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Rosacea is a chronic inflammatory skin disease of the face that affects many people with either one or more symptoms such as flushing episodes, noticeable blood vessels and the appearance of swollen and red nodules. Rosacea is a harmless disease but becomes problematic due to its aesthetics which can negatively affect the quality of life.
It is still not fully known what the root cause of rosacea is, but among many factors, a damaged skin barrier has received a lot of attention. Rosacea patients are sensitive to stimulation, both chemical (applying certain products) and physical (touching and rubbing the skin). This is associated with more transepidermal water loss or TEWL (=the water leaving the skin) and lower skin hydration which in turn is associated with a damaged skin barrier, which in turn is associated with changes in the innate immune functions (=your personal immune response).
In addition to topical and systemic treatments, consistent application of appropriate non-irritating skin care that maintains and repairs the skin barrier can significantly prevent symptoms of rosacea and improve the patient's quality of life.
The good thing about cleansing the skin is that it removes dirt, pollution particles, sunscreen, make-up and excess sebum. This improves the absorption of moisturizers, which in turn increases hydration and repairs the skin.
But something many do not know is that cleaning also washes away the outermost cells of the skin, which is the layer that gives the skin much of its protective barrier but also the natural softening and moisturizing substances that the skin consists of. This not only makes the skin drier, but also more sensitive and susceptible to external influences, which you want to avoid in order not to disturb the skin. Many cleaning products can also contain surfactants that directly irritate the skin or are allergenic, which disrupts the skin barrier. Therefore, cleansing, if used more than necessary, can damage your skin in the long run. If, on the other hand, you minimize cleaning, wash with mild and gentle cleaning products max. once a day or when it's really necessary, you give the skin the best conditions to be in
A large study was conducted in China on how cleansing habits affect the onset and development of rosacea. The study was in the form of a retrospective case-control study of 999 cases of rosacea and 1010 skin-healthy controls. Healthy controls with sensitive skin were excluded.
The questionnaire contained questions about skin care habits for the two years before rosacea for the rosacea group and the last two years for the control group. The survey was divided into two sections:
1. Normal cleaning behavior:
* How often did they clean?
* How much detergent did they use per year?
* Cleaning time per time
2. Reinforced cleaning behavior if they used any of the following:
* Oil control products
* Exfoliation
* Face masks
* Treatments at a beauty salon
The rosacea group was asked what their current symptoms are, where on the face they were, duration of redness and what their triggers are for redness (heat, food, emotions, use of skin care products, etc.)
The results showed that certain cleaning aspects affect rosacea. The following results were observed from the study:
Positive association with rosacea occurred:
There was no association with rosacea:
As mentioned earlier, surfactants in cleaning agents affect the skin barrier. Surfactants are molecules that pick up dirt and excess sebum from the skin, but they will also interact with the lipids (fats) in the skin and therefore break down the skin barrier to some extent. Using cleaning devices will also do this mechanically. Exfoliants destroy the top layer of skin and can also be sensitizing.
Excessive cleansing can disrupt the skin barrier, leading to a higher pH in the skin. A healthy skin's pH is low (4.5-5.5), having a higher pH can attract bad bacteria. Excessive cleaning and preservatives in cleaning products can affect the skin's microbiome (=the bacteria and microorganisms that live in the skin). Removing good bacteria and attracting bad bacteria can weaken the skin's immune system and make it more sensitive.
The advice to take away from this study is that less is more! Not using cleansers more than once a day, using less than 300 grams per year and refraining from cleansing devices are good for avoiding developing rosacea. It's also best to avoid exfoliants, oil-controlling masks and products, and avoid doing these types of treatments at the salon.
It should be noted that since this, a study based on a survey may have occurred Second, they did not ask what water temperature the participants used. Third, the study did not include any measurements.
Li, G., Wang, B., Zhao, Z., Shi, W., Jian, D., Xie, H., Huang, Y., Li, J., 2020. Excessive cleansing: an underestimating risk factor of rosacea in the Chinese population. Archives of Dermatological Research.. doi:10.1007/s00403-020-02095-w
