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Rosacea for the Esthetician: A Comprehensive Guide—Part II

By: Cynthia Bailey, MD
Posted: July 30, 2013, from the August 2013 issue of Skin Inc. magazine.
Facial distribution of rosacea

Image courtesy of Cynthia Bailey, MD

In Part I of this article, which appeared in the July 2013 issue of Skin Inc. magazine, the different types of rosacea were described and explained, and tips were provided to help skin care professionals identify rosacea versus acne, dermatitis and facial dandruff. Part II will discuss how to design a skin care program for clients with rosacea, as well as how to work with these specialized clients.

Designing a skin care program for rosacea

The first and most important step is to decide if clients are suffering from the exquisitely sensitive skin of the erythematotelangiectatic type of rosacea, or the tougher skin of papulopustular rosacea—or if they fall somewhere in between. In general, the facial skin barrier strength in rosacea is abnormal, making any irritating products or treatments—such as those for anti-aging or acne—much more aggravating to rosacea-prone skin.

What’s the best way to begin working with clients who you believe might have rosacea?

  • Ask what products and procedures they have used before. What have they tolerated or not tolerated? Use this history as a guide.
  • When in doubt, start cautiously by using nonirritating products.

Following are the basic skin care steps that you can use to create a complete skin care routine for your rosacea clients.

  • Cleansing
  • Treatment
  • Hydration
  • Protection


  • Use gentle, nonirritating products, and minimize scrubbing or exfoliation at first.
  • Avoid foaming cleansers, except for only the most oily papulopustular rosacea.
  • Synthetic detergent cleansers, such as Cetaphil*, are excellent to use.
  • In addition, a medicated cleanser, such as a soap with 2% pyrithione zinc or a prescription sodium sulfacetamide/sulfur cleanser (a sulfa antibiotic and sulfur combination), should often be used once a day as a great way to deliver treating ingredients. Alternate this medicated cleanser with a nonirritating synthetic detergent cleanser, because some of these products can be drying.
  • For excessive facial scales and engorged or clogged pores, you can very gently try using a facial sponge or automated skin-cleansing brush on a gentle setting with a delicate brush only. However, the skin may not tolerate this, so only try it when rosacea is in remission.
  • Generally avoid facial toners for all but the most oily rosacea complexions. If you do use them, stick to alcohol-free, gentle products only.

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