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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

page 2 of 6


  • Use high-concentration green tea antioxidant and caffeine combination products. This should be considered part of treatment because studies have shown that clients with rosacea have skin that is antioxidant-depleted, so it is important to use products that contain extremely high levels of soothing green tea antioxidants. When combined with caffeine, they are even more anti-inflammatory. Avoid vitamin C as an antioxidant because it is too acidic for most rosacea-prone skin.
  • Facial dandruff often occurs with rosacea and needs to be treated, too. A soap with 2% pyrithione zinc, and green tea antioxidant and caffeine products together may be sufficient treatment. If not, clotrimazole cream can be used twice a day until it’s under control.
  • There are prescription U.S. Food and Drug Administration (FDA)-approved and “off label” skin care treatments that dermatologists use. These need to be worked into the skin care routine by the treating physician. Typically, clients should be asked to apply medicated treatments after the green tea antixoidant and caffeine products, but before their moisturizers or sunscreens. Some of the FDA-approved products include metronidazole cream or gel, sodium sulfacetamide, sulfur cleansers and azelaic acid.


  • Moisturizers are important to heal the compromised skin barrier. Choose only nonirritating moisturizers, meaning no alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs) or vitamin C. Pick your moisturizer based on skin type, selecting heavier, richer, oil-containing products for drier skin.
  • People with oily papulopustular rosacea may not want to use a moisturizer. Non-oil hydrating ingredients, such as hyaluronic acid and glycerin, may help increase skin moisture without leaving a heavy product feel on clients’ skin.


  • Sun may play a role in rosacea, especially the erythematotelangiectatic type, which means that daily sun protection is important. For people with rosacea, physical sunscreen ingredients—such as zinc oxide or titanium dioxide—are preferred to chemical ingredients. Chemical sunscreens can sting and irritate sensitive rosacea skin, and they also generate a slight amount of heat as they deflect UV rays. Five percent or higher zinc oxide products are recommended.
  • Mineral makeup can provide additional sun protection when applied on top of sunscreen. Mineral makeup powder is tolerated best due to its simple ingredients.

*Cetaphil is a trade name of Galderma Laboratories, Fort Worth, TX.

Adding skin care treatments and procedures

Rosacea-prone skin is sensitive and has weakened barrier strength, meaning it’s easy to irritate with facial acid peels, massage or mechanical stimulation, such as microdermabrasion, as well as many of the products used to target acne or anti-aging concerns. Following are general guidelines to adhere to for rosacea-prone clients.

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