Treatment Strategies for Flaky Facial Skin
One of the most frequent inquiries I receive from my dermatology patients revolves around the most effective solutions for flaky skin on the face caused by dandruff and rosacea. A recent message from a reader posed this very question, and I am sharing my detailed response to help others facing similar challenges.
Greetings from a loyal reader who has followed my newsletter and blog for years. She has been managing rosacea for over 15 years and has tried various treatments including sulfacetamide lotion, Metrogel, and Finacea gel. After pausing the sulfacetamide lotion for two years, believing her rosacea had improved, she was unexpectedly diagnosed with seborrheic dermatitis, commonly known as facial dandruff, this year.
Her dermatologist prescribed Noble Zinc Soap, sulfacetamide lotion for both morning and night applications, ketoconazole cream at night, and Finacea Gel in the morning. Inspired by my blog, she incorporated the Green Tea Antioxidant Skin Therapy Cream, which she describes as a luxurious product that has significantly improved her skin’s condition. She also added the Advanced Corrective Eye Cream based on my recommendations, noting remarkable anti-aging benefits.
Her specific concerns include whether Finacea is causing slight dryness on her face, especially since she applies it before the Green Tea cream, using the latter as her primary moisturizer. She wonders if she should discontinue Finacea, if it might be detrimental to her seborrheic dermatitis given the persistent dry skin around her nose, and if it could be hindering a complete resolution of the facial dandruff. She is considering simplifying her routine to just the zinc soap, sulfacetamide lotion, and Green Tea Cream.
Thank you for your appreciative feedback on my content; it’s rewarding to know it has been educational for you. While I can offer general guidance based on my clinical experience with similar cases, please consult your dermatologist to tailor this to your needs.
Understanding Flaky Skin from Dandruff and Rosacea as a Prevalent Facial Issue
Rosacea and seborrheic dermatitis, or facial dandruff, both trigger dermatitis rashes that manifest as red, flaky skin on the face. Facial dandruff tends to produce more noticeable flaking in the nasal creases compared to rosacea alone. A critical point to grasp is that these rashes impair the skin’s natural barrier function, rendering it highly sensitive and prone to irritation.
This barrier disruption means the affected areas react strongly to abrasive products, severe weather conditions, or potent cleansers. These two conditions frequently occur simultaneously, as you have personally observed. They may exacerbate each other, with one potentially dominating at certain times. For patients dealing with this challenging duo, I emphasize the need to shield the skin from all irritants once the conditions persist. This protective approach allows the rash to calm, enabling the skin barrier to mend through the exclusive use of gentle, non-irritating products. I refer to this strategy as a Rosacea or Seborrheic Dermatitis Cool-Down period.
This cool-down routine is essential because exposing compromised skin to irritants is akin to applying lemon juice to an open wound—it sustains inflammation and delays recovery. Supporting barrier repair involves bland moisturizers and soothing formulations exclusively.
Potential Irritation from Finacea for Certain Skin Types
Individual skin responses to products vary widely, so I always inquire about what a patient’s skin accepts well and what provokes discomfort. Finacea, with its 15% azelaic acid concentration, can be particularly bothersome for skin with weakened barriers during the cool-down phase. Therefore, we prioritize only well-tolerated products in this initial healing stage.
Dr. Bailey’s Recommended Cool-Down Routine for Rosacea or Facial Dandruff
For cleansing flaky and sensitive facial skin twice daily, select from these gentle options, alternating as needed based on tolerance:
1. pH-Balanced, Soap-Free Cleanser
My preferred recommendation is the Extremely Gentle Foaming Facial Cleanser, which I use myself for my rosacea- and seborrhea-prone skin. An alternative is the VaniCream Cleansing Bar, known for its minimal irritation potential.
2. Calming Zinc Soap for Rosacea
This stands out as the superior pyrithione zinc bar soap, enriched with shea butter for added benefits. I favor it over alternatives like Noble Zinc due to shea butter’s rich profile of anti-inflammatory and antioxidant elements that aid in healing irritated, flaky skin. I formulated this product, and countless patients have reported exceptional results for managing rosacea and seborrhea.
- Users rave about its effectiveness: one long-time rosacea sufferer, even after oral antibiotics, no longer needs them since incorporating this soap.
- Another individual in their 60s finally resolved scales, redness, and flakiness between the eyebrows after trying numerous remedies. Since using the Calming Zinc Bar about a year ago, they enjoy completely clear skin in that area with no recurrence, praising its quick action, longevity, and affordability.
3. Sodium Sulfacetamide Prescription Cleanser
While the zinc-based options work well for many, they may dry or irritate some skins, underscoring the importance of tolerance testing. You’ve used a lotion form of this ingredient previously, and prescription cleansers with it are also available.
Selecting the Ideal Cream for Flaky Skin Due to Rosacea and Seborrhea
Post-cleansing, apply products in this sequence for optimal results:
- Green Tea Antioxidant Skin Therapy first, as inflammation depletes the skin’s antioxidants. Replenishing them is key to why this cream excels in resolving facial dandruff and rosacea rashes. Patients apply it before other treatments.
- Clotrimazole cream targeted at active seborrheic dermatitis flare-ups.
- A nourishing moisturizer across the face where extra hydration is needed. Barrier-damaged skin benefits from stratum corneum-repairing ingredients. My hypoallergenic Daily Moisturizing Face Creams are top choices, bundled conveniently with Green Tea and Calming Zinc in the Facial Flaking and Redness Solution Kit.
The Facial Flaking and Redness Solution Kit is highly recommended for those battling both rosacea and seborrhea concurrently.
Additional elements in the Seborrhea and Rosacea Cool-Down routine may encompass:
- Non-irritating prescription treatments for rosacea or seborrheic dermatitis as required, such as Cleocin Lotion, Sodium Sulfacetamide Lotion, Metrogel, Metro Cream, or occasionally permethrin cream, following precise dosing. These are typically applied after Green Tea for better absorption with lighter bases preceding heavier ones.
- A mild 1% hydrocortisone cream applied solely to red rash areas for up to two weeks under physician oversight to avoid side effects. Only non-halogenated cortisones are suitable for facial use.
- Pure mineral zinc oxide sunscreen to prevent flares from sun exposure, selecting non-irritating formulas ideal for sensitive, barrier-compromised skin. These are featured in comprehensive sun protection selections, integrated into the Rosacea Skin Care Kit alongside the pH-balanced cleanser for a streamlined routine tailored to rosacea and seborrhea-prone skin.
Patients follow this Cool-Down routine for a full two months to adequately quell inflammation. Premature cessation often leads to relapse. Even after inflammation subsides, skin barrier recovery takes at least a month or longer, demanding patience and avoidance of irritants.
This comprehensive approach should provide valuable insights, and I appreciate you raising a question that resonates with many others experiencing these issues.
Warm regards,
Cynthia Bailey MD, Board Certified Dermatologist
Reference: Why is Rosacea Considered to Be an Inflammatory Disorder? The Primary Role, Clinical Relevance, and Therapeutic Correlations of Abnormal Innate Immune Response in Rosacea-Prone Skin. Del Rosso JQ et al., J Drugs Dermatol. 2012;11(6):694-700.
Disclaimer: Engaging with this content does not establish a doctor-patient relationship. The advice is general, inspired by common queries, and not a replacement for professional medical consultation. Always prioritize your physician’s guidance.
