This article is a review and summary of “The Role of Skin Care in Optimizing Treatment of Acne and Rosacea,” published in SkinTherapyLetter’s June edition. The original article is written by Calgary dermatologist, Dr. Catherine Zip.
Context: Acne and Rosacea
Acne and rosacea are very common skin conditions that dermatologists see in their patients. Both acne and rosacea involve an impaired epidermal barrier function and require ongoing management in addition to appropriate treatment. In both conditions, educating patients about proper and specific skin care and cosmetics advice improves outcomes, both in terms of quality of life and efficacy of treatment.
Acne:
Providing patients with appropriate therapy alone is not enough. Optimizing outcome is integrative, including patient education about acne, and proper skin care. There is evidence that acne patients have impaired epidermal barrier function, and moreover, the medications used to treat acne like benzoyl peroxide may further affect barrier function. Skincare products, used appropriately can help to mitigate these negative effects, increasing patient compliance and ultimately improve outcomes.
Cleansing: Although unsupported by scientific evidence, many acne patients still believe that acne is related to suboptimal skincare or dirt on the skin.1 Mild cleansers are recommended so that the skin isn’t irritated during washing. Dermatologists recommend twice a day cleansing. In a trial, more frequent washing did not improve acne. Aggressive scrubbing should be avoided to prevent further irritation and trauma leading to further inflammation.
Moisturizing: Contrary to public perception, moisturizing is an important part of acne therapy. Acne patients have damaged barrier functions, and require the help of moisturizers to protect their skin. Moisturizing, using a non-comedogenic product, should be a part of an acne patient’s treatment routine. Unfortunately, moisturizers can sometimes trigger acne itself – and there isn’t a way to guarantee that a non-comedogenic product won’t trigger acne for you. Some experimenting may be necessary to see which products work for you.
Sun Protection: Sun protection is recommended to all acne patients. There is no scientific evidence suggesting that sun exposure improves acne.2 Several treatments like doxycycline and isotretinoin may be photosensitizing. The FDA labeling also recommends sun avoidance for medications containing topical retinoid and benzoyl peroxide, both very common ingredients for acne medication. Sun protection is also essential in preventing post-inflammatory hyperpigmentation, especially in patients with darker skin.
Rosacea:
As with the case with acne, proper skin care is very important in managing rosacea. A triad approach of treatment, education about triggers, and advice to appropriate skincare and cosmetics. Skincare, makeup, and the psychological aspects of rosacea were deemed very important by rosacea patients taking a questionnaire by the Canadian Rosacea Awareness Program.3
Cleansing: Surfactants in cleansers can disrupt proteins and lipids in the stratum corneum (the uppermost layer of the skin); as rosacea patients already have a weakened barrier function and are more susceptible to irritants, mild cleansing is important. pH levels and the type of surfactant used are important considerations for rosacea patients.
- Choose synthetic detergents (syndets) and lipid-free cleansers
- Mild cleansing showed reduced dryness, stinging, burning, itching compared to using soap bars in studies
- Patients should avoid hot water when washing, as well as mechanical trauma like granular exfoliation, can worsen rosacea symptoms
- Astringents and toners should also be avoided
Moisturizing: Moisturizing has incredible benefits for patients with rosacea. It helps reduce TEWL (transepidermal water loss – natural moisture loss via evaporation), critical in improving barrier function and controlling dryness. This helps to reduce skin sensitivity and improved tolerance for topical medications.
- Avoid emollients that contain urea, glycolic acid, lactic acid, menthol, camphor if possible as they may be irritating
- Choose cream type products over lotions and gel products
- Although data is limited, rosacea patients may be more prone to contact allergy due to their damaged barrier function
Sun Protection: Daily sun protection is an important part of rosacea management. Sun exposure is one of the most common triggers that worsen rosacea symptoms, and may even be a contributing cause of rosacea itself. It is thought that proinflammatory peptide production may be triggered by acute sun exposure reducing antioxidant reserves and triggering reactive oxygen species. The challenge is that rosacea patients are often hypersensitive to cosmetic ingredients, and finding a sunscreen that doesn’t aggravate the symptoms take some experimenting.
Optimal acne and rosacea management must include appropriate skin care regimens – most importantly, specific advice related to cleansing, moisturizing, and sun protection. This is an unmet need and has shown to improve quality of life. Integrating skincare will help improve tolerability, leading to a higher quality of life, improved compliance, and thus better outcomes.
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1Tan JK, Vasey K, Fung KY. Beliefs and perceptions of patients with acne. J Am Acad Dermatol. 2001 Mar;44(3):439-45.
2Magin P, Pond D, Smith W, et al. A systemic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Fam Pract. 2005 Feb;22(1):62-70.
3The Role of Skin Care in Optimizing Treatment of Acne and Rosacea
