Patients with acne and rosacea are often confused about selecting appropriate skin care products, cosmeceuticals and cosmetics to add into their daily routine. While they want to continue to see results with the treatment regimen from their dermatologist, they also want to be comfortable using products that address other skin issues, such as wrinkles or that protect their skin, such as sunscreens. They also may want to select skin care products that can help improve the overall appearance and health of the skin during treatment, especially if their medications have left their skin with redness, dryness or inflammation.
Speaking at the 69th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Diane S. Berson, MD, FAAD, assistant clinical professor of dermatology at Weill Medical College of Cornell University in New York, NY, discussed how proper skin care and using some of the newly formulated cosmeceuticals can improve the skin of acne and rosacea patients, as well as helping them comply with their treatment regimen.
"When the skin is stripped of lipids, which are part of its protective outer layer, the skin barrier is compromised and can worsen acne and rosacea," said Dr. Berson. "By keeping the skin well hydrated with the proper skin care products, the barrier will stay intact, allowing patients to better tolerate their medications."
Cleansing 101: Gentle, Gentle, Gentle
When it comes to cleansing the skin, Dr. Berson recommended gentle cleaning and cleansers for skin prone to acne and rosacea. Scrubbing the skin will actually worsen acne, as it can remove skin lipids and can increase irritation. Instead, gently wash with a non-irritating, pH balanced cleanser to decrease inflammation.
"Harsh cleansers, alkaline bar soaps and alcohol-based products may worsen irritation," said Dr. Berson. "Cleansing products with mild surfactants can remove surface oil and dirt without compromising the skin's barrier function. It is important to thoroughly rinse cleansers from the skin because the residue can be irritating."
In addition, Dr. Berson recommended the use of body washes, which contain moisturizers that can deposit moisture back into the skin. By keeping the skin well hydrated, the skin's barrier function remains intact and, in turn, helps patients remain compliant with their treatment regimen without interruption due to skin irritation.
Moisturizers: Good for All
It is a common myth that patients with acne should not use moisturizers, but Dr. Berson explained that this is simply not true. If patients do not use a daily moisturizer, their skin can become red and peel easily due to the drying effect of their acne medications. By using a moisturizer, patients counter the effects of these medications by adding moisture back into the skin.
"Those with acne should use a light, oil-free moisturizer that is non-comedogenic, or won't clog the pores," said Dr. Berson. "Moisturizers containing heavy mineral oils should be avoided, though products containing silicone oils such as dimethicone are good choices."
For patients with rosacea, Dr. Berson noted that their skin is more sensitive and likely to react to ingredients in both prescription medications and skin care products. Moisturizers containing lipids, such as ceramides, are usually well tolerated and improve the barrier that is often compromised in patients with this condition.
"Moisturizers are extremely important for both acne and rosacea patients, and the key is finding the right moisturizer for your specific skin type," said Dr. Berson. "In addition to ceramides, the humectants glycerin and hyaluronic acid are often added to moisturizers to hold moisture in the skin and hydrate it."
New Technologies Improving Sunscreen Formulations
While the health consequences of ultraviolet (UV) radiation from sunlight and artificial light sources are well known, some acne and rosacea patients might not be aware that sunlight also can further aggravate their condition. Dr. Berson recommends the daily use of broad-spectrum sunscreen that protects from both UVA and UVB light, and commented on the new technologies which are improving the feel of sunscreen on the skin.
"One of the newer developments in sunscreens is the use of microfine particles, which takes active ingredients and grinds them down to small particles that are less visible to the naked eye," said Dr. Berson. "In the past, the physical blockers zinc oxide and titanium dioxide were more opaque, greasy, and heavy. Sunscreens with microfine zinc oxide are smoother, lighter textured and more cosmetically appealing formulations."
In addition, since some of the newest sunscreens are designed to not clog pores or worsen acne, Dr. Berson noted that patients are more likely to use these products regularly. She added that spray or gel-based sunscreens also work well for those with acne or oily skin.
Cosmetics and Cosmeceuticals Offer Many Skin Benefits
Manufacturers of cosmetics and cosmeceuticals are continually improving their products by adding ingredients that offer many benefits to the skin, including skin affected by acne or rosacea. Many nonprescription acne products now contain salicylic acid to reduce inflammation and help exfoliate in and around the pores.
"As far as prescription medications are concerned, the reformulation of existing active ingredients has led to better-tolerated products," said Dr. Berson. "The vehicles that deliver the active ingredients to the skin now contain more emollients and humectants that are soothing and non-irritating. Active ingredients can also be released slowly through microsponges – a unique technology that consists of tiny sponges that release its active ingredient on the skin slowly over time and also in response to other factors, such as temperature or massaging the product into the skin. These advances result in products that are more cosmetically pleasing, thus enhancing results by improving compliance."
In addition, Dr. Berson explained that cosmetics –traditionally used to camouflage redness and pimples common with acne and rosacea – are continually improving and can be found in formulations that are non-greasy and non-comedogenic. For example, mineral-based cosmetics, which contain powdered formulas of silica, titanium dioxide and zinc oxide which absorb oil and camouflage redness, are non-irritating for acne and rosacea patients. The ingredient dimethicone also creates a smooth, matte finish when added to cosmetics. These can camouflage breakouts or redness while also protecting the skin from ultraviolet light, a common trigger for rosacea flares.
"Patients with acne or rosacea should talk with their dermatologist to determine the best skin care products for their condition and how these can improve their overall medical therapy," said Dr. Berson. "Choosing the appropriate vehicle formulation for a given patient will also increase tolerability and enhance compliance. There also are several in-office cosmetic procedures – such as peels and lasers – that can improve acne, redness, scarring and pigmentation problems. Dermatologists understand that patients want to look good even in the face of a noticeable skin condition like acne or rosacea, and today that is entirely possible."