Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens

April 2021 | Volume 20 | Issue 4 | Original Article | 384 | Copyright © April 2021

Published online March 16, 2021

Hilary Baldwin MD,a Andrew F. Alexis MD MPH,B Anneke Andriessen PhD,c Diane S. Berson MD FAAD,d Patricia Farris MD FAAD,e Julie Harper MD,f Edward Lain MD FAAD,g Shari Marchbein MD,h Linda Stein Gold MD,i Jerry Tan MD FRCPCj

aAcne Treatment & Research Center, Brooklyn, NY
bIcahn School of Medicine at Mount Sinai, New York, NY
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dCornell University Weill Medical College, Weill Cornell Medical Center, Dermatology, New York, NY
eTulane University School of Medicine, New Orleans, LA; Sanova Dermatology, Metairie, LA
fThe Dermatology and Skin Care Center of Birmingham, Birmingham, AL
gSanova Dermatology, Austin TX; Austin Institute for Clinical Research, Austin, TX
hNYU School of Medicine, New York, NY
iHenry Ford Health System, Detroit, MI
jRoyal College of Physicians and Surgeons of Canada; Schulich School of Medicine and Dentistry, Department of Medicine, Western University, Windsor, ON, Canada; Windsor Clinical Research Inc; The Healthy Image Centre, Windsor, ON, Canada


Rosacea is a disease of skin inflammation that leads to derangements in skin barrier function. This contributes to the sensation of pain, burning, itching, stinging so often bothersome in those affected. Addressing barrier dysfunction by using moisturizer and cleanser formulations that restore skin hydration, normalize skin pH, and restore the microbiome and skin lipids can help improve rosacea signs and symptoms.

The panel's consensus was that in addition to the use of prescription medications, skincare recommendations are a crucial part of successful rosacea therapy. Participants noted that the use of quality OTC products could improve rosacea symptomatology and severity in and of themselves. As adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen.

The importance of providing the patients with specific branded recommendations was discussed both in terms of the presence of reparative actives and the omission of irritating substances. In addition to occlusives and humectants, barrier restoring ingredients such as ceramides, hyaluronic acid, and niacinamide were considered beneficial. Equally important was the absence of potentially irritating substances. In particular, cleansers with harsh surfactants, antibiotics, and elevated pH can strip lipids, proteins, and NMF, thereby stimulating inflammation.

Patients benefit from specific recommendations when faced with the bewildering array of options in the pharmacy skincare aisle. The wrong choice can derail an otherwise ideal therapeutic approach.

There are many types of OTC skincare products available; however, robust comparative studies on their use for rosacea are scarce. Information from studies that combine biophysical measurements with clinical assessment may help to make an informed choice.


The authors disclosed receipt of an unrestricted educational grant from CeraVe USA for support with this work's research. The authors also received consultancy fees for their work on this project.

All authors contributed to the development and review of this work and agreed with the content.


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