How to Treat and Beat Rosacea

Airdate: 8/11/11

If you or someone you know, suffers from rosacea this is a can't miss show! Paula covers effective solutions for treating rosacea, as well as discussing her own customized skin-care sets designed to get symptoms of rosacea under control.

Paula Begoun: Hello, I'm Paula Begoun, the Cosmetics Cop, with my Paula's Choice team, Bryan Barron who has been writing books with me and writing all kinds of information for, and, and just general all-around genius and beauty expert, Bryan.
Bryan Barron: Hi.
Paula Begoun: Hi Bryan.
00:00:30 And Kate Mee, who is my gorgeous and wonderful product development director who is filling in for Desiree, my assistant and normal producer. But Kate has generously stepped in as Desiree wasn't able to be here this evening. And Kate, you have been busy.
Kate Mee: Hello. I've been very busy.
Paula Begoun: You've been very busy. In fact, somebody, I was on Facebook today answering questions from our friends, our "likes," people who follow us on Facebook.
00:01:07 And did we do a panel test on a new product I didn't know about? Did you sneak in a new product you have been working on?
Kate Mee: It's quite possible. What are they telling you? I need to know what you know first.
Paula Begoun: Is there an ultra lightweight antioxidant thing you are working on?
Kate Mee: Yes. We are working on an ultra light antioxidant concentrate for oily skin for the Resist line.
Paula Begoun: Do I know about this? Did I approve this?
Kate Mee: You did know about it.
Paula Begoun: Okay, figures.
Kate Mee: But it has been awhile since we have talked about it.
Paula Begoun: Okay.
00:01:41 So everyone is excited about it. Everyone is excited about it.
Kate Mee: It's an incredible product.
Paula Begoun: Because I don't remember, because of the million different reasons why I don't remember, can we go over that at some point when I'm back in the office?
Kate Mee: It's on the list for next week.
Paula Begoun: Okay, thank you Kate. So Kate keeps my memory and our products for Paula's Choice, the many different ones we do panel tests with and she is just all around genius and is wowing the fashion magazine editors back east, but we will talk about fashion magazine editors, beauty editors in just a second.
00:02:21 Tonight, and we are going to get to this pretty fast, is how to treat and beat Rosacea. It is just a very difficult disorder to deal with it. We are going to talk about how you recognize it, what makes it worse, what makes it better, what not to do, what to do. Because absolutely if you know what you are doing, if you get the kinds of products your face needs, you actually can keep it under control. If not, if you leave your Rosacea untreated or continue using products that make it worst or situations that make it worse, it will get worse.
00:03:09 It will actually cause more damage, more Rosacea, and all of the problems associated with it. So we are going to help stop that. We are going to help change that pattern and get you what you need to know to get your Rosacea under control. But on the subject of sensitive skin, because sensitive is on many levels an issue of sensitive skin, well, very seriously sensitive skin.
00:03:39 There was an article in Glamour Magazine, Rihanna is on the cover. And actually Rihanna is a lot more beautiful than she looks in the cover of Glamour. But Lord knows she is a stunning woman. But there is an article in Glamour – "Do you really have sensitive skin?" – and then it gives you a list of things to know if you have sensitive skin.
00:04:00 And then it gives some of the craziest information. I mean a lot of beauty articles in fashion magazines give bad information. It's hardly the first time. This one is just so loaded – it was glaring to us. Actually it was glaring to Bryan. Bryan is the one who brought this to the table. So their Sensitivity 101 piece of information guarantees if you follow even just one of her suggestions you are going to have sensitive skin.
00:04:35 So for example, one of the things they say, it's normal for any skin to turn red and tender after several applications of crazy potent anti-pimple or anti-wrinkles ingredients like retinol or glycolic acid since these do their jobs by acting on the skin's protective barrier. I don't even know where to start to say how insane that is. Because first of all, "crazy potent," what does crazy potent mean? They don't explain what that means.
00:05:09 But even so, it depends on the formulary. Retinol, if you are putting in amounts that are gentle, meaning you are not overloading it, because really much over 0.3% and you have a great product that can tell skin cells to act younger, and glycolic acid when it is in a formula that doesn't contain other irritating ingredients and is pH balanced, the research actually shows that it makes wrinkles less, does not increase irritation, builds collagen.
00:05:39 I don't know where they are getting this from. They also say your best bet for sensitive skin is to try a formula labeled "sensitive skin" – good for sensitive skin. Because according to this article most of them don't contain the typical offending ingredients for sensitive skin. Obviously whoever wrote this article didn't look at any of the formulas that we have, the thousands of formulas we have presented on for all, hundreds and hundreds of products, many labeled for sensitive skin that contain terrible ingredients.
00:06:18 Contain irritating fragrance, both natural and synthetic, alcohol, menthol, just devastating formulas and they are saying for sensitive skin.
Bryan Barron: There's no standards. Just like the terms "hypoallergenic" or "noncomedogenic." Any product, even one that is loaded with the who's who of irritating ingredients can proudly state on the label "for sensitive skin." And if that is your only barometer for shopping for those products, it is a guarantee that you will end up making your skin worse. It has to be more than that.
Paula Begoun: And then, oh this just – where do they find these dermatologists? Do they just make it up and find a dermatologist to say something crazy so it sounds like this is a serious article?
00:07:07 So some dermatologist says "and try mineral makeup which seeps into skin less deeply than conventional makeup does." First of all, conventional makeup doesn't seep into skin. If it did you wouldn't see it on the surface. The reason foundation stays on the surface and covers skin is because it doesn't seep into it.
