Rosacea and facial dandruff are usually “bilateral and symmetrical,” but it’s possible to be more affected on one side of the face. I was asked this question by a reader and I want to share my answer.
hello dr Bailey, I only get flare-ups of rosacea and seborrhea dermatitis on my left cheek. Can you tell me why I only get it on one side of my face? Also, my doctor prescribed me Metrogel, Desonid lotion (corticosteroids) and Ketoconazole cream (antifungal). Can you please explain the order and give me the steps for using all of the above products with the other products on your site that you recommend as the best skin care for rosacea and dandruff such as: B. Calming Zinc, Green Tea Antioxidant Skin Therapy, Daily Moisturizing Face Creme and my zinc oxide sunscreen. Thank you, Mimi
Unilateral rosacea is possible but uncommon, so I’m always looking for another diagnosis that could masquerade as rosacea. This is because we consider rosacea and seborrhea to be skin conditions resulting from an as yet unknown internal predisposition. This means we expect them to manifest on both sides (both sides of your body) on your skin.
Conditions that can aggravate rosacea and dandruff on one side of the face
Rashes that cause redness, flaking, and pustules can cause additional inflammation on the face. Some of these can be asymmetrical.
The most common causes of asymmetrical facial redness and inflammation include:
- allergic contact dermatitis (an allergic reaction to something touching your face like glasses, a phone, etc.),
- Sun causes phototoxic or allergic dermatitis (especially if you are taking a medicine that causes sun sensitivity such as NSAID, medicine for high blood pressure, etc.),
- Tinea faciei (a fungal infection) and
Demodex mites (everyone has some mites in their pores, but occasionally they can cause a lot of inflammation).
Solar reactions are important to consider because here in the United States, the left side is the driver’s side of a vehicle. Sun exposure induced rashes such as photo drug flares or polymorphic light rash are high on my suspect list since you indicate the left side is the problem. Sun can also trigger rosacea. Ask your doctor about the conditions I just listed to see if any of them could be causing the asymmetry in your facial flushing.
Treatment of facial redness on only one side of the face
Tinea (fungal skin infection) can respond to topical ketoconazole cream, but often tinea faciei requires oral antifungal treatment.
Demodex mites, on the other hand, require a very different treatment. Soolantra topical is the only FDA-approved cream for this problem. Some doctors use oral ivermectin. I’ve had success with the economical off-label use of topical permethrin.
Mineral sunscreens with an SPF of 30 or higher prevent the sun’s UV rays from triggering rosacea and sun-related skin problems. In fact, I always recommend patients with rosacea to wear a zinc oxide mineral sunscreen every day. I include a great mineral sunscreen in mine Rosacea Therapy Skincare Set. This kit contains the same products I use for facial seborrhea which, as you mentioned, is common with rosacea. Treating the other conditions I mentioned above requires a more thorough medical evaluation by your dermatologist.
How do you apply skin care products when you have rosacea?
I always recommend using products from water based to oil/occlusive based and in order of the 4 skincare steps Complete Skincare™: CLEANING RIGHT HYDRATE PROTECT™
Here’s how I layer the skincare products for facial rosacea and seborrhea at my dermatologist’s office:
TO CLEAN: with wash Soothing Zinc alternating with a pH-neutral gentle cleanser such as the Extremely Gentle Cleanser in the Rosacea Kit.
CORRECTLY: I let my patients apply Antioxidant skin therapy with green tea to the whole face. This antioxidant medicinal product helps calm inflammation to control both rosacea and seborrhea. It’s a thin, water-based product and I have patients use it before prescription products in my office.
I let the Green Tea Antioxidant Skin Therapy dry and then apply the other Rx products like Metrogel and Ketoconazole Cream. This would need to be approved by your doctor as your other medicines require a prescription. In my practice, I only use the mild cortisone for active reddening of the skin and symptoms and for no longer than two weeks.
HYRATE: We put a good moisturizer over the treatment products to help heal a compromised skin barrier. It is important to know that both rosacea and seborrhea damage the skin barrier. This makes a moisturizer with good restorative ingredients an important part of the skin care routine. i use this Daily moisturizer in the Rosacea Kit because it contains ceramides, squalane and phospholipids similar to those naturally present in the skin barrier called the stratum corneum of the epidermis.
TO PROTECT: Zinc oxide sunscreen is applied during the day when UV rays pose a risk. Remember that some UV rays can penetrate glass to trigger rosacea and sun-sensitive skin problems. My first choice sunscreen for sensitive skin is mine Sheer Strength Pure Physical Matte tinted sunscreen with SPF 30+ (This is my personal favorite!). Mineral zinc oxide SPFs are non-irritating to sensitive skin and offer superior protection compared to chemical sunscreens.
Mimi, I also want to acknowledge that the three drugs you are taking create many layers. In my practice, once rosacea and seborrhea are under control, I have my patients come off the cortisone. In another month or so I’ll have her come off the ketoconazole. At this point, the routine is much easier.
Dermatological skin care set to cure rosacea and seborrheic dermatitis on the face
The products in the skincare routine I just described are all combined into one kit that I call mine Rosacea Therapy Skincare Set. It helps control both rosacea and seborrhea and is the perfect skincare routine to keep both conditions in remission. This is a complete skincare routine made up of compatible medical-grade products and ingredients to boost success.
I use my 35 years of dermatology experience to cover all the bases so you don’t have to. This routine calms what is triggering these skin problems and provides healing products to help skin recover. Like a trip to the dermatologist without the trip! – Dermatologist Dr. Cynthia Bailey
Mimi, thank you for sending us a great question that shows how complex seemingly everyday skin problems can be.
Click here to learn more about the Rosacea Therapy Skin Care Kit.
Cynthia Bailey MD, dermatologist
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 that 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.