil glands are deficient in making longer chain fatty acids, which are important for forming a healthy working barrier.
- Too much inflammation: The cells of the skin barrier (called keratinocytes) make too much of a protein known as cathelicidin LL-37 that is normally produced to fight off an infection. However, in people with rosacea, the skin makes too much of this protein, leading to more skin inflammation and disruption of the skin barrier.
The Skin Is More Reactive in Rosacea
Since the skin barrier function is impaired in rosacea, the skin is more vulnerable to irritating substances. Indeed, researchers have shown that people with both type 1 and type 2 rosacea experience “stinging and burning” more often than those without rosacea when 5% lactic acid is applied to their face. The stinging response was seen in 100% of those with type 1 rosacea, 68% of those with type 2 rosacea, and only 19% of those without rosacea.
Owing to the dysfunction of the skin barrier on one hand and extra reactivity on the other, people with rosacea do not tolerate topical products as well as others without rosacea. Here are a few items that can cause the skin to overreact and become sensitive:
- Hot water: The skin in rosacea is more sensitive to temperature changes. This includes direct contact with warm/hot water in the shower or when drinking warm or hot fluids like tea or coffee.
- Soaps: Soaps strip the skin of its natural oils. In rosacea, this can be particularly irritating as it decreases the skin barrier’s performance, creating a vicious cycle where the skin becomes more reactive as the skin barrier function worsens.
- Peeling ingredients: Ingredients that are typically used to peel and exfoliate the skin (such as salicylic acid and glycolic acid) can be very irritating to those with rosacea. Chemical peels need to be discussed and considered carefully with a medical provider for patients with rosacea.
- Drying and irritating ingredients: There are many ingredients that are not tolerated well by those with rosacea. One example is benzoyl peroxide. Not everyone with rosacea will be sensitive to benzoyl peroxide but it can dry the skin and worsen the skin barrier function.
How to Keep the Skin Happier in Rosacea
The key is to use anti-inflammatory and soothing agents on the skin. Here are a few examples.
- Sulfur-based face cleanser: While cleansers can be irritating to the skin, sulfur-based cleansers may be helpful in rosacea. Sulfur has anti-inflammatory properties and improves the inflammation of rosacea.[7,8] People with an allergy to sulfur and sulfa based medications should not use sulfur based face cleansers.
- Moisturizers: Gentle moisturizers that can support the skin barrier and increase the skin’s hydration may help rosacea. Two ingredients that help to hold onto water in the skin and support the skin barrier are glycerin and ceramides. The downside to glycerin is that too much of it can make the cream very sticky.
- Switch to physical sunscreens: Sunscreens are an essential part of good skin care in rosacea. Ultraviolet light is a well-known trigger for rosacea. Chemical sunscreens have the potential to irritate the skin. If you are using a moisturizer with the sunscreen built-in, read the label to see if it is a chemical or physical sunscreen. Zinc oxide and titanium dioxide are physical sunscreens.
The key to happy skin in rosacea is to keep it simple. If you are currently using several different facial products, you should consider a partial “skin-fast” where you take a holiday on almost all of the products except the most vital. For some, the most vital may be make-up to help you get through the day. For others, it may be a bland moisturizer. Do not stop any prescription medications without discussing with your health care provider.