Bryan Barron: Absorb into it.
Paula Begoun: That's the whole purpose.
00:07:32 But the other thing is mineral makeup, because it is a mineral, whether it is talc or in many of these "mineral" make-ups from companies like Jane Iredale and Bare Escentuals and they contain bismuth oxychloride. Those are irritants. They irritate skin. It is not that they are bad, but they are drying and absorbent and their mineral/grainy texture, even though it is soft, that graininess can be irritating for sensitive skin. It's just such a crazy recommendation.
Bryan Barron: Actually, a little interesting side fact about bismuth oxychloride is that when it is looked at under a microscope it has a crystalline shape and some women who use mineral make-ups with the high amount of bismuth oxychloride, they complain of a prickling sensation on their face when they apply it and as they are wearing it. Well, they are not imagining that sensation; it's really happening because the shape of that ingredient is poking your skin as you work it in with the brush because of its shape.
Paula Begoun: And actually, you know it is kind of interesting…well, I won't even get into it. Chemically from a –
Bryan Barron: It's not natural.
Paula Begoun: Well, it's not natural, but if you were to look at this bismuth oxychloride that shows up in a lot of mineral make-ups, it looks like asbestos.
00:08:58 It actually looks like asbestos. And talc actually…no, wait a second. Bismuth oxychloride looks like arsenic and talc looks like asbestos. Not that that is bad. I mean I am not saying that those are bad, but they are potential irritants. They are not like brilliant options for sensitive skin. Then the other thing this article says, this one just floored me – that thanks to, usually the fixes that cause your sensitive skin can be thanks to the strong salicylic acid and glycolic acid, benzoyl peroxide and retinoids in many breakout fighters, many products for acne.
00:09:36 But those are the ingredients that research has shown can stop acne, it just depends that you are not using those that contain alcohol and menthol and other irritating ingredients and then pushing a product from Dr. Dennis Gross that says try switching to a less drying sulfur based product from Dr. Gross. Sulfur is far more, by far one of the most irritating skincare ingredients you can put on your skin.
00:10:08 In fact, they have stopped making…they don't make products with sulfur anymore, really almost any medications. It's rare for acne because it is so seriously damaging to skin. And actually increases bacteria content. I mean I could go on and on. This article is…and the products they recommend almost all of them contain irritating ingredients.
00:10:33 Almost all of them. Either fragrance or eucalyptus or alcohol or…I mean just on and one…witch hazel and fragrant oils, all of the ingredients that are problematic for those with sensitive skin. Okay, that article goes. Look at Rihanna, though, she is gorgeous. Okay, I'm done complaining. But that just threw me.
00:11:00 There's more crazy information. Oh, you know, one of the good things in there, one that they did talk about that actually I thought was interesting is that they mentioned about toothpaste can be a problem for sensitive skin. And it can be. Fluoride can be an irritant if you get it around your mouth and it doesn't just stay inside your mouth. So, I thought that was interesting but of course you would never give up toothpaste unless you talk to a physician first.
00:11:31 But absolutely some people with irritation, what they call perioral dermatitis around the mouth can be a result of toothpaste, so that was a bit of good information in the middle of a lot of bad information. So if you have any questions for us or the Paula's Choice team, you can call us at 347-426-3783 and we will do our best to get to as many callers. Let's talk about Rosacea. So Rosacea is a frustrating skin disorder that has a very specific appearance.
00:12:07 It starts in the beginning to just look like you are intermittently turning red like you are blushing all over the face or red flushing. It can be all over the face or what they call the butterfly area of the face which is across the nose and out onto the cheek, along the center of the forehead and the chin. And, it can be random meaning it shows up at different times, or it can be there all the time.
00:12:34 It almost always comes with extreme sensitivity. You can also get acne like bumps but the jumps are generally not acne. They are associated to the inflammation related to Rosacea. You can get flakey skin, you can get oily skin, or you can get both. But it would always come combined with this red flushing over the face.
00:13:04 With time you get visible tiny blood vessels that can actually expand and become very noticeable blood vessels. And you can absolutely have such severe sensitivity that some women can't even use anything more than water on their face and even that can be problematic. Almost anyone can get Rosacea. My boyfriend who is of the Indian descent has Rosacea, very clear Rosacea.
Bryan Barron: He does?
Paula Begoun: Yeah. I didn't tell you that? Yes, Harsha has…
Bryan Barron: No, I never noticed that. I just saw him…
Paula Begoun: It's not unusual.
00:13:40 Well, I try to keep it under control so hopefully you don't see it.
Bryan Barron: You are doing something right.
Paula Begoun: I'm doing something right. Yeah, he has…it actually can be, especially when he swims, it can flare up. And if he is sneaky and we are traveling somewhere and he uses the shampoo that the hotel provides, for sure he is going to get an intense reaction, almost without exception.
00:14:10 And then I have to say, "Stop doing that, darling. Here is what you are supposed to use instead." He goes, well, but it wasn't in the shower. So I just chase him down. But, yes, he has Rosacea. So even though men, other than my boyfriend, are less likely to have Rosacea, when they do get Rosacea they have more noticeable problems, meaning a more very intense flare-ups, lumpy skin, not so much the bumps but lumpy skin.
00:14:43 And they get swollen noses. So W.C. Fields, the actor, even though everyone blamed his big bulbous nose and said it was about him being an alcoholic – I don't know whether he was or wasn't really an alcoholic – but his swollen big nose was because he had very clear signs, the redness, the swollen nose of Rosacea.
