Choosing Sensitive Skin Products for Rosacea Patients

Taking time to recommend the right skin care products for these patients will pay off in improved outcomes., By: Coyle S. Connolly, DO, Linwood, NJ

Most rosacea patients know all too well that there’s no quick-fix treatment for their condition.

These patients need to understand that curtailing their problem will require changes in the way they live their lives–some major, some minor.

In addition to the usual recommendations about avoiding triggers such as excessive sunlight, spicy foods, alcohol, and hot drinks, it’s important to speak to rosacea patients about their everyday skin care regimens.

Moreover, these patients often fall into the so-called “sensitive skin” category, by which I mean patients who report that use of many common skin care products causes irritation, burning or stinging.

The challenge to practitioners is to find cleansers, cosmetics and sunscreens–not to mention prescription drugs for controlling rosacea- -that are effective without causing irritation or aggravating the rosacea. Here is a brief review of the products I recommend to rosacea patients with sensitive skin, as well as those I try to have them avoid.

CLEANSERS

The general philosophy I try to adhere to in recommending products is “the fewer the ingredients the better.” To this end, I tend to disapprove of cleansers that contain fragrances or perfumes, which can cause irritation. Benzyl alcohol is another agent to avoid. Also steer clear of glycolic acid, isopropyl palmitate, lactic acid, sodium hydroxide and propylene glycol. What do your rosacea patients have in their medicine cabinet? The wrong products can irritate sensitive skin.

I find that most soap-free cleansers work best with rosacea patients for everyday use. Soaps are in many cases too strong, often drying sensitive skin. However, most soap-free cleansers come in liquid form only, and I’ve found that male patients usually prefer a solid bar cleanser. Galderma’s Cetaphil makes a superb cleansing bar, one for normal and one for oily skin. Another excellent cleanser is the Cleansing bar made by La Roche-Posay specifically for sensitive skin patients. What I like about the La Roche-Posay bar is that it lasts a lot longer than most. This resistance to disintegration justifies the product’s slightly higher price tag.

I warn my patients to be very careful with the so-called “natural” products that are so popular in today’s skin care market. The makers of these products will attempt to deliver a “shotgun effect” by including as many ingredients as possible, hoping that one will deliver on the advertised benefits of the product. The myriad vitamins, detergents and biological agents in natural products may do more harm than good. These products can put the patient at risk for allergies. For example, aloe–common in natural products–may cause contact dermatitis. A well formulated, pharmaceutical grade product is preferred.

MOISTURIZERS

For those patients who need moisturizers, I find Tolerin Skin Care from La Roche-Posay a reliable choice. Water-based instead of oil- based, it tends to feel lighter on the skin and doesn’t have the uncomfortable greasy feel of some moisturizers. This product also doesn’t contain propylene glycol, often used as a preservative in skin products and known to be the cause of stinging.

I see a lot of patients in need of moisturizers because my practice deal of dry skin. To women in need of a product to remove makeup without damaging dry skin, I recommend the Tolerin Dermo Cleanser.

It should be noted that the Tolerin can only be dispensed from a practitioner’s office. It’s a little more expensive than what can be found OTC, but I think it’s worth it. Some patients like the convenience of buying skin care products in their practitioner’s office, but others would rather shop at their favorite pharmacy. I like to give patients a choice, without making the choices so numerous they get confused. For those who prefer OTC products, Cetaphil offers a moisturizer that is well tolerated on sensitive skin.

MEDICATED CLEANSERS

For patients with more severe forms of rosacea, you might try to steer them toward a combination of medicated cleansers and non-soap cleansers, using one in the morning and the other before bed. However, be careful which patients you choose for this regimen. Sometimes getting a patient to use one product is difficult; two is an even bigger gamble. Men are especially prone to poor compliance when too many products are foisted upon them.

Plexion (sodium sulfacetamide 10% sulfur 5%), a prescription product from Medicis, is an excellent medicated cleanser. The nice thing about this product is that, although it contains sulfur, it doesn’t produce the unpleasant odor associated with sulfur products in the past. Additionally, it is cosmetically elegant in every other way. I ask the patient to leave this on for 20 seconds in the morning, and then at night to use Tolerin or Cetaphil.

