Take Control of your Rosacea
posted: Feb. 09, 2021.
Take control of your rosacea
Rosacea (sometimes called “adult acne”) is a chronic inflammatory skin condition of the face and is one of the most common skin problems I treat. It can be extremely frustrating to be a person living with rosacea because there is no permanent cure and we still don’t know for certain what causes rosacea. Having said that, lifestyle changes and medical therapies can effectively control the signs and symptoms of rosacea. According to the National Rosacea Society, an estimated 16 million Americans have rosacea, yet only a small fraction are being treated.
There are four main types of rosacea, each with their own common symptoms:
- Papulopustular rosacea – pimples and pustules on the face that resembles acne
- Erythmatotelangiectatic rosacea – flushing and visible blood vessels on the face, which can progress to persistent redness
- Rhinophymatous rosacea – large nose (or other facial area) due to enlargement of oil glands and skin thickening
- Ocular rosacea – eye irritation that leads to a burning or gritty feeling in the eyes with red eyes or eyelids
Who’s at risk
Rosacea typically affects adults between the ages of 30 and 60, and it is found more commonly in women and fair-skinned individuals. For most people, rosacea tends to come and go periodically with intermittent flares, but for others it can continually get worse over time.
Common triggers for rosacea
Identifying triggers for rosacea is an individual process. What causes a flare-up for one person may have no effect on another. Frequent triggers (things that increase face blood flow) of rosacea include:
- Hot drinks
- Spicy foods
- Hot baths or saunas
- Hot or cold weather
- Emotional stress
Identify and minimize any exposure that triggers episodes of rosacea:
Avoid sunlight - use a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or more on your face
Avoid drinking hot liquids and alcohol
Avoid eating spicy foods
Avoid excessive heat exposure
Avoid excessive wind - protect your face in the winter with a scarf or mask
Avoid irritating facial products - (e.g. astringents, toners, sorbic acid, menthol, camphor)
Things you can try at home that may help:
Fair-skinned people may find that green-tinted makeup or foundation helps to hide redness
A gentle skin-care routine can help control rosacea. Clean your face with a mild and non-abrasive cleanser (e.g Dove soap or Cetaphil cleanser). Then rinse with lukewarm water and blot dry with a thick soft cotton towel.
When to seek medical care
While rosacea is not usually an emergency, you should seek medical care as soon as possible if you suspect you may have rosacea. There are many different treatment options available that may significantly improve your skin health and quality of life. Visiting a dermatologist is easy, so make an appointment today.
Treatment options for rosacea
Numerous treatment options including topical treatments, oral pills, and light-based treatments are effective at treating rosacea. Scheduling an evaluation with a board-certified dermatologist is the best way to get yourself headed down the right path to clearer skin.
Many topical medications (applied once or twice daily) are effective, but they are significantly more effective in the treatment of papulopustular rosacea than the erythematotelangiectatic type. Below is a list of the most commonly prescribed topical treatments for rosacea. Please note that some of the topical treatments listed below are FDA approved for the treatment of rosacea and some are considered off-label.
- Metronidazole gel, cream or lotion
Azelaic acid (Finacea) gel
Sodium sulfacetamide with sulfur lotion, cream, suspension, or cleanser
Erythromycin or clindamycin lotion or solution
Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel)
Ivermectin cream (Soolantra)
Brimonidine gel (Mirvaso) – primarily to reduce facial redness
Oxymetazoline cream (Rhofade) – primarily to reduