When I see facial flushing in the clinic that just won't settle, I ask about cleansing habits before asking which cosmetics someone uses. How many times a day you wash and what you scrub with influence the course of rosacea more than you might think. Today I would like to explain, in the language of the clinic, a study that forms the background of this approach.
An unfamiliar question: could cleansing be a cause?
When rosacea is discussed, UV, temperature changes, food and stress are usually mentioned first. Cleansing is generally regarded only as "something you obviously have to do," so it tends to be left off the list of risk factors. A study published in Archives of Dermatological Research in 2021 tackled exactly this blind spot head-on. Its very title points to excessive cleansing as an underestimated risk factor.
This does not mean that washing itself is bad. It means that when the intensity and frequency of washing cross a certain line, a habit you believed was skincare may be keeping the symptoms going.
People with rosacea and people with healthy skin washed differently
The researchers compared side by side the cleansing habits of 999 people with rosacea and a control group of 1,010 people with healthy skin.
The points that separated the two groups can be summarized as follows.
- A tendency to wash more often each day
- Using a larger amount of cleanser each time
- Using cleansing tools instead of the hands more frequently
- A higher rate of using functional cleansing products
- A higher rate of visiting skincare salons
- More frequent use of sheet masks for cleansing purposes
| Cleansing factor | Rosacea group | Healthy control group |
|---|---|---|
| Washes per day | More frequent | Less frequent |
| Amount of cleanser | More | Less |
| Use of cleansing tools | Higher | Lower |
| Salon visits | Higher | Lower |
Which came first, the chicken or the egg
Looking only this far, it is hard to draw a conclusion right away. We cannot tell the direction: whether excessive cleansing brought on rosacea, or whether people who already had symptoms ended up scrubbing more often out of frustration. Correlation and causation are different, after all. I, too, hold off on judgment for a moment at this point.
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When people scrubbed every day, which way did the symptoms move?
What offered a clue to this question was the course of people who used exfoliants every day.
In those who used an exfoliant daily, it was reported that people who initially had only a burning sensation progressed to flushing, papules and pustules, and vasodilation. Lesions that had been confined to one area of the face sometimes spread across the whole face. In other words, it becomes possible to interpret that excessive physical stimulation pushed the course of rosacea toward worsening. Of course, the degree of reaction varies from person to person.
So how do I set the direction in the clinic?
If you keep increasing cleansing power when the skin barrier has already loosened, a vicious cycle sets in where the barrier becomes thinner and more sensitive to stimuli. I have explained this a little further in the post on why the skin barrier matters. That is why, for people whose rosacea is hard to control, I tend to recommend first cutting back on how they wash before adding a new cream.
In summary, the direction is as follows.
- Reduce the number of washes so that it does not exceed twice a day
- Pause physical friction such as scrubs and exfoliants for a while
- Choose a gentle, low-irritation cleanser instead of soap
- Wash gently with your hands and put the cleansing tools down
If you are unsure about choosing a cleanser, Why I recommend mildly acidic cleansers for sensitive skin and the post on the right way to cleanse may help. If flushing and rosacea themselves are unfamiliar to you, I recommend starting with the post on the symptoms of facial flushing and rosacea.
Because rosacea does not have a single fixed cause, it is hard to say that adjusting your cleansing habits alone will make all the symptoms disappear. Still, if you have been living with flushing for a long time, it is well worth looking back once at whether your daily cleansing is propping up the symptoms. If you cannot tell which way your own condition leans, let us look at it together through Consult via chat.
Author: Dr. Cho Mingyeol, Medical Director (board-certified dermatologist; Master Certification in Pigmentation, Acne, Rosacea and Hair from the Korean Dermatologists Association). You can find the full profile on the Medical Team page. First published 2023-03-02 / Last reviewed 2026-07-09
This article is intended for general information only; the appropriate treatment and outcomes may vary depending on each individual's condition.