00:15:06 President Clinton had very clear signs of Rosacea. I'm fairly certain he went through laser treatments which we will talk about because his big swollen nose isn't quite as swollen. So I am pretty certain he got it treated. Of course, who knows? But just looking at him it definitely got better with his second administration.
Bryan Barron: Mm-hmm.
Paula Begoun: So that is what Rosacea looks like. That's what Rosacea looks like.
00:15:32 And it affects mostly white women. The fairer the skin, the more likely you are to have Rosacea. They say that 40% of Caucasian women have Rosacea and in the survey, I thought this was kind of surprising, the survey of over 1,000 women with Rosacea, 60% said that their symptoms were so uncomfortable and they were so embarrassed by it that they found it hard to do their work.
00:16:07 It's really, that it was just emotionally debilitating for them when they had a bad flare-up. And according to this article, in the United States alone 16 million people have Rosacea. I actually think it is higher than that. But 16 million is what was quoted in the article.
00:16:30 So let's talk about what happens if you don't treat Rosacea. So, if you have this redness, well first here's a blanket statement: while I do think skincare can play a significant role, just regular cosmetic skincare of the right products that don't make it worse can make a significant difference in the appearance of Rosacea, over-the-counter products, skincare products that you buy at a cosmetic counter or from Paula's Choice, my line, can't stop Rosacea and make it go away.
00:17:13 It just can't happen because of the nature of what causes Rosacea and why it gets worse because it is such a complicated disorder. So, absolutely great skincare products can reduce the symptoms. But to really get the symptoms under control, that takes medication and probably laser treatments that we will get to in a second.
00:17:39 So, what causes Rosacea. You know, actually, I'm going to mention some things but overall they are not exactly sure why some people get Rosacea and other people don't get Rosacea. But it seems to be a vascular disorder. That means it is about blood vessels. It is about the body making too many blood vessels on the face. It seems to be associated with weight, the more skin you have, if you are making more blood vessels you've got, because fat distributes and your skin stretches, the more skin you have the more blood vessels will be created, the more Rosacea you are going to have.
00:18:20 It seems to have something to do with genetics. If you have family members who have it you are likely to have it. But other than some technical things about enzymes and other things your body does, it actually is relatively irrelevant why you have it. Because in the long run whatever the reason is, the way you treat it is the same regardless of the theory behind why you get it.
00:18:51 Now there was one thing, Bryan, you brought up today was that excess iron consumption is suspect in making it worse. Not causing it, right, just making it worse?
Bryan Barron: Right. It's about what happens is that the iron that your body cannot use is stored and converted to ferritin and this ferritin can basically cause some inflammation and problems on its own because excess ferritin generates hydrogen peroxide free radicals.
00:19:31 So as that is going on in the body when your immune system or the inflammatory response is already kicking into high gear because of other Rosacea triggers causing this excess oxidation in the body is only making matters worse.
Paula Begoun: So in terms of excess iron consumption, that is absolutely something…actually, I think the thing I would be concerned about are women who take supplements and maybe have extra iron in these supplements that they don't need. But anything around this issue of iron consumption would be, and ferritin levels, because ferritin levels are very important in terms of anemia. I mean you need ferritin. You need iron.
00:20:16 But in terms of excess, that is something you would absolutely want to discuss with your physician. So the issue is that aside from what may or may not have, you know, why you are the one who has Rosacea and somebody else doesn't, if you leave it untreated, if you leave it untreated, then the inflammation – the redness, obviously, that angry red flushing that starts out looking just like an embarrassment blush but with time almost without exception it will get worse, that constant inflammation, that constant flushing and then eventually that inflamed redness that doesn't go away, that inflammation is actually causing skin and collagen to break down.
00:21:08 It actually causes advanced aging faster. That is a serious problem aside from the inflammation redness and sensitivity and just the emotional impact of how you feel you look. The other thing that can happen, now this is primarily for those who tend to have Rosacea with oily skin is that the inflammation and the increased oil production that it seems that that disorder of the oil gland that is combined with the Rosacea actually makes and distorts the shape of the pore worse for those with Rosacea and oily skin than somebody who just has oily skin.
00:21:53 Now it is kind of interesting: people with Rosacea who have oily skin and these bumps that tend to not be acne actually usually don't have blackheads. But they have oily skin and they have pores that start looking distorted and enlarged. The other thing, because of the inflammation you are making more free radicals in the body, free radicals cause collagen breakdown and hurt the skin's healing process, make you more vulnerable to sun damage and on and on.
00:22:25 So all of these things absolutely mean that if you want to have healthy skin you have got to get the Rosacea under control. So lifestyle things are some of the easier things, I think, to get under control. But the National Rosacea Society did a huge survey and their conclusion from the women and men that they interviewed said that some of the major triggers for Rosacea was sun exposure, unprotected sun exposure, especially in hot weather; emotional stress; hot or cold weather, wind – getting blown, your face getting hammered or irritated; alcohol, drinking alcohol; spicy foods, anything that increases blood flow; heavy exercise, again, blood flow; hot baths; heated beverages; and skincare products with irritating ingredients.
00:23:30 Now let me be very clear that absolutely sun exposure needs to be kept at a minimum. Hot or cold weather, well it just gets hot or cold – that is very hard to avoid. You can keep your face out of the wind as much as possible. You can reduce alcohol consumption. Spicy foods tend to be very healthy but you need to figure out what spicy foods are the trigger for you. I'm never going to tell anybody to give up heavy exercise. Hot baths – if you steam your face, either hot showers or hot baths, it is going to make things worse.
