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Can too much cleansing cause rosacea?
A study on the Chinese population showed that excessive cleansing negatively affects the skin and increases the risk of rosacea. In this article, we have summarized the study. 

What is rosacea?

Rosacea is a chronic inflammatory skin disease of the face that affects many people with either one or more symptoms such as episodes of redness, noticeable blood vessels and the appearance of swollen and red bumps. Rosacea is a harmless disease but becomes problematic because of its aesthetics which can negatively affect quality of life.

What causes rosacea?

The root cause of rosacea is still not fully known, but among many factors, a damaged skin barrier has received much attention. Rosacea patients are sensitive to stimuli, both chemical (applying certain products) and physical (touching and rubbing the skin). This is associated with more transepidermal water loss or TEWL (=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 innate immune functions (=your personal immune response).

How do you reduce treatments for rosacea?

In addition to topical and systemic treatments, consistent application of appropriate non-irritant skin care 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?

The good thing about cleansing the skin is that it removes dirt, pollution particles, sunscreen, makeup and excess sebum. This improves the absorption of moisturizers, which in turn increases hydration and repairs the skin.

Men något många inte vet är att rengöring även tvättar bort hudens yttersta celler vilket är det lager som ger huden mycket av dess skyddande barriär men även de naturligt mjukgörande och återfuktande ämnen som huden består av. Detta gör inte bara huden torrare, utan även mer känslig och mottaglig för påverkan utifrån, vilket man vill undvika för att inte störa huden. Många rengörande produkter kan även innehålla ytaktiva ämnen som direkt irriterar huden eller är allergiframkallande vilket stör hudbarriären. Därför kan rengöring, om det används mer än nödvändigt, skada din hud på lång sikt. Minimerar man däremot rengöringen, tvättar med milda och skonsamma rengörande produkter max 1 gång per dag eller när det verkligen behövs, så ger man huden de bästa förutsättningarna för att vara i

How does cleansing affect rosacea?

A large study was conducted in China on the impact of cleansing habits on 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 included 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 questionnaire was divided into two sections:

1. Normalt rengöringsbeteende:

  • Hur ofta rengjorde de?
  • Hur mycket rengöring använde de per år
  • Rengöringstid per gång

2. Förstärkt rengöringsbeteende om de använde något av följande:

  • Oljekontrollerande produkter
  • Exfoliering
  • Ansiktsmasker
  • Behandlingar på skönhetssalong 

The rosacea group was asked what their current symptoms are, where on their face they were located, duration of redness and what their triggers for redness are (heat, food, emotions, use of skin care products etc.).

The results showed that certain aspects of cleaning affect rosacea. The following results were observed from the study:

A positive association with rosacea was found:

  • Being a woman
  • To be working
  • Have a higher level of education and more personal income
  • Cleaning more than once a day
  • Använder en stor mängd rengöring, mer än 500 g per år
  • Risk factor of using a cleaning tool more than four times/week
  • Risk factor of using oil control products, exfoliants and masks
  • Risk factor of getting treatments at beauty salon (exfoliation, oil control)

No association with rosacea was found:

  • Type of cleaning
  • Cleaning time

Why do cleansing habits affect rosacea?

As mentioned earlier, surfactants in detergents 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. The use of cleansing devices will also do this mechanically. Exfoliants destroy the upper layer of the skin and can also be sensitising.

Excessive cleansing can disrupt the skin barrier, leading to a higher pH of the skin. A healthy skin's pH is low (4.5-5.5), having a higher pH can attract bad bacteria. Excessive cleansing and preservatives in cleansers can affect the skin's microbiome (=the bacteria and micro-organisms that live in the skin). Removing good bacteria and attracting bad bacteria can weaken the skin's immune system and make it more sensitive. 

Advice to take away from the study

 Advice to take away from this study is that less is more! Not using detergents more than once a day, using less than 300 grams a year and refraining from cleaning appliances are good ways to avoid 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 questionnaire may have occurred Secondly, they did not ask what water temperature the participants used. Thirdly, the study did not include any measurements. 

Referens

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

SKIN ACADEMY