Cleansing and the Management of Rosacea

Written by David Pascoe on May 26, 2011 with 0 Comments

It might seem unusual, but a gentle cleansing routine is important to getting relief from rosacea.

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.

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. Pretty ugly hey!

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

Solvents	Alcohol, acetone
Aromatics	Menthol, benzyl alcohol, cinnamates
Penetrants	Propylene glycol, butylene glycol, alpha hydroxy acids
Surfactants	Sodium lauryl sulfate, quaternary ammonium compounds
Sunscreens	Para-aminobenzoic acid (PABA), benzophenones, cinnamates
Abrasives	Polyethylene beads, bismuth oxychloride, mica, silica
Pharmaceuticals	Tretinoin, benzoyl peroxide, urea.

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

soaps
synthetic detergents
lipid-free lotions, and
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 actually 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.