Cleansing and the Management of Rosacea

Written by on October 27, 2005 in Cleansing Rosacea Skin, Rosacea Moisturizer with 20 Comments

It might seem unusual, but a gentle cleansing routine is important to getting relief from rosacea. How could something that you already have in your bathroom be so important in your quest to beat rosacea? Here are some clues.

One characterization of rosacea is that it is a disorder of the stratum corneum barrier; irritants are allowed to affect the epidermis and dermis causing vasodilation, flushing and inflammation.

Skin Barrier is important

Typically the function of the skin barrier is tested using the lactic acid test. This test involves applying lactic acid to the skin and assessing how much it stings. For rosacea sufferers with sensitive skin this sounds like torture.

A paper from 2000 published in Cutis and a National Rosacea Society Survey from 1997 both confirm that a large majority of rosacea sufferers have hyperirritability, burning, stinging and general sensitivity to common skin care products including cleansers.

According to Scheman 1999 in Cosmet Dermatol, 20 years of experience shows the list of chemicals most associated with skin irritation include;

Chemical Classes Associated with Skin Irritation

Chemical ClassExamples
SolventsAlcohol, acetone
AromaticsMenthol, benzyl alcohol, cinnamates
PenetrantsPropylene glycol, butylene glycol, alpha hydroxy acids
SurfactantsSodium lauryl sulfate, quaternary ammonium compounds
SunscreensPara-aminobenzoic acid (PABA), benzophenones, cinnamates
AbrasivesPolyethylene beads, bismuth oxychloride, mica, silica
PharmaceuticalsTretinoin, benzoyl peroxide, urea.

So what should we use?

This paper tells us that there are 4 classes of cleansers:

  1. soaps
  2. synthetic detergents
  3. lipid-free lotions, and
  4. prescription antimicrobials

The paper then moves on to discuss the new prescription antimicrobial cleansers and their use in treating rosacea.

The new class of prescription antimicrobials that contain both sodium sulfacetamide and sulfur, (and sodium cocyl isethionate as the surfactant) are discussed. Examples of these sorts of cleansers include Rosanil, Plexion, Novacet and Clenia (related see: Rosac Cream vs. Metrocream and Sulfur / Sodium Sulfacetamide Topicals).

These preparations are formulated to reduce the likelihood of irritation while also allowing any benefit from the therapeutic actions of the active ingredients.

Facial hygiene and comprehensive management of rosacea,

Cutis. 2004 Mar;73(3):183-7.

Draelos ZD. Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

The skin of patients with rosacea is exquisitely sensitive to various dietary, environmental, and topical factors that initiate the facial erythema characteristic of this sensitive skin condition. This sensitivity is probably due to epidermal barrier dysfunction. Overall management of rosacea involves the avoidance of dietary and environmental triggers, concurrent with the use of prescription therapies.

The appropriate selection of over-the-counter and prescription skin care products is equally important. (emphasis added)

This article reviews the use of therapeutic skin cleansers, including the newest category of prescription antimicrobial cleansers, which can enhance the overall management of this inflammatory dermatologic disorder.

Conclusion Patients in various stages of rosacea show increased skin sensitivity to numerous skin care products.

This increased sensitivity is probably due to a defect in stratum corneum barrier function.

The barrier dysfunction may be due to an underlying disorder in the immune system, leading to a release of inflammatory mediators.

The choice of therapeutic cleanser is a critical factor in the overall management of patients with rosacea.

A new class of prescription therapeutic cleansers, the antimicrobials, offers dermatologists a new option for optimal management of this condition.

Disclaimers: This article is supported by an educational grant from Galderma Laboratories, L.P. Dr. Draelos is a member of the advisory board and speaker’s program and has received a research grant from Galderma. She is also a researcher and consultant for Berlex Laboratories and Medicis Pharmaceutical Corporation.

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Can it be True?

Can using one of the cleansers like Plexion or Clenia help your rosacea? Please let us know in the comments below.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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20 Reader Comments

  1. karen says:

    has anyone seen improvement in their skin using seabuckthorn oil soap? If so, what soap do you use…..where can it be bought? (Retail, please)

  2. Hi Karen,

    I wish it were that simple. I haven’t seen anyone talking about a seabuckthorn oil soap that you can get retail. Anyone have a suggestion ?


  3. Kathie says:

    A fellow poster recommended a seabuckthorn oil soap, the brand is “Aubrey”. My local health food store carries it but was out of stock – they’re ordering it for me & it should arrive w/in the next week. Retail price around $5 – I’ll let you know how it works for me!

  4. Margie says:

    I used the seabuckthorn soap, essential oil and also took the capsules twice each day…to no avail. My redness did not go away, and I am still getting the rosacea associated acne. Pretty frustrating…the oil cost 28.00, the soap 7.50 and the capsules 35.00.

  5. Aileen says:

    I tried seabuckthorn oil and it helped initiatlly with the redness and bumps but has not continued to be great help. I am also taking herpanacine via capsules and that has been of some help. I am willing to try these routes until next spring and then am seeking either v beam or intense light therapy through a dermatologist in Canada.

