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report by Holly of the Cosmetic Connection Product Panel

So, you have rosacea. Or maybe you just think you might. Now what? Suddenly your own skin seems foreign to you. It's red and bumpy where it used to be smooth and clear. Your old skincare staples don't seem to work anymore. That cleanser you've always loved is starting to burn and sting. What's a girl to do? You're not alone. It is estimated that up to 20 percent of the population suffers from rosacea. In its mildest form, rosacea causes prominent redness in the cheeks, giving the impression that the affected person is chronically blushing. Further along, it can cause papules (red solid bumps) or pustules (pus-filled bumps, often mistaken for acne, but unresponsive to acne treatments). Regardless of the stage, once rosacea comes on the scene, old skincare regimens go out the window. Is there any one regimen that works for everyone? Of course not. But staying informed and following some basic guidelines will help you make the right decisions for your skin.

Where do I turn for help?
The absolute first thing you have to do is see a dermatologist. If you don't have one, get one. Period. There is no known cure for rosacea, but a dermatologist can get you started on a treatment regimen that will help control and minimize your symptoms. Furthermore, a dermatologist can monitor your response to therapy and make adjustments if necessary in order to normalize your skin. When should you try the do-it-yourself approach? In my opinion, never. The World Wide Web is teeming with sites targeted at consumers suffering with rosacea and other skin disorders. Some go so far as to suggest that their systems are substitutes for medical care. Message board posts on these sites often bear a common theme. "I don't have health insurance and can't afford prescriptions or medical care, so boy, was I happy to find this system to use instead!" Puh-lease. Given the cost of these systems (sometimes hundreds of dollars) I can't help but wonder if these posts are for real. A visit to the dermatologist will cost approximately $60. A single 45g tube of MetroCream (by prescription only) costs about $45 and will last approximately four to six months with twice-daily application. (Other treatment prices will vary). Spend your money on proven treatments combined with the guidance of a trained professional and leave the "cyber skin gurus" with their magic potions to dream up a new moneymaking scheme.

Now what do I do?
O.K. So you've sought treatment and your skin is normalizing. Now how do you take care of it?

Cleansing is probably one of the hottest issues for rosacea sufferers. The number-one rule in caring for your skin is to avoid irritating it at all costs. Anything that makes your skin red is just worsening the problem. Stick with mild cleansers targeted at sensitive skin. Cetaphil (4 fl. oz. for about $4 at drugstores) is one of the mildest cleansers out there and an ideal choice for delicate, irritable skin. Even though I don't use it all of the time, I always have a bottle on hand just in case of a flare-up, when the gentlest cleansing is required. Avoid cleansers that are heavily perfumed or contain detergents, alcohol, or other known irritants. Olay Daily Facials ($7 at drugstores) now come in a sensitive skin formula and offer gentle exfoliation while you cleanse. Just because a cleanser says it provides "mild cleansing" doesn't mean it will be kind to rosacea skin. (I nearly burned my face off with the "mild cleansing action" of a Neutrogena Original Formula Cleansing Bar!) When looking for a cleanser, look for "Sensitive Skin Tested" on the label. The bottom line: If it stings, don't use it. It's as simple as that. Return it, throw it out, or give it away and start again.

Exfoliation is a bigger problem and a legitimate concern. Often, these ultra mild cleansers just don't do the job. The big news in skin care these days is AHA (alpha hydroxy acid) products for exfoliating and renewing the skin. AHAs achieve their effect by mildly irritating and therefore gently "puffing" the skin to slough off dead cells and minimize the appearance of fine lines. Since their purpose is to irritate, (even if it is just a little bit) these products are, by definition, a bad idea for rosacea-affected skin! BHAs (beta hydroxy acids) work by a less well-understood mechanism, but do not have the irritating effects of AHAs and are a better choice for exfoliating sensitive skin. Oil of Olay's Age Defying line (available in drugstores) uses a beta hydroxy complex, is quite mild, and has worked well for "renewing" my skin without irritating it. (And the products smell divine...). It is marketed for all skin types and comes in a cream or a lotion, so it should work well whether you're basic skin type is oily or dry.

Manual exfoliation (i.e., scrubs) should be done with great care. Gritty scrubs are generally too abrasive. At the very least, they will cause redness, but more often they will just plain hurt. If you must scrub, do so very gently with a product targeted at sensitive skin. St. Ives' Ultra Gentle Apricot Scrub for Sensitive Skin ($3 at drugstores) is not only affordable, but also very gentle and effective. I found that I can even use it on my cheeks - by far the most sensitive part of my face - and I can use it on a daily basis if necessary. Choose scrubs with beads, which are smooth and spherical, not irregular "chunks" of abrasive materials (i.e., ground-up walnut shells). If necessary, use scrubs only on problem spots, avoiding the more delicate rosacea-affected areas.

Toners, too, are a problem. Avoid all products that contain alcohol, acetone or witch hazel, as these tend to burn and irritate. A good cleanser pretty much eliminates the need for toning so far as I'm concerned, but for those who love to freshen up with a toner, use a gentle product and again, one that is designed and marketed for sensitive skin. Neutrogena Alcohol Free Toner (about $5.50 at drugstores) is a good non-irritating, fragrance-free product. Lancome Tonique Douceur is an ultra mild and soothing toner/freshener that is even mild enough to use around the eyes without irritating. It is alcohol-free and retails for $18.50 for 6.8 fl. oz.

Sunscreen is vitally important for rosacea-affected skin, so I tend to lean towards moisturizers with sunscreen in them. Oil of Olay Age Defying Protective Renewal Lotion ($9 at drugstores) contains the afore-mentioned BHA and has an SPF of 15, making it a nice choice. Neutrogena Face Moisture SPF 15 ($9 at drugstores) is another excellent option that is fragrance-free for those who are especially sensitive. It also comes in a tinted formula, which helps minimize redness! Rosacea sufferers who have oily skin may find that their topical medication is all the "moisturizer" they need. In that case, just add a sunscreen and go! Clinique Super City Block ($15.50 at department stores) provides an SPF of 25, is fragrance- free, oil-free and safe to use around the delicate eye area. It is an excellent choice for a stand-alone sunscreen and works well under makeup.

How about a little color?
Rosacea has made me a big fan of self-tanners, since sun worship is now a great big no-no and can cause flare-ups. An added benefit of the "sunless" tan is that darkening the entire face tends to minimize the contrast between rosacea red spots and the rest of my skin. Clarins Self Tanning Face Lotion ($24 at department stores) is a terrific, natural-looking self tanner (available in Light or Deep Tan) that is gentle, non-irritating, non-comedogenic and has the added bonus of a 15 SPF. Check self tanner ingredients carefully and use formulations designed specifically for the face, which are more likely to be non-comedogenic and less likely to irritate.

So what does it all boil down to?
Bobbi Brown is a big proponent of treating skin on a day-to-day basis, and I think that's the best skin care advice I've heard. What's right for your face one day may not be necessary the next. This is especially true with rosacea, since variables such as temperature, stress level, and even what you eat or drink on a given day can affect the way your skin behaves. (My favorite spicy Thai dishes wreak havoc on my face these days). Be kind to your temperamental skin. Evaluate it every day and address its daily needs. Choose your products carefully and stay informed. Your face will thank you for it!



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