Retinoids and rosacea: good or bad idea?

Rosacea is a chronic skin disease, characterised by periods of flare-ups and remission. It initially manifests itself through redness sensations of heat but also a significant dilation of the facial blood vessels, making them more visible , particularly on lighter skin tones. In some cases, rosacea can progress to skin lesions, with the emergence of papulo-pustules on the skin's surface.

The symptoms of this form of rosacea being quite similar to those of acne, it is sometimes referred to as acne-rosacea. The development of papulopustular rosacea is linked to the excessive presence of skin mites in the sebaceous glands, the Demodex. The cause of their excessive presence would be due to an immunological disorder that would lead to the formation of a permanent oedema promoting an excessive proliferation of these parasites. Given the similar clinical manifestations of papulopustular rosacea and acne, one might wonder if the use of retinoids, recommended in cases of acne, could be relevant for people suffering from rosacea.

The retinoids are a family of molecules that include vitamin A, its metabolites and its derivatives (both natural and synthetic). Among the forms permitted in cosmetics, we notably find retinol, retinoid esters and retinal. Generally recommended for mature skin, retinoids are also very useful for people suffering from acne. Indeed, these molecules possess a keratolytic effect that allows them to eliminate dead cells accumulated on the surface of the epidermis. This action notably helps to unclog pores of the skin and to prevent the appearance of future comedones.

Several studies have focused on the effects of retinoids on rosacea, and more specifically on acne-rosacea. It has been demonstrated that these molecules, when applied topically, promote the remodelling of connective tissue and the downregulation of TLR2 receptor expression (Toll-like receptor 2). This membrane receptor plays a significant role in bacterial recognition and in the production of interleukin-6 (IL-6), a pro-inflammatory cytokine. Clinical studies have reported that retinoids, due to their mechanism of action, offer a reduction in erythema, papules and pustules, as well as telangiectasias, the small vessels that appear on the surface of skin affected by rosacea due to their permanent dilation.

Please note : although retinoids present in cosmetics can help manage the symptoms of rosacea, it is important to bear in mind that they should not replace a treatment prescribed by a dermatologist.

The topical application of retinoids can lead to adverse effects on the skin. The most common are skin dryness, photosensitivity and irritation. That's why it's recommended for those using them to always apply a moisturiser afterwards and to use sun protection during the day. Moreover, retinoids should not be applied around the eye area, due to the sensitivity of this region. We also advise you to introduce retinoids gradually into your routine. It's good to start by applying a retinoid-based treatment every other day, or even every three days at the beginning. If your skin tolerates it well, you can increase the frequency up to once a day.

Finally, even when applied topically, the use of retinoids is contraindicated for pregnant women or those planning a pregnancy. Although the risk of these molecules entering the bloodstream is low when applied topically, the teratogenic effects of retinoids should not be overlooked. Indeed, they can cause malformations of the central nervous system of the foetus or cardiac malformations.

• HATA T. R. & co. Topical and systemic therapies in the treatment of rosacea. American Academy of Dermatology (2014).

• FELDMAN S. R. & al. Rosacea Management. Skin Appendage Disorders (2016).

• ALI F. & et al. Rosacea. British Journal of Hospital Medicine.(2021).