Dear Paula's Choice Research Team - Rosacea

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Dear Paula,
I have rosacea, and I have been very happy with your skin care line and the way it has calmed my skin. My eyes have become sensitive to eye makeup and concealer and I have been unable to find one that works without making my eyes water. Paula's Soft Cream Concealer looks good but slips after an hour or two. Any suggestions for concealing sun damage and dark circles for my sensitive eyes?

Catherine, via email

Dear Catherine,
First, I'm glad my products have been working so well to keep your rosacea under control. You've won that battle but the sensitive eyes and eye makeup issue is definitely tricky. Although I don't have a slam-dunk recommendation for you, I encourage you to experiment with various concealers and eye makeup to see what combination works best. Make sure any concealer or eye makeup you choose is fragrance-free (most eye makeup is but a surprising number of concealers contain fragrance, which can be especially irritating when used around the eyes).

Also, if you're using another brand's product (such as eye cream) around your eyes, check to make sure it doesn't contain irritating ingredients, including fragrant plant extracts such as lavender. You can consult my Cosmetic Ingredient Dictionary to help you decipher the list.

Last, I cannot guarantee these concealers won’t prove problematic for you, all of the following are worth a try because they provide excellent coverage and omit fragrance:

  • Revlon Age Defying with DNA Advantage Concealer ($10.99)
  • Make Up For Ever Full Cover Concealer ($32)
  • Mary Kay Concealer ($10)
  • L'Oreal Visible Lift Serum Age-Reversing Concealer SPF 20 ($12.95)
Be sure to save your receipts and return any concealer that doesn't work for your situation.

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Category: Rosacea

Dear Paula,
I've been using your cleansing and moisturizing products for a few years and they work extremely well on my sensitive, rosacea-prone skin. Unfortunately, nothing I've tried (including your suggestion of a BHA product) has helped with the redness from occasional flushing episodes. I use MetroLotion and apply sunscreen with SPF 15 as a moisturizer every morning. Short of using makeup (not an option for me, although I am in awe of all the women who put time and effort into making themselves so beautiful every day), do you have any suggestions for concealing, or reducing, the appearance of flushing on my cheeks and forehead? Is there a medical procedure I should consider, or can I find relief with over-the-counter products?

Robert, via email search

Dear Robert,
It seems like you have practiced due diligence and experimented with various gentle over-the-counter options, which is great. Reducing facial redness from rosacea is, as you know, not an easy task. The redness begins in the blood vessels well beneath the surface. Unless you're familiar with what triggers your rosacea flare-ups, finding the right product to minimize the redness can prove fruitless. Identifying what causes your bouts of redness is critical to managing the episodes, so do pay attention and take notes on your circumstances during a flushing episode. Did the climate change? Did you ingest something (such as wine, cheese, or something spicy) that caused it? What about cologne, a new laundry detergent, or exercise? Once you have a better idea of triggers, avoiding them (as much as possible) will likely result in fewer instances of reddened skin.

Regarding medical procedures versus over-the-counter products, there is no question that medical treatments are preferred for rosacea. Over-the-counter products have their place as part of a comprehensive skin-care plan, but to really address the most bothersome, persistent side-effects of rosacea (redness and broken capillaries), nonablative laser treatments are the current state-of-the-art therapy. There are several studies documenting successful clearance of rosacea symptoms following treatment with Intense Pulsed Light (IPL) devices, a good indication that such treatments can be worthwhile for you (Sources: Dermatologic Surgery, October 2005, pages 1285-1289; and Journal of the American Academy of Dermatology, October 2004, pages 592-599).

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Category: Rosacea

Dear Paula,
I have always been a fan of your no-nonsense approach to evaluating the claims cosmetics manufacturers make about their products. However, I must take you to task for your dogmatic insistence on sunscreen in foundation. Like 14 million other Americans, I suffer from rosacea, an inflammatory skin condition with few reliable treatments and no cure. As you have written, rosacea is characterized by facial redness, enlarged pores, acne-type lesions, and often eye irritation. As such, my skin is completely intolerant to all foundations containing sunscreen of any kind. The chemical sunscreens make my eyes and skin burn, and the mineral sunscreens clog my pores, resulting in relentless breakouts. I wish I could skip foundation altogether, but I must use it to help hide the redness and the bumps from rosacea.

It is becoming nearly impossible to find a sunscreen-free foundation, in part, I believe, because of public comments made by cosmetics experts (including you) that manufacturing a foundation without sunscreen is irresponsible. It certainly is not irresponsible when one considers consumers like me. I encourage you to rethink your stance on this issue.

Caroline, via email search

Dear Caroline,
I understand your frustration; however, I have never been dogmatic or insistent that foundations contain sunscreen. I have never ever suggested it was irresponsible either. What I have consistently and emphatically said is that some part of a daily routine, whether it is in the form of a moisturizer, gel, or foundation, must contain a sunscreen that is SPF 15 or greater with UVA-protecting ingredients of titanium dioxide, zinc oxide, or avobenzone (also called methoxydibenzoylmethane). I have also insisted that when a foundation does contain sunscreen it should at least be well formulated, meeting the basic requirements I just mentioned.

I can't do anything about the abundant amount of research indicating the need for using sunscreen to protect skin from wrinkles, skin discolorations, and skin cancer. It is also important to realize that while 14 million people have rosacea, not all of them, or even most, experience your personal sensitivity to all sunscreen. Nor are all people with rosacea prone to breakouts (sometimes the disorder is only flushing and redness with surfaced capillaries). If anything, rosacea is a skin disorder that can be aggravated by sun exposure. Sunscreens containing titanium dioxide or zinc oxide can work wonderfully for those with rosacea (Source: Cutis, September 2004, Supplemental, pages 13-16 and 32-34).