  6. Melelina says:

    I googled this site after purchasing a clarisonic system. I have mild rosacea outbreaks after alcohol consumption or extended exposure to hot or cold weather. I am using the cleanser that came with the clarisonic on the low or mild one minute setting. I have not tried the body brush yet. After using the clarisonic and rinsing my face my skin is smooth but seems to have a film on it similar to the under makeup primers. Has anyone else had this experience? Should I use a mild exfoliant with the clarisonic or do I need more time to adjust to the texture of my skin using this brush?

  7. selina says:

    the seabuckthorn oil soap – Face doctor is sold at shoppers drug mart in canada for about 17$. Initially, it did make my rosacea appear less red, but when i continue to use it. it really really dried out my skin. Even though i was only using it once a day at bedtime. It made my skin really tight in the morning and thus, the redness got worse because of the dryness.

  8. marlene levitt says:

    Is it o.k. to use any form of makeup on your face (with appropriate moisturizer, or best to leave it bare?

    • Joanne says:

      I did some research and found mineral powder to be considered good as it has mica and zinc oxide and titanium dioxide but no silica talc or bismuth oxychloride. Demure foundation powder. It’s made by Deluvia. Check it out. It has colors from iron oxides and ultramarine. All very pure. Read up on mineral powders and what to look for and avoid. I like it! Been using for just a week or so.

  9. angela says:

    After three years of dermatologists, antibiotics, light therapy, etc., to no avail and increasing outbreaks and redness, I have started using Head and Shoulders basic clean as well as lotromin anti fungal cream on the lesions. I also am using olive oil in the afternoon to counter act the dryness and Manuka Honey both internally as well as in the morning as an antibacterial. I am feeling better and the lesions are less painful and are drying out. will keep u posted.

  10. Alice Blonski says:

    Has anyone seen improvement using baby shampoo and water 10/1
    This was recommended by an eye specialist.

  11. Pam says:

    My Dr wrote a script out for me for Tretinion cream 0.25%, he said it would help my Rosacea, but I am not too sure can anyone give me a feed back on this.

    Thank you…..

  12. Pam says:

    My Dr wrote a script out for me for Tretinion cream 0.25% he said it would be good for my Rosacea, but the chemist said it is not for that complaint, I have
    finished my anti biotics and my skin erupts every now and then and I am really getting upset about it , feed back on this would be appreciated. and also what products I could use that is sold in Australia to help cleanse and maintain a healthy skin that has rosacea.

    thanking you

  13. Vicki says:

    My derm gave me CeraVie Hydrating Cleanser and CeraVie moisturizer. They work very well on my rosacea, and don’t dry me out at all. A good alternative is DML moisturizer.

    • Hunny says:

      I don’t know why but since I started using the Cerave mousturizing cream, I’m having breakouts and increasing redness on my face. Think I’m gonna return it. Really wish, it suited me.

  14. Lucas says:


    There has been some indication that tretinoin can, over time, help with management of rosacea. You should discuss this further with your doctor, since introducing tretinoin can be irritating, but that should subside over time.
    I can tell you from personal experience tretinoin has helped my rosacea, both with the redness/flushing and with the pustules/papules. I can’t use it every night, only 3-4 times a week.

  15. Pete says:

    My Dr. Wrote me an Rx for Triamcinolone acetonide cream USP,0.1%. He cautioned me to use sparingly, so I use it only with severe breakouts around my nose and forehead.

  16. Cervae hydrating cleanser is great. I’ve just bought chantecaille emulsion with magnolia and lily of the valley after success with a sample. eye cream is gentle. Cervae pm lotion also good for face as is their moisturizing cream. I have very dry skin, no acne, very sensitive. Oh and I now have an anti allergy, dust mit cover from allersearch that I change along with my case twice a week…just in case the dermodex are really there. Not sure if it helps but I think it does a bit.

  17. robb schultz says:

    I am sporadic rosacea sufferer in that my red flush & pustules come and go mysteriously, often when I want to look my best, it seems to hit me overnight. I cleanse with Cetophyl, use Cetophyl cream for dry skin, along with direct but sparing use of Rosiver 1% cream on pimples and red areas. Rosiver will cause its own burns and redness if I use it every day. 3 times a week works for me.

    I read that Trump uses something else on his red face and wonder if I can believe any of it?
    His veracity is in serious doubt with me and I’m a Canadian too!
    I have seen that red face of his on TV and put it down to him spending too much time in the sun. Has anyone tried the trump treatment? If so, what happened to your rosacea?


    • Peg says:

      Per the press release following his annual physical in 2018, President Trump uses the prescription Galderma product Soolantra. I use this in my regimen and it seems to help somewhat. Nothing seems to help 100% but a combination of Galderma’s Soolantra and Allergan’s Rhofade, gentle cleaners and non-chemical suncreens help to keep the redness and roughness under control.

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