00:24:05 And very hot beverages will make things worse. And now we are going to talk about skincare products because that is a…oh, let me mention real quick – diet plays a very significant role because if you eat a diet that creates inflammation in your body, like drinking too much alcohol, a diet high in sugars, you are going to make more free radicals in your body and that will show up on your face. Smoking, that kind of goes without saying. And because weight – when you are heavy you have got more skin, you are making more blood vessels.
00:24:43 That will just give you more room to have more Rosacea – that's a problem. And unfortunately menopause. Just when you thought your Rosacea might be getting better, perimenopause and menopausal symptoms can actually trigger it. So, there are things you can do. There are things that I don't want you to stop doing. I don't want you to give up heavy exercise. I don't want you to give up having a wonderful full life outside, but you can reduce sun exposure, you can keep your face protected from hot and cold weather as much as possible, wind in particular.
00:25:20 But absolutely the other major thing you can do is around skincare. What kind of skincare products you are using and then medical treatments. Let me go over that real quick. So, here's what it is for skincare, that is such a very major issue, is that it's got to be gentle – no irritation. Now I know I harp on that but after reading this article in Glamour Magazine it gets so undermined by all of the crazy products out there and all of the crazy information.
00:25:51 It's just so easy to run into irritating products. It's just astounding how many are out there and they can say "for sensitive skin." Or they can say "redness relief." Bryan, which one – was it the Dr. Weil product that was in, by Origins, that was in a jar and contained fragrance? Which one was that? I just closed the…
Bryan Barron: Yes. The [Plantidote]. I think it is called "Mega Mushroom Cream" from Dr. Weil. It does have some good anti-inflammatory ingredients in it like trimeric grape seed. But when they are comingled with all of those fragrant oils that no one's skin needs, it doesn't matter.
Paula Begoun: And it's in a jar, so any of those good ingredients would degrade in the presence of air which is what jars let in. So, okay, it's got to be gentle. It really has to be gentle.
00:26:47 The cleanser has to be gentle. All the products you use have to be gentle. That means nothing drying or irritating. No fragrance, not synthetic or "natural." It doesn't matter the source – if it is highly fragrant, there are very few exceptions to that rule, whether it is synthetic or natural it is going to hurt your skin.
00:27:12 You absolutely need to use products that don't contain alcohol, that are loaded with antioxidants because antioxidants reduce inflammation. I do feel strongly about salicylic acid as being one of the better products for those with Rosacea. The thing about salicylic acid is by its nature it has anti-inflammatory properties. It exfoliates in the pore which helps reduce the misshapen size of the pore that can happen with Rosacea.
00:27:48 And it helps get off the dead built-up layers of skin on the surface which can be a problem for those with Rosacea because the skin tends to not shed normally as it should. The other thing is that whatever ingredients, whatever products you use, whether it is for oily skin or dry skin, what you use has to contain healthy ingredients like antioxidants and none of the bad stuff.
00:28:15 So you have to eliminate irritating or sensitizing ingredients, you have to use products that reduce redness in skin, meaning they contain state-of-the-art antioxidants, you have to improve cell turnover to remove the build-up of dead skin cells that can clog pores and make the red bumps worse. You have to protect the skin from sun damage. And for those with Rosacea that means using sunscreens that contain titanium dioxide or zinc oxide; you want to avoid synthetic sunscreen ingredients.
00:28:46 It's not that synthetic sunscreen ingredients are bad, it's just that they can be irritating. In fact, a great way for women who have Rosacea to get sunscreen to the face is to use a liquid foundation with sunscreen that only has titanium dioxide and zinc oxide and then you can use a soothing moisturizer underneath that's lightweight. And that is a great way to get a good moisturizer with antioxidants to the skin and then a sunscreen on top with a foundation that has titanium dioxide and zinc oxide as the only active ingredients.
00:29:24 So that's in terms of skincare. In terms of medical treatments that you absolutely need to consider and discuss with your physician – there was a great study that was done and published in the British Journal of Dermatology just this June, June 2011, that took a look and reviewed all of the studies on Rosacea. It looked at over 60 studies, over 6,600 participants, and what they concluded is that the medical interventions, the medical treatments that seemed to have the best results was prescription-only products that contain metronidazole which is typically in products like MetroGel, MetroLotion.
00:30:24 There's topical azelaic acid creams. They seem to have benefit. And oral doxycycline but in very low doses so that it is an oral antibiotic in very low doses so that you don't get any of the issues that come with taking oral antibiotics such as adapting where the bacteria in the body adapts and you can't use that anymore. So low dosage doxycycline because there is some theory that one of the things that triggers Rosacea is little critters, little microbes in the skin that's causing the problem.
00:31:12 Again, the theory doesn't matter as much as trying these different treatments to see which one along with gentle skincare can work for you. Let's talk about lasers real quick. IPLs – intense pulse laser treatments, YAG lasers, CO2 lasers – there's a whole bunch of lasers out there that target the redness in skin. And there is a great deal of research saying that one treatment doesn't work, that multiple treatments with lasers, these certain kind of lasers that are targeted toward redness can make a huge difference. Bryan, you said that some lasers, that you might need to shop different lasers because not one works for everyone.
Bryan Barron: Right. So, the intense pulse light treatments are your first line of defense when you are ready to consider the services a cosmetic dermatologist can provide. The intense pulse light works in most cases after a series of treatments. You typically need anywhere from three to five treatments, spaced about four to eight weeks apart. It is not a one-shot deal and even after a series of treatments you will need to have maintenance treatments maybe every 12 to 18 months depending on when the blood vessels start becoming a problem again.
