Rosacea and tretinoin... good or bad? I have orange peel skin texture with extreme sensitivity.

Question

My derm diagnosed me with Rosacea. I have been on metro cream and three different antibiotics. He recently prescribed Tretinoin .025%. I’m terrified it will make my condition worse. I’ve heard it causes swelling and can actually cause the problems I am having now. Have you ever heard of prescribing tret for Rosacea? Do you recommend or should I seek another opinion?

Deborah M. Longwill, DO · Answer

Rosacea skin is very sensitive.  Tretinoin cream or gel  can cause a lot of redness and irritation.  Finacea foam twice daily, and a physical sunblock with a gentle moisturizer is a better option in my opinion. None the less, inform your dermatologist about these concerns. They know your skin and what it can and cannot tolerate.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Rosacea is very complex and a tailored treatment program give the best results. This is because there are many types of rosacea (telengtctatic or capillaries, flushing and redness, acne like rosacea, ocular rosacea and even rhinophyma rosacea.) To answer your question, tretinoin in the context of rosacea is trail and error. Start off with a tiny bit of tretinoin, 1/4 pea size mix with pea size bland moisturiser. Use on a test area, eg. side of cheek, forehead. Leave on for 4-6 hours, then wash off. If you can tolerate this increase the area, then the duration. Titrating is very important. Tretinoin is a retinoid, and can help rosacea in some patients- best used with a laser to control the redness.
To add to the complexity, everyone has different flare factors- Sunlight, stress, foods, chemical irritants, creams, changes in temperature, alcohol. The list goes on. 
  
A detailed history, together with a treatment tailored according to YOUR type of rosacea will give the best results. As a guide, I use a combination of -
  
1. Lasers ( to treat redness, broken capillaries, rhinophyma, flushing)- best laser is the V BEAM. IPL can be used, but usually not as effective. Laser toning using the long pulse Nd Yag at 1064 can help with background redness. 
  
2. Creams - anti inflammatory
  
3. Tablets -anti - inflammatory and sometimes low dose Vitamin A. 
  
4. For females- Mineral make up is recommend, over make up that contains parabens. 
  
For the best results, consult a dermatologist for both medical and laser treatment options. 
  
Kind regards.
  
Dr Davin S. Lim.
  
Laser Dermatologist.
  
Brisbane, Australia.

Rosacea and tretinoin... good or bad? I have orange peel skin texture with extreme sensitivity.

Answers (2)

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