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Category: Rosacea

Dear Paula,
I am sure you've received a few notes about this already, but I'd thought I'd chime in with my support. In your January/February 2004 newsletter "Dear Paula" column, someone asserted that, "...in the Yahoo! Rosacea email list, which has over 3,000 members, the consensus seems to be that anyone who has tried BHA (salicylic acid) has had bad experiences with it."

Well, I'm on that list and I use your 1% and 2% BHA formulations (as spot treatments) without any problem. I have posted my positive experiences with Paula's Choice BHA products to the list, as have others. Certainly, more people on the list have had problems with BHA products than not, but there's also the very good chance that some of these individuals may have overused a product, or combined it with other irritating topicals. I'm writing to apologize for the incorrect implication that the aforementioned statement makes, as I don't want to see you have to defend yourself against something that is not true.

Erika, via email

Dear Erika,
I am glad to hear you found success using my products. I completely understand how tricky and fickle rosacea can be and how hard it is to find a combination of products that is successful. While I feel BHA-based (salicylic acid) products can be helpful for some, they clearly don't work for everyone. It takes experimentation to find what is best for your skin. Actually, when it comes to rosacea, nothing works for everyone, whether it is laser, topical agents, or general skincare products.

While I'm on the subject of rosacea, another reader asked me what my specific differences were with Dr. Geoffrey Nase, who wrote the book Beating Rosacea: Vascular, Ocular and Acne Forms with regard to his skin care recommendations for rosacea. Interestingly enough, the primary area where Dr. Nase and I disagree is in the use of BHA (salicylic acid). While he agrees that it can help with pustules and papules that can accompany some rosacea conditions, he feels it causes other underlying irritation of the blood vessels and skin that is not good for rosacea. That doesn't coincide with the research I've seen, however. Salicylic acid is unique because it is an anti-inflammatory agent, exfoliant, and antimicrobial agent. Those factors can have an overall positive effect on rosacea (Sources: British Journal of Dermatology, May 2003, pages 906-912; Archives of Dermatology, November 2000, pages 1390-1395; and QJM: An International Journal of Medicine, August 2001, pages 445-448).

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Category: Rosacea

Dear Paula,
I am 33 years old and have rosacea. At its worst it was never very extreme, but it drove me nuts. I went to three very well-esteemed dermatologists at UCLA. I was put on the antibiotic doxycycline, [and] Noritate creme (much like Metrogel only it is applied only once a day). None of this really made much of a difference. Then I went to another dermatologist more focused on "vanity" issues. She used a laser on my chest and face. I had no swelling and only a slight redness. This was six months ago and my rosacea was completely gone until recently, when it has come back a little bit.

My doctor said I might need one or two more treatments. But it has worked. I don't know the name of the particular laser. I just wanted you to know that there is an alternative that works for rosacea. I'm sure the prices vary, and I believe my doctor was very reasonable. It was $500 to laser my face and chest. My chest has remained completely clear, so I'll only have to do my face next time.

Madeleine, via e-mail

Dear Madeleine,
I have written before about the benefits of laser treatments for rosacea. They can be impressive though they are not always the success story you experienced. Some people have complete relief for long periods of time while others have their symptoms reduced though not eliminated, and occasionally there are those who receive no benefit whatsoever.

Several lasers or intense pulsed-light source machines are used for rosacea. The most typical pulsed-light machine used is the PhotoDerm. Other laser machines include the Argon-pumped Tunable Dye Laser, Flashlamp-Pumped Pulsed Dye Laser, Copper Bromide Laser, and the Krypton Laser.

As with any laser therapy, several treatments may be necessary to obtain the best results.

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Category: Rosacea

Dear Paula,
I have rosacea with dry flaky skin, though my skin used to be quite oily. During the cold winter months, I started experimenting with different foundations to try and find one that would moisturize and protect my skin from the cold and wind (which exacerbate my rosacea). I tried Bobbi Brown's Moisturizing Foundation, but found that after using it for a short while my skin became more red and flaky. Obviously there is something in the makeup or sunscreen ingredients that may aggravate rosacea. One woman at the cosmetics counter told me anything with oil in it could make the condition worse.

Are you aware if oils make rosacea worse? If so, what suggestions do you have for fighting dryness? Are there any particular sunscreens, moisturizers, or foundations you might suggest? Thanks so much for any suggestions you might have. I've been reading your books (and diligently following your advice) for years. With all the products on the market, and the myriad claims, I appreciate having a voice of reason to help guide me to the best products.

Susan, via e-mail

Dear Susan,
There is nothing specific about oils (other than fragrant oils) that makes them problematic for someone with rosacea. Several factors can make rosacea worse but these are not the same for everyone, as many people have different reactions to the same ingredient or external elements. Typically rosacea is exacerbated by hot liquids, spicy foods, exposure to extreme temperatures (including cooking over a hot stove), alcohol consumption, sunlight, stress, saunas, hot tubs, smoking, rubbing or massaging the skin, irritating cosmetics, and anything else that overstimulates the skin and blood vessels.

Rosacea symptoms can also be made worse by AHAs, Retin-A, Renova, Differin, and exfoliants of any kind, including scrubs and washcloths. In terms of skin care there is no absolute rule, but generally eliminating the use of irritating ingredients such as peppermint, alcohol, fragrance, citrus, eucalyptus, and the like can help. Plus, the fewer products you use, and the fewer the ingredients in each, the happier rosacea-afflicted skin is going to be. The bottom line is that if you have rosacea (or any skin sensitivity) it takes experimentation to find products that work for you.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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