The best treatment for flaky facial skin is a common question I answer, particularly from my dermatology patients who suffer from facial dandruff and rosacea. I recently received this exact question from a reader and wanted to share my answer.
Treatment for flaky facial skin
hello dr Bailey, I love your newsletter and blog posts; i learned so much from you I have had rosacea for at least 15 years. I’ve been on the sulfacetamide lotion, metrogel and finacea gel. I had stopped using the sulfacetamide lotion for 2 years. I thought my rosacea would get better. This year, out of the blue, I was diagnosed with seborrheic dermatitis (dandruff) on my face.
My dermatologist prescribed Noble Zinc Soap, sulfacetamide lotion (evenings and mornings), ketoconazole cream in the evenings and finacea gel in the mornings. Since reading your blog, I’ve been using it now Antioxidant Skin Therapy Cream with Green Tea. What a beautiful cream and what a difference it has made on my skin. I bought those too Advanced corrective eye cream because of your review of it and what an anti aging difference it has made.
My questions are,
I think the finacea dries my face slightly.
I use it first before green tea because I like to use green tea as a moisturizer.
- Do you think I should stop using Finacea?
- Is it bad for my sebaceous gland infection because I can still see a bit of the dry skin around my nose?
- Could the finacea prevent a complete elimination of facial dandruff?
I was just thinking of using the zinc soap, sulfacetamide lotion and green tea cream. Many thanks for your help! Laura B
Hi Laura, thank you for your kind words about my blog and newsletter; I’m glad you found helpful information here. I can give you general information on how I deal with this combination of skin problems in my practice. You can discuss this information with your dermatologist.
Dandruff and Rosacea Flaky skin is a common facial problem
Both rosacea and facial dandruff (seborrheic dermatitis) cause skin rashes (called dermatitis) that result in red, flaky facial skin. Of the two skin problems, facial dandruff is more likely to cause flaking in the nasal folds.
What is really important to know is that both facial dandruff and rosacea rashes compromise the integrity of your skin barrier and make your skin very sensitive.
This means that the affected skin is very easily irritated by aggressive products. It is also more sensitive to harsh climatic conditions or strong skin cleansers.
Seborrheic dermatitis (dandruff) and rosacea skin problems often coexist.
You’ve probably already experienced that! They can also flare up together, or one can be worse than the other at any given time. I tell my patients who suffer from this frustrating combination of skin conditions that once one of these conditions has become persistent, we must protect the affected skin from anything that is irritating. This allows the rash to subside, allowing the integrity of the skin barrier to be repaired. The process requires that only non-irritating products be applied to the skin to allow it to recover. I call that A Rosacea or Seborrheic Dermatitis Cool-Down.
This “cool-down” skincare routine is important because applying irritating products to barrier-damaged skin is like squeezing lemon juice onto a cut, meaning it prolongs inflammation and slows healing. The healing of the weakened skin barrier is supported by the exclusive use of mild moisturizing creams and soothing products. – Dermatologist Dr. Cynthia Bailey
In my experience, finacea can be irritating on some skin types.
Product compatibility varies from person to person and I always ask patients which products their skin tolerates and which not. Finacea contains 15% azelaic acid, an ingredient that can irritate a barrier-damaged complexion. For the “cool down” we only use products that your skin tolerates well.
dermatologist dr Bailey’s Rosacea or Facial Dandruff Cool-Down Skin Care Routine
Cleanse scaly and sensitive facial skin twice a day with one of the following cleansers (they can be alternated depending on skin tolerance and needs):
1. A pH neutral, soap-free cleaner.
My first choice is mine Extremely gentle, foaming facial cleanser (I personally use this for my sensitive skin prone to rosacea and seborrhea). Another option is VaniCream cleansing bar (the least irritating option)
2. Soothing Zinc.
This is the best natural pyrithione zinc soap as it is made with shea butter. I prefer this much more than Noble Zinc or any other similar product. Shea butter is complex and very beneficial for the skin. It contains a high concentration of anti-inflammatory and antioxidant compounds that help heal irritated, flaky skin. I developed this recipe and many thousands of patients and customers have found this pyrithione zinc soap to be especially beneficial for their rosacea and seborrhea.