00:32:37 But we hear from a lot of women who go through a series of those treatments to handle their Rosacea and the broken capillaries and they don't have very good results. And naturally and understandably they are upset, they have spent a lot of money. There are other types of lasers to consider and so the message we wanted to get out is don't throw in the towel and give up hope on what lasers or light emitting devices can do.
00:33:04 Some of those broken blood vessels, those capillaries, are simply more stubborn. Some of them are deeper in the skin beyond where intense pulse light can target. And so you can ask your dermatologist about other options such as there is an 810 nanometer laser that goes by different brands. Any dermatology center that specializes in laser treatments should certainly have other options for you and they are definitely worth asking about if IPL doesn't work as well as you would like.
Paula Begoun: Oh, Bryan, thank you for correcting me, I appreciate that. IPL stands for Intense Pulse Light, it isn't a laser per se in terms of some of the other lasers that tends to work more superficially than the deeper layers like C02 or the YAG laser. So, right, you don't have to remember those names; you just need to be sure you talk to a dermatologist who gets that there are more than one option for Rosacea depending on the severity.
00:34:02 If when you talk to a dermatologist and they don't get that, then it is a problem, you got to find another dermatologist. Kate, I see that Daphne from Texas has a question about sunscreen and Rosacea. Can we talk to Daphne?
Kate Mee: We absolutely can. Hi Daphne, are you there?
Daphne: Yes. Hi Paula.
Paula Begoun: Hi Daphne. How are you?
Daphne: Good. Thank you so much for taking my call. I am 42 years old and I have Rosacea, not a real severe case. Over the years it has gotten a little worse. I use all of your stuff and go to a dermatologist for Finacea and I get IPL sometimes too and those really help.
00:34:50 But one thing that I am noticing now…
Paula Begoun: I'm sorry, Bryan, Finacea, is that azelaic acid?
Bryan Barron: It is. Finacea is a brand name for a prescription with azelaic acid.
Paula Begoun: And what is that, Bryan, 15% or 20% azelaic acid?
Bryan Barron: I'm fairly certain it's 15%.
Paula Begoun: All right. So you are getting good results with IPL?
Daphne: Pretty good. But it does still – it's pretty strong the Finacea when it comes on. But then I put your stuff, the serums and all your lotions and stuff after and then it kind of cools it off. But, one thing that I am noticing is obviously I am in Texas and it is so hot, and I am also very athletic and I run and do a lot of sports, I put a lot of sunscreen on and I use zinc oxide because she told me when you have Rosacea you need that zinc oxide.
00:35:43 But since I have been using zinc oxide I have noticed that my pores, I don't know if it is my age, or what, but my pores on my nose, like blackheads, and they will not go away. And the more sunscreen I use, if I am using it pretty heavy like a week at the beach or something, it's worse at the end of the week. So what do I do?
Paula Begoun: Daphne, I know. Believe me. Now are you using any of my BHA products, Daphne?
Daphne: Yes. I have all of your stuff and really I need to know what order to use everything in sometimes because I have so much I don't know which one – I definitely use the BHA and then I mix it up sometimes with the AHA.
Paula Begoun: Right. I would rather you not mix it up with the AHA unless you don't get a reaction.
Daphne: No, I mean every other day, not at the same time mix it up. Every other day.
Paula Begoun: And that is working for you versus just the BHA?
Daphne: Actually I probably use it maybe every few days because then I will start noticing my face will get too dry or it is just kind of irritated.
Paula Begoun: Daphne, I would rather you just use the BHA. I would rather you experiment with my different types of BHA than use an AHA.
00:36:59 AHA generally is not the best option. Alpha hydroxy acid which is the active ingredient is either glycolic or lactic acid isn't the best for Rosacea because it doesn't have natural anti-inflammatory properties like salicylic acid/BHA does, not to mention especially considering you are having problems with clogged pores, blackheads, because there is no way around it. AHAs can't address that quite like salicylic acid, BHAs can. But let's go back to the problem.
00:37:32 So whose zinc oxide product are you using?
Daphne: I'm using Obagi 50.
Paula Begoun: Obagi 50 is just zinc oxide? That can't be.
Daphne: I think it just mostly has zinc oxide. It might have some of the chemicals. But I move around, I mean my daughter has sensitive skin. I always buy the sensitive skin zinc oxide for her and sometimes I put that on if we are at the beach or I need to reapply or something.
Paula Begoun: Daphne, wait one second for me.
00:38:04 Bryan, does Obagi's 50, it can't be just zinc oxide. Do we have that? It would have to have synthetic sunscreen.
Daphne: It's kind of new, they said this year.
Bryan Barron: Yes, is this from his ZO Skin health line?
Daphne: Let me grab it. But I was using some of yours and my skin was kind of dry, sometimes it flakes off like white. So that is the only one of your products I don't use.
Paula Begoun: So let's do this –
Daphne: Well you have stuff with the 15 and all that.
Paula Begoun: And that's not enough.
00:38:45 Bryan, Neutrogena has an SPF 30 with just titanium dioxide and just zinc oxide?
Bryan Barron: Their sensitive skin SPF 30 has titanium dioxide only. And then they have a couple in their, what is it called, their Pure and Simple, or actually Aveeno's products with the zinc oxide are probably a better bet than Neutrogena's, because Neutrogena tends to use that problematic preservative system.
Daphne: Hey Paula, I want to tell you one other one I use sometimes when I don't want to have a white face.
Paula Begoun: Yes.
