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Type 2 rosacea significantly impacted by wearing a facemask every day at work (past 8+ months)

Since I've had to wear a mask every day to work I've developed bad rosacea on my cheeks - both redness and papules and some pustules (exactly where my masks lays). It is itchy and often burns. I previously was using Paula's Choice Perfectly Balanced Foaming Cleanser both AM & PM and First Aid Beauty Ultra Repair Cream AM & PM for about 2 years along with the Paula's Choice BHA which had both improved my previously sensitive skin so much. I'm so frustrated that after finally finding a routine that was working I'm having this reaction. I suspect that First Aid Beauty may have changed an ingredient in their Ultra Repair Cream because my sister's skin also flared at the same time after we both received a new jar this fall so I've cut that out and tried to go back to basics with Cerave products to try to repair my barrier.

AM - Everyday
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Moisturising Lotion CeraVe - Moisturising Lotion
PM - Everyday
1
Hydrating Cleanser CeraVe - Hydrating Cleanser
2
Moisturising Lotion CeraVe - Moisturising Lotion
PM - Once a week
1
2% BHA Liquid Exfoliant Paula's Choice - 2% BHA Liquid Exfoliant
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I feel for you. These mask side effects suck big time for people with sensitive and rosacea-prone skin. I wish there would be more research going into developing masks or methods of wearing that would be safer… I’m not a doctor, so I’m just researching the problem with you. There is this recent study that basically confirms that masks can trigger acne and rosacea flare ups (I know you knew that already…). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995182/ This is what the authors think are the reasons: “ Hua et al 3 evaluated cutaneous short‐term changes in patients wearing SM and N95, finding that masks induce microenvironment changes in the skin by dehydration, increased sebum and increased PH… Demodex folliculorum, regarded as the a trigger in rosacea, takes advantage from sebum overproduction producing/amplyfing inflammation (papules, pustules, and erythema)”

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Based on this, I think an azelaic acid (10-20%) product could be helpful. I’d also consider getting access to a dermatologist for a consultation - it is possible that they would recommend a short-term course of topical antibiotics.

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This is an example case - a treatment from a derm might be the best option. Is there a chance you could get at least a teleconsultation in your country? (over a video call?) - “ A 54-year-old woman had rosacea with central facial erythema with papulopustular lesions during three years. Minocycline and ivermectin (IVM) 1% cream treatment provided remission during 1.5 years. When the COVID-19 pandemic began, the patient used surgical mask that she changed every four hours. Prolonged use of masks provoked exacerbation of the rosacea. Over a 3-week treatment with IVM 1% cream, a marked clinical improvement was observed. During the next 4 months, the patient did not use mask, lived in a village, ordered groceries via internet and had a complete remission of rosacea. After quarantine, the patient moved to the city. The rosacea recurred with central facial erythema with papulopustular lesions under the mask” https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.17546

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