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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

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Facials. My team created the Calming Facial specifically for rosacea clients in our office. The goal is to cool and soothe inflammation, and avoid overstimulating skin. Steam is often avoided and steam towels are cooler than normal. A moisturizing, soothing mask is applied, along with a hyaluronic acid serum and a green tea antioxidant cream. A thermal spring water mist is used on the skin between steps, and only the gentlest massage pressure is used throughout the treatment. A light moisturizer and zinc oxide sunscreen finishes the service, followed by a light dusting of loose mineral makeup powder. If an automated skin-cleansing brush is used, it is kept on the lowest settings with a delicate brush. If a toner is used, it is witch hazel-based. (See Calming Facial Results.)

Anti-aging treatments. Anti-aging skin treatments are tricky because they can irritate rosacea. It’s best to avoid chemical peels on rosacea-prone skin and, instead, use very cautious microdermabrasion treatments. This is because skin barrier function in rosacea is altered, and chemical peel predictability depends on absorption of the peeling agent. Microdermabrasion, on the other hand, is a purely physical exfoliation of the skin. However, the mechanical stimulation can aggravate rosacea. To help counter this, follow a microdermabrasion treatment with a Calming Facial. Another great anti-aging treatment for rosacea clients is intense pulsed light (IPL), because it offers anti-aging and anti-rosacea benefits.

Incorporating anti-aging products into a rosacea client’s skin care routine needs to be done cautiously because most effective products can be irritating to sensitive skin. Only introduce anti-aging products when rosacea is in remission and the skin barrier has had a chance to heal for at least a few months. One of the most well-tolerated anti-aging product for rosacea-prone skin is tretinoin. In fact, some dermatologists use tretinoin to treat rosacea.

The acid pH of many of the powerful anti-aging skin care products, such as professional vitamin C and AHA products, makes them poorly tolerated, especially for erythematotelangiectatic rosacea. Papulopustular clients may, however, do surprisingly well with acid pH anti-aging products once their rosacea is controlled.

Final considerations

Encourage your clients to avoid trigger factors that exacerbate their rosacea or cause flushing, such as temperature extremes, spicy foods, alcohol and harsh climates. Very gentle facial massage can be helpful. In fact, one study showed that gentle central facial massage done daily can help rosacea. Also, the treatment and control of rosacea helps prevent permanent telangiectasias and skin damage.

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