OTC Retinols or Vitamin C for Oily Rosacea W/blackheads?

I'm a 49 y/o WF; peri-menopausal; hypothyroid. I have acne rosacea (severe w/blackheads & cysts in addition to breakouts) no longer well controlled w/Oracea. I've used Cerave cleanser & G.M. Collin Sensiderm Gel moisturizer. (Condition is so extreme that I regularly get blackheads & acne between creases of lids & brows & IN my eyebrows. I even have a purplish blackhead @ my lower lash line!) Will OTC retinols help? Vit C instead? I know Rx's would be too harsh. Tried to add photo but couldn't.

Doctor Answers 3

Skin Care Regimens for Rosacea

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Since Rosacea can present with inflammatory lesions ,tiny broken facial veins , scaly or oily skin and enlarged pores,it is important to begin a therapeutic skin care regimen recommended by a healh-care skin expert. Ideally, a routine of cleansing, toning and oil control with salicylic acid products and mild exfoliants  will help the skin to obtain a balance of sebum production and eliminate the redness and breakouts.

San Juan Capistrano Physician

How to improve acne and rosacea in perimenopause

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Cysts can be part of rosacea but blackheads are part of acne.  Both acne and rosacea will improve with low dose doxycycline like Oracea, but acne would improve with retinols and vitamin C whereas rosacea will be more irritated and get worse.

If the condition is severe and there are cysts, there are no over the counter medications that will improve it and it needs to be evaluated and treated by a board certified dermatologist.

Also, consider the fact that hormonal changes during perimenopause can contribute to worsening acne breakouts.

For hormonal acne, medications like spironolactone may be helpful.  Spironolactone blocks androgens, which are responsible for acne.  Spironolactone cannot be used by women who are pregnant or may become pregnant.  There are other health considerations and only your doctor can determine if you are a good candidate for it.

Emily Altman, MD
Short Hills Dermatologic Surgeon

Sounds like you may have adult acne rather than rosacea...

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blackheads are not a characteristic of rosacea...they indicate a variety of acne...at your age with such ongoing problems, it may be time to consider isotretinoin...in other words accutane...ask your doctor if that might be the best option...obviously can't even make a firm diagnosis without a picture...so the suggestion might not pertain to your condition

Ken Landow, MD
Las Vegas Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.