Prime women in their 50s and above who are doing their best to stay young and healthy cry foul when all of a sudden they look in the mirror and see redness, pimples, and/or pustules on their nose, cheeks, and chin. When I diagnose Acne Rosacea, patients will exclaim, “Wrinkles and acne, that’s just not fair!” My patients want to look younger — but developing pimples like a teenager was not what they had in mind.
We are not sure what causes acne rosacea. It is thought that people of Scotts-Irish descent have a higher risk of developing the condition. However, it is seen in patients of all skin color. Rosacea starts in adulthood and is a chronic condition that can wax and wane over a person’s lifetime. Triggers include stress, heat, sun, spicy food, and alcohol. Patients with acne rosacea commonly have red bumps and or pustules on the nose and cheeks but they can also be present on the chin and forehead. The nose and cheeks may just look bright red and on closer inspection spider veins can be seen.
If you have developed acne, there are some over the counter treatments you can try first. But, if it is not getting better after a month or two or if it is worsening, you may need to see a dermatologist. Patients with acne rosacea may need to take oral antibiotics to get the condition under control. There are also topical cleansers, gels and creams that can only be purchased with a prescription from your doctor. But let’s take a look at what you can try first: over the counter (non-prescription).
Let’s start with the type of cleanser that should be used. Benzoyl Peroxide, salicylic acid and glycolic acid cleansers can be used to cleanse the face if you have extremely oily skin and are not allergic or sensitive to these ingredients. Oftentimes, the ingredients in these cleansers are too irritating or drying for mature skin with acne. A gentle cleanser like the Aveeno Foaming Cleanser is a great choice.
Cleanse your face in the morning using your cleanser on clean fingers, massaging the cleanser over your face and rinse with lukewarm or cool water. Pat dry with a soft towel. Avoid wash cloths, buff puffs, and rotating brushes (that are so popular now). These may be too irritating for patients with rosacea and aggravate the redness.
The next step, if you have active pimples, is to apply a topical antibiotic. This is where it gets really challenging to recommend an OTC product because the majority of products for rosacea require a prescription. Prescription products have also become increasingly expensive. The best OTC product that comes closest to prescription strength, at a fraction of the cost, is called Adult Acnomel which contains Resorcinol 2% and Sulfur 8%. It is a tinted product so use a light application in the morning so as not to interfere with your makeup. It can be applied a little heavier at night and some patients prefer to use it only at night.
A topical glycolic acid product can treat acne and wrinkles, killing two birds with one stone. The key to success with this product is finding one that does not irritate your skin. It was challenging to find, but there is a line that fits the bill called alpha hydrox. Their web site www.alphahydrox.com reviews their glycolic acid products, which are very reasonably priced. The concentration of glycolic acid in their products ranges from 10% to 14%. If your skin is easily irritated, start with the oil-free 10% concentration. For oilier skin or normal skin, the 14% serum may be fine. Apply a small amount and start out just once a day. It may sting at first but, over time, your skin will usually develop a tolerance and you will see the benefits. Be patient. Improvement in wrinkles takes time. In some cases, it will only prevent wrinkles getting worse.
After cleansing, apply the glycolic acid first. The adult acnomel should go on over the glycolic acid.
After cleansing in the morning and applying glycolic acid, the next step is to apply a moisturizer with SPF 15 or 30. Eucerin Redness Relief contains a subtle green color to neutralize redness and licorice root extract for soothing. Apply a water based makeup with SPF over moisturizer.
To summarize, if you have acne rosacea your skin care routine may look like this:
Step 1: gentle cleanser
Step 2: glycolic acid and/or topical antibiotic if tolerated
Step 3: moisturizer with sunscreen
Step 4: makeup with sunscreen
Step 1: cleanser
Step 2: topical antibiotic to acne areas
Step 3: oil free moisturizer to dry areas
Glycolic acid makes your skin more sensitive to the sun. If you plan to be outside all day, switch the glycolic acid application from morning to night time. If after two to four weeks your skin is improved and not too dry from glycolic acid you could increase use to twice daily. Again, Acne Rosacea is a medical condition. If you are not getting results with an OTC treatment, please see a Dermatologist who can help you get it under control because wrinkles and acne are not fair!
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