Daphne: If I am going to see other people and it's not just my kids, the doctor gave me Elta MD UV Physical because like I said I run a lot and it is SPF 41. But it says "transparent zinc oxide 9 and transparent titanium dioxide 7, tinted chemical-free sunscreen."
Paula Begoun: Okay, that sounds great.
Daphne: But it's drying. And then I still have the problems with the blackheads.
Paula Begoun: Right. So, it's a tradeoff. It's a tradeoff.
00:39:58 First I want you to use the BHA and I want you to use it around your nose.
Daphne: I don't use any of your AHAs anymore?
Paula Begoun: No, use that on your body. It will be fine. But don't use it on your face. I do think zinc oxide and titanium dioxide is the only way for you to go. I think you can experiment though with different brands. You don't have to use expensive brands. You can look at the Aveeno. You could look at the Neutrogena and you just have to make sure when you look at the active ingredients it is only titanium dioxide and/or zinc oxide. That's it. No other sunscreen actives.
00:40:32 I do think you need to go on my website and look at the options around how to remove blackheads. I think that will help you a lot because sometimes stubborn blackheads just have to be extracted. Once you get them they don't necessarily just jump out of the face. Salicylic acid can have, BHAs can help dislodge them but sometimes it takes a little bit more than that. I have a whole article about how to do that.
00:40:57 So Daphne, here is what I am going to do. Are you using any of my antioxidant serums?
Daphne: Yes.
Paula Begoun: The Skin Recovery or the Resist?
Daphne: The older ones, the white?
Paula Begoun: The Skin Recovery.
Daphne: Yes, Skin Recovery.
Paula Begoun: I'm going to send you my cleanser from my Resist line and I'm going to send you my antioxidant concentrate from my Resist line and I would like for you to give those a shot and see how they feel on the face. Do you use my 2% BHA liquid or my 2% BHA gel or lotion? Which one are you using?
Daphne: I use the lotion because that is what it says for dry skin.
Paula Begoun: Okay. So what I am going to give you instead, particularly for around the nose area, but I would like you to experiment with it – maybe alternate between my 2% BHA liquid and my 2% BHA lotion and see how your face does. And I actually think you are on the right track.
00:41:56 I think you are doing a lot of the right things given that you are athletic and out there and you are being really good about sunscreen. I get the feeling you are far better along than you would be otherwise and I am proud of you and I have to go. But try those new products and we will see how you do. Thanks for calling, Daphne. Next caller, Kate.
Kate Mee: We have Maureen from Washington.
Paula Begoun: Maureen, how are you?
Kate Mee: Oh, I'm sorry, she is from California, not Washington.
Paula Begoun: Hi Maureen, how are you?
Maureen: Hi, how are you?
Paula Begoun: I'm good. Tell me what I can do…is it Marine or Maureen?
Maureen: Maureen.
Paula Begoun: Not like Marine like the ocean. Okay. That would have been an interesting name though. So, Maureen, what can I do for you?
Maureen: Well, I have Rosacea and I have been to several different dermatologists and without getting any help. I think I must have another type of skin condition with it.
00:43:00 The problem I am having is the scaling of the skin. What happens is that occasionally and this is progressively getting worse, I have…it feels like a really bad sunburn and then the next day the skin gets really hard and then it starts peeling, scaling.
Paula Begoun: That's exactly what my boyfriend goes through. It's exactly what he goes through.
Maureen: Really?
Paula Begoun: Literally like a patch.
00:43:30 Almost like a callus over…
Maureen: Yes, exactly. And then the more I try to put stuff on it or rub, the worse it gets.
Paula Begoun: I bet you are trying to scrub it off.
Maureen: Yes, well I don't anymore, but that is what I tried to do.
Paula Begoun: Yes, don't do that. So, Maureen, tell me what skincare products…tell me how you are taking care of your skin?
Maureen: I use yours. I use the Resist line. I use your Skin Recovery cleanser, your toner.
Paula Begoun: And are you using any of my BHA products?
Maureen: No. I use your alpha hydroxy…
Paula Begoun: I don't want you to do that anymore. So, here's what I want you to do.
00:44:20 When you get…so, are you using any products from…?
Maureen: Oh, and I use Retin-A.
Paula Begoun: You do?
Maureen: Yeah.
Paula Begoun: And how does that work for you? You don't know.
Maureen: Well I don't know if that is making it worse or…?
Paula Begoun: I think it is making it worse.
Maureen: You do?
Paula Begoun: I'm very skeptical of Retin-A on Rosacea or any sensitive skin because it is such a…I mean if you can use it, it's great. But for Rosacea that tends to be sensitive anyways, I think it is problematic.
00:45:01 I would at least try for awhile to go without it and do some of these things I am going to recommend. But I am very skeptical about Retin-A, Renova, any of the retinoids, even a retinol products. If it is very low dosage retinol, maybe you could do that. But it's not the best because it tends to cause inflammation. So here is what I am going to suggest.
00:45:30 I know because they are my products, I know that the cleanser you are using is gentle, no fragrance in any of my products. What I would like you to do when you get that flare-up of that hard skin, I am going to have you add a BHA. I am going to have you add a salicylic acid product to help your skin do turnover to just have healthy turnover, unclog pores. It has some anti-inflammatory properties. Remember, Rosacea is an inflammatory disorder.
00:46:00 But what I would like you to try – go to the drugstore and pick up a product called Cortisone 10 Hydra Sensitive Aloe Formula, forget the aloe, it doesn't really matter. The aloe is a neither here nor there ingredient, it is just the name of the product. What this is a topical over-the-counter cortisone cream. It is in a beautiful formulation.