Wow! This soap is amazing! I’ve struggled with rosacea for years. Even with oral antibiotics. Since using this soap I no longer have to use the oral medications. CM
I’m 65 years old and I’ve finally found the answer to the dandruff, redness and flaky skin between my eyebrows. I had tried countless remedies with no results until I discovered this Soothing Zinc Bar. I cannot stress enough how great this product is. Since I started using it about a year ago I have had NO flaking, flaking or redness at all… nothing but clear skin in my eyebrow area. I still can’t believe how completely and quickly it worked! My only regret is that I didn’t discover it 25 years ago. The bars last a long time, which also makes them affordable. Thank you Cynthia Bailey. I have never been so impressed with a facial product!! Debbie B
3. Prescription Sodium Sulfacetamide Cleanser
The last two products can dry out or irritate some people, so the issue of skin tolerance is important when choosing the cleansers we use to cool down. It appears you used a lotion that contained this ingredient. Prescription facial cleansers are also available.
What cream is best for scaly facial skin from rosacea and seborrhea?
After cleaning, I have my patients apply in this order:
- Antioxidant skin therapy with green tea because the skin’s anti-oxidative reserve is stressed by inflammation. I believe that antioxidant replenishment is one of the main reasons Green Tea Antioxidant Skin Therapy makes such a big difference in healing facial dandruff and rosacea. I let my patients apply it first before using any other products.
- Clotrimazole cream to soothe seborrheic dermatitis where it has flared up.
- A soothing moisturizer for full face skin that feels in need of a richer hydration. This is important because skin with a compromised skin barrier needs ingredients that help heal the skin barrier (known as the stratum corneum). My first choice is one of my hypoallergenic and barrier-healing daily moisturizing face creams. Get this along with Green Tea Antioxidant Skin Therapy and Calming Zinc in my Facial dandruff and redness solution kit.
My Seborrhea and Rosacea Cool Down Skincare Routines may also include:
- Prescription drugs that are non-irritating to treat rosacea or sebaceous glands, if needed (e.g., Cleocin lotion, sodium sulfacetamide lotion, Metrogel or Metro cream, and occasionally permethrin cream, all according to their dosage requirements). I usually have my patients apply this after the green tea because lighter base products are often better applied before those with heavier bases.
- A very mild cortisone cream such as 1% hydrocortisone cream. I only have her use this where the rash is red and usually no longer than 2 weeks. As the doctor treating my patients, I always supervise the application, as there are side effects. I only use “non-halogenated” (a term a doctor will understand) cortisone products on my face.
Pure mineral zinc oxide sunscreen, because both skin conditions can flare up from exposure to the sun. Pure mineral zinc oxide sunscreens that are non-irritating and perfect for sensitive (even barrier-weakened) skin. Find them on my sun protection page here. I add the sunscreen for you and add the pH neutral cleanser to mine Rosacea Skin Care Set; This is a complete skincare routine for rosacea and seborrhea-prone skin that I’ll take the guesswork out of.
I have my patients do this cool down skincare routine for 2 months, which is necessary to calm skin inflammation. Quitting too early leads to a relapse.
It takes a month or more for the skin barrier to heal AFTER the inflammation from rosacea and/or seborrhea has subsided.
This means it’s important to be patient and not re-add irritating products too soon. I hope it helps. Thanks for a really good question that I know others share.
Cynthia Bailey MD, board-certified dermatologist
Why is rosacea considered an inflammatory disease? The primary role, clinical relevance, and therapeutic context of an abnormal innate immune response in rosacea-prone skin. Del Rosso JQ et. al., J Drugs Dermatol. 2012;11(6):694-700.
Disclaimer: Please note that using the opportunity to get answers to your questions from Dr. Bailey and get your questions answered, no doctor-patient relationship with Dr. Bailey reasoned. The one from Dr. Information provided by Bailey is general health information inspired by your question. It is not intended to be a substitute for medical advice from your physician and is not intended to diagnose or treat any specific medical condition (and is not an extension of the care Dr. Bailey provides in her practice to existing patients in her practice). Never ignore your own doctor’s advice about anything you read here; This information is for general informational purposes only.