Excessive cleansing: an underestimating risk factor of rosacea in Chinese population

Arch Dermatol Res. 2021 May;313(4):225-234. doi: 10.1007/s00403-020-02095-w. Epub 2020 Jun 27.


Appropriate skincare is essential in the prevention and management of rosacea. We sought to investigate whether cleansing habits, the initial step of skin care, would influence the onset and progression of rosacea and their associations with clinical features of rosacea in the Chinese population. We analyzed the daily cleansing habits data collected from 999 rosacea cases and 1010 skin-healthy controls from China. Overall, the high frequency of cleansing (more than once daily) (OR = 1.450) and the large amount of cleansers (> 5 pieces/year) (OR = 1.612) presented a positive correlation with rosacea occurring. The cleansing duration and types of cleansers appeared not to be correlated with the onset of rosacea in this study. Significant risk factors also included the deep cleansing habits, such as the overuse of cleansing tool (more than four times/week) (OR 2.179) and oil control and exfoliating behaviors via daily used products (OR 2.435), facial mask (OR 1.459) or projects in beauty salons (OR 2.688). The analysis of the clinical features of rosacea showed that patients who prefer deep cleansing were more prone to present an initial symptom of papule and pustule (OR 1.63-3.15). What is more, using daily exfoliating products presented a positive correlation with the progression of the symptoms from flushing to erythema (OR = 2.01), papule and pustule (OR = 2.28) and telangiectasis (OR = 2.14), and the affected areas from a single area to pan facial (OR = 1.650). In conclusion, excessive cleansing habits were substantial risk factors for the incidence and progression of rosacea in the Chinese population.

Keywords: Cleansing habits; Risk factors; Rosacea; Skin barrier.

MeSH terms

  • Adult
  • China / epidemiology
  • Cosmetic Techniques / adverse effects*
  • Cosmetic Techniques / instrumentation
  • Cosmetic Techniques / statistics & numerical data
  • Cosmetics / administration & dosage
  • Cosmetics / adverse effects*
  • Disease Progression
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Rosacea / diagnosis
  • Rosacea / epidemiology*
  • Rosacea / etiology
  • Severity of Illness Index
  • Skin Care / adverse effects*
  • Skin Care / instrumentation
  • Skin Care / methods
  • Skin Care / statistics & numerical data
  • Surveys and Questionnaires / statistics & numerical data
  • Young Adult


  • Cosmetics