00:46:30 Now I know a lot of people go, "Oh cortisone, I'm afraid of cortisone – if I use it too often I am going to get collagen breakdown." Yes, if you use it repeatedly without stopping over a long period of time you are going to get collagen breakdown. But if you constantly have Rosacea, red flare-ups, you are going to get collagen breakdown. When you get that, start noticing just the beginning signs of that thickened, the kind of skin you were saying where it gets thick and callus looking read patches
00:47:00 Before it gets very far, just when you start noticing it I want you to try putting some topical cortisone cream on. It would be the last thing you would put on in your skincare routine at night. You can try it twice a day, then it would go on before you put your sunscreen on. And see how that works to keep that inflammation down. It might take two or three days of usage. It should take care of it and then you should be done and the red patching should not show up.
Maureen: Oh, okay.
Paula Begoun: So we are talking about getting Cortisone 10 Hydra Sensitive.
00:47:39 It is an over-the-counter topical cortisone. When you start feeling that red flare-up, those patches come up, before it gets very far, apply that for two or three days and see if that doesn't keep it at bay. And then you would only use this when those patches started showing up. So I am going to send you my 2% BHA lotion. I'm going to send you my Moisture Boost Hydrating Treatment Cream.
00:48:06 It's a very soothing, emollient moisturizer. And then I am also going to send you my Resist Antioxidant Concentrate. I would like you to experiment with that. And see how you do. But definitely adding a BHA product and a cortisone cream that you get at the drugstore for the Rosacea flare-ups I think will make a huge difference in how you experience the flare-ups.
Maureen: Oh, that would be fabulous. I would be so grateful.
Paula Begoun: So if you have any questions along the way, just don't hesitate to chat with anybody in my customer service team. If they can't answer your question they will get it to me. You can let them know that Paula made these recommendations for you and they will…if they can't answer it they will get to me. But good luck, Maureen. You will let us know how you are doing.
Maureen: Okay, great. Thank you so much.
Paula Begoun: Take care. Kate, next caller.
Kate Mee: We have Sharon from Missouri.
Paula Begoun: Sharon from Missouri.
00:49:07 Is that the Show Me State?
Sharon: That is the Show Me State.
Paula Begoun: All right, I'm ready. Tell me, tell me Sharon…what do you have going?
Sharon: Well, I am 40-10 this year.
Paula Begoun: 40-10? Does that 50? If I do my math right?
Sharon: Yeah, I like to tell people I have gone to L, Roman numeral L. Finally gone to L. It's so sad, isn't it?
Paula Begoun: Well, you know what people say when you say that, that it is better than the alternative.
Sharon: I know.
Paula Begoun: I know. But believe me…
Sharon: I really thought I would age gracefully and I'm not. I'm just not.
Paula Begoun: You know something? There is no such thing as aging gracefully. The very definition of aging…okay, I won't get started. But, you know, when I think of the way young people bounce across the room and can…
00:50:09 And Olympians and tennis players, the reason they are not in their seventies is because they are not aging gracefully. They are just old and can't do the things young people can do. I'm going down fighting. I ain't doing anything…I'm in all-out war with my aging. People can do it all the ways they want. But I have my boxing gloves on.
00:50:35 So Sharon, who is 40-10 and going to L, tell me what I can do for you.
Sharon: Well I have had Rosacea probably for about 20 years now. And I was on MetroGel probably 15 years ago. And I wasn't really impressed with it. And so I stopped using it. And I have really light skin and I burn in 20 minutes, so I just am not ever out in the sun.
Paula Begoun: What are you doing now to take care of your skin, Sharon?
Sharon: Well, I just try and use sensitive skin products.
00:51:20 And I try to go to your website. And here I am looking at this BHA product that I bought last night, Neutrogena Pore Refining with BHA.
Paula Begoun: That's not a bad one. Actually it is one of the…
Sharon: It got a frownie face. It has alcohol.
Paula Begoun: Bryan, it has alcohol?
Bryan Barron: Oh, yeah, Neutrogena. We only recommend one…
Paula Begoun: Oh, their lotion one doesn't.
Bryan Barron: We only recommend one of their BHA products.
Paula Begoun: Sorry, through that out.
Sharon: I have the toner and, yeah…
Paula Begoun: Throw that out.
Sharon: So here I thought I was doing so good, you know? And it gets a frownie face.
Paula Begoun: So what are you doing to clean your face, Sharon?
00:52:01 What are you using to wash?
Sharon: I use Cetaphil.
Paula Begoun: Which one? Their oily skin or their dry skin?
Sharon: The oily skin because my skin is oily in the summer and drier in the winter.
Bryan Barron: So it is a gel?
Sharon: Yes.
Bryan Barron: Okay.
Paula Begoun: Is that the one – that's the one they put fragrance in, isn't it?
Bryan Barron: Yeah, they have masking fragrance in it, but it's not terrible. It's no worse than a lot of other cleansers with fragrance.
Paula Begoun: Yeah, but it would be best to have none. So Cetaphil and then you…
00:52:34 Okay, well you are not going to use the Neutrogena one anymore because that is going to put your skin in L. And then what else do you do?
Sharon: I have a Derma…oh what is that stuff called, it's an alpha lipoic sort of Ester C serum.
Paula Begoun: Oh, I know the one you are talking about. Bryan, do you know how we reviewed that?
00:53:02 Or Sharon, did you look up how we reviewed that?
Sharon: No, I didn't.
Paula Begoun: Bryan, have we reviewed that one? Do you know the one she is talking about? It sounds familiar.
Sharon: Derma-E, DMAE Alpha Lipoic…
Paula Begoun: Yeah, I don't like DMAE. Sorry, I mean it is too long to explain why I don't like that ingredient for your skin type. But, Bryan, did we…?
Bryan Barron: Yes, Paula, we did review that.
00:53:33 And they all got unhappy faces.
Sharon: Oh no!
Paula Begoun: Oh no! But you know something, the good news is you are talking to me now and we are going to change it. Bryan, what was it about Derma-E that we didn't like besides the DMAE?
Bryan Barron: Are we talking about the serum or the cream?
Sharon: The serum. The serum was in some packaging, you know, it's in a little pump bottle.
Bryan Barron: Beyond the risk associated with the use of DMAE, there isn't anything in this water-based serum worth getting excited about. The clear bottle packaging won't help keep the antioxidants stable unless you store it away from light.
00:54:08 And the amount of alpha lipoic acid is miniscule. We wouldn't choose this serum over similarly priced options from Olay, Neutrogena or Clinique. It is $22.50 for 2oz. Actually not a bad price point at all for a serum, but definitely more of a case where looking at the formula you get what you pay for. It also contains a high amount of lemongrass extract which is just fragrance.
Paula Begoun: So it is interesting to mention, you know Bryan, this is kind of a little bit of an interesting departure.
00:54:38 So alpha lipoic acid was an ingredient that Dr. Perricone launched as being this brilliant antioxidant for skin which of course…
Sharon: Yes, my dad sent me this book about Dr. Perricone, you know.
Paula Begoun: Well Dr. Perricone actually stopped putting it in his products because alpha lipoic acid when you stick it in a skincare product smells and you put it in effective amounts, smells like rotten eggs. It is a…I mean really rotten eggs. It smells like sulfur.
00:55:10 It isn't sulfur. But it radiates potently when you put it in effective amounts. So we actually stopped using it a long time ago and most cosmetic companies…in fact, it is rare to see alpha lipoic acid anymore on any ingredient label because it is a bad ingredient to formulate with.
Sharon: I'm sorry!
Paula Begoun: No, no, we are helping. We are helping.
00:55:31 We are getting over the bad stuff. You do need to treat your Rosacea and here is what I'm going to do. So first of all, Cetaphil isn't bad. I'm going to send you one of…I take it you are working more with normal-to-oily skin, right?
Sharon: Yes.
Paula Begoun: All right. I'm going to send you my Skin Recovery Cleanser. However, if you wanted to play around at the drugstore you could always use CeraVe's cleanser.
00:56:00 That is a very good fragrant-free cleanser that you can also consider. Of course, I love my cleanser and I am going to send it to you. I want you to stop using the Derma-E. I know it is a huge problem. I am going to send you my Resist toner. I would like you to give that a try. You do need to play with a BHA product that doesn't have irritation. I am going to send you my BHA liquid. When you get started with it I just want you to use it every other day or just test it out, patch test it in certain areas.
00:56:35 Just use very little of it, very lightweight, and see how it works. I think that will get you in a good direction. And then for moisturizer, now I'm stuck. Moisturizer for normal-to-oily?
Bryan Barron: Well she mentioned having normal-to-oily skin so one quick correction I wanted to make…Paula, the Skin Recovery cleanser you mentioned is better for normal-to-dry skin. So how about we send her the Hydra Light…
Paula Begoun: Oh, Hydra Light. Oh, I love you, Bryan.
00:57:06 Hydra Light, of course, of course. Our Hydra Light cleanser. Thank you, thank you.
Bryan Baron: The Resist toner is amazing as is Skin Recovery or the Healthy Skin toner, but based on getting towards L there in the alphabet, let's have you start using Resist.
Paula Begoun: So the advance replenishing toner. And then I think, Bryan, for moisturizer, what do you think? Just the Moisture Boost Treatment cream?
Bryan Barron: I think the combination, I think Moisture Boost Hydrating Treatment cream around the eyes would be great, but if you don't have dry patches elsewhere on your face, the combination of the Resist toner and Skin Balancing Moisture Gel would more than likely be enough. And the Skin Balancing Moisture Gel has some great cell communicating ingredients, some good anti-inflammatory antioxidants so you can help keep your skin under control in terms of redness.
Sharon: Thank you.
Paula Begoun: So I'm going to have to go real quick, but here's one thing. I want you to give these a try. You need to consider going back to a dermatologist. See how your face does with this, but if you don't want it to get worse you really do need to consider a dermatologist.
00:58:22 But play with these things and let us know how your skin is doing. And we can see if we need to take it to the next step. All right, we need to call it a day. Thank you so much Sharon. Thank you Bryan Barron, my Paula's Choice Team and Kate Mee, my product development director standing in, sitting in – she's sitting somewhere – for Desiree Stordahl, my assistant and producer.
00:58:45 This was great. God, we've got to do this show again. Rosacea is so complicated. These questions were great. Thank you all for calling in. Next week we are going to talk about 7 hair care secrets you need to know to have healthy beautiful hair because the crazy information out there isn't helping your hair. On the 25th we are going to be talking to Dr. Leslie Baumann about looking younger without surgery. And on the 1st, this show I am really looking forward to, is a facial really worth it? The benefits and risks…
00:59:14 We have just done a whole bunch of new research on it. The information will shock you. I'm Paula Begoun, the Cosmetics Cop. Come visit me at Information you won't get anywhere else. And I absolutely can guarantee my products are some of the best around. I know because I made them. And I have also reviewed a lot of other products. A lot of great other products, too, to consider, which is why you need to visit Thank you for listening. We will talk to you next week.
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