Can too much cleansing cause rosacea?

A study done on the Chinese population showed that excessive cleansing affects the skin negatively and increases the risk for rosacea. We have summarized the study below.

What is rosacea?

Rosacea is a chronic inflammatory facial skin disorder affecting many people with either one or more symptoms such as flushing episodes, noticeable blood vessels, and occurring swollen and red bumps. Rosacea is a harmless disease but becomes problematic due to its esthetics which can influence the quality of life negatively.

What causes rosacea?

It is still not fully known what the root cause of rosacea is but among many factors, a damaged skin barrier has been given a lot of attention. Rosacea patients are sensitive to stimuli, both chemical (applying certain products) and physical (touching and rubbing the skin). This is associated with more trans epidermal water loss or TEWL (= the water that leaves 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).  

How do you lessen rosacea treatments?

Apart from topical and systemic treatments, consequent application of suitable non-irritating skincare that maintains and repairs the skin barrier can significantly prevent symptoms of rosacea and improve the patient’s quality of life.

How does cleansing affect the skin?

Cleansing is the first step in a skincare routine. Cleansing the skin has both positive and negative aspects.

Pros: Cleansing the skin removes dirt, pollution particles, sunscreen, and makeup (if applied), and redundant sebum. This improves the absorption of moisturizers which in turn increases hydration and repairs the skin.

Cons: Surfactants in cleansers disrupt the skin barrier. Therefore, cleansing more than necessary will harm your skin in the long run.

How does cleansing affect rosacea?

A large study was done in China on how cleansing habits influence the onset and development of rosacea. The study was in the form of a retrospective case-control survey of 999 rosacea cases and 1010 skin-healthy controls. Healthy controls with sensitive skin were excluded.

The questionnaire included questions about skincare habits for the two years before rosacea for the rosacea group and the recent two years for the control group. The questionnaire was divided into two sections:

1. Normal cleansing behavior:
* How often did they cleanse?
* How much cleanser did they use per year?
* Duration of cleansing per time

2. Reinforced cleansing behavior, if they used any of the following:
* Oil controlling products
* Exfoliation
* Facial masks
* Beauty salon treatments

The rosacea group was asked what their present symptoms are, where on the face it was present, duration of flushing, and what their triggers are for flushing (heat, food, emotion, using skincare products, etc.)

The results showed that some cleansing aspects do affect rosacea. The following results were observed from the study:

  • Positive correlation with rosacea occurring:
    • Being a female
    • Being a labor worker
    • Having a higher education level and more personal income
    • Cleansing more than once daily
    • Using a large amount of cleanser, more than 500 g a year
    • Risk factor to use a cleansing tool more than four times/week
    • Risk factor to use oil control products, exfoliants and masks
    • Risk factor to have treatments at beauty salon (exfoliating, oil control)

  • No correlation with rosacea occurring:
    • Type of cleanser
    • Cleansing duration

Why do cleansing habits affect rosacea?

As mentioned before, surfactants in cleansers 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 to some extent break apart the skin barrier. Using cleansing devices will also do this mechanically. Exfoliants destroy the upper skin layer and can also be sensitizing.

Excessive cleansing could disturb the skin barrier leading to a higher pH in the skin. A healthy skin pH is low (4.5-5.5), having a higher pH could attract bad bacteria. Excessive cleansing as well as preservatives in cleansers could affect the skin microbiome (= the bacteria and microorganisms that live in the skin). Removing good bacteria and attracting bad bacteria could weaken the skin’s immune function and make it more sensitive.

Takeaways from the study

The advice to take away from this study is that less is more! To use cleanser no more than once daily, use less than 300 g a year and avoid cleansing devices is good to avoid developing rosacea. It is also best to avoid exfoliants, oil-controlling masks and products, and avoid having these types of treatments done at the salon. 

It should be noted that since this a study based on a questionnaire some recall bias might have occurred. Secondly, they also did not ask about what water temperature they used. Thirdly, 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 Chinese population. Archives of Dermatological Research.. doi:10.1007/s00403-020-02095-w