Another solid prescription medication is Noritate (metronidazole cream 1%) made by Dermik, which is fairly new and raises the level of metronidazole from its previous level of 0.75%. There are no studies to prove the enhanced formula is any more effective, but I’ve seen good results in my patients. The enhanced formula also offers a compliance benefit since it can be used once a day instead of twice.

Galderma’s MetroGel and MetroCream–which, of course, also contain metronidazole–have been considered very reliable in the past, so I expect Noritate to prove just as valuable. These products are elegant and have a non-greasy feel. I would recommend the MetroGel for patients with oily skin because the gel base can be drying. The Noritate cream is a better choice for patients with dryer skin.

A third topical I’m fond of is another Dermik product, Klaron (sodium sulfacetamide lotion 10%). This medication contains no sulfur and is recommended for patients who have shown an allergic reaction to sulfur.

COSMETICS

Toners are popular with women because they give a tight feeling to the skin. They require extreme caution, however, because they can be very irritating. Often they contain alcohol which can be very drying and cause burning. Also, they are likely to contain fragrances. One toner I recommend is BioClear (Genesis Pharmaceuticals), which tends to be less drying than most other toners. BioClear is available for office dispensing.

In terms of makeup, it is best for rosacea patients to stick with water-based products. Most makeup will fall into one of two categories: water-in-oil based, or oil-in-water based. Oil-in-water based products actually contains more water, so those are the products that should be recommended. They feel lighter on the skin and are less likely to cause irritation.

The two buzzwords to tell your patients to look for on cosmetic products or cleansing products are “non-comedogenic” and “non- acnegenic.” If the product claims these two properties and feels good on the patient’s skin, then the patient should stick with it.

ANTIOXIDANTS

Antioxidants have received a lot of support in marketing circles these days. In general, there are a number of misconceptions about their efficacy among the general public. The one exception is vitamin C, which when applied topically may help reduce erythema. The reason: free radicals may play a role in inflaming rosacea when patients are exposed to the sun, and vitamin is known to reduce free radicals. But just because a product contains vitamin C does not mean it will help reduce redness. You still have to watch how the product is formulated, preferably avoiding those with alcohol, propylene glycol and other irritating agents. If patients opt to use vitamin C, I encourage them to use Active C (La Roche-Posay). The light-textured cream can be used under make-up, a fact that appeals to many women.

There is also some evidence that vitamin C works at the cellular level to enhance collagen, which can reduce wrinkles. So there might be some value to vitamin C, but try to keep patients’ expectations reasonable, since these improvements tend not to be extreme.

ALPHA HYDROXY ACIDS

AHAs can be helpful to patients with mild rosacea because they exfoliate the skin nicely and reduce the rough texture of the skin that rosacea produces. I would not, however, recommend them for patients with more severe forms of the condition, such as those with papules or pustules.

A good AHA product is called WellSkin by Genesis. This is light and mild and can be used once a day every other day, increasing to twice a day every other day if necessary. It should be left on for 20 seconds and then rinsed. But proceed cautiously with WellSkin; it contains glycolic acid, which might cause irritation.

SUNSCREENS

Everyone should be wearing sunblocks or sunscreens, but rosacea patients even more so. Exposure to ultraviolet light will cause rosacea to flare up. But again we have to be realistic in our expectations. Not everyone likes the feel of sunscreens on their skin, and we should recommend the products patients will most likely put to regular use.

The most recommended product is, of course, a titanium dioxide sunblock. These products offer the widest range of sun protection and are much more cosmetically elegant and attractive than they were in the past. But not everyone will wear a sunblock lotion. Men for example often prefer a gel sunblock. However, gels are apt to contain alcohol, which can lead to irritation. So, tell the patient to watch for that.

I like SPFs to be above or at 30, but will allow the patient to come down to 15 if the product is comfortable. One excellent sunscreen to recommend is Ombrelle, which contains Parsol 1789.

Definitely stay away from sunscreens with fragrances, and those with low SPFs, and Hawaiian-themed illustrations on the bottle alongside ad copy that promises a “savage tan” to the user.

My advice to patients is that when choosing a sunscreen, or any other product, if they have a question, they can bring the product to my office and I’ll evaluate it. This illustrates to my patients how much these products can mean to their treatment, and that we both need to expend time, effort and care to keep their skin looking and feeling its best.

Dr. Connolly is in private practice in Linwood, NJ. He is assistant clinical professor ion the department of dermatology at Philadelphia College of Osteopathic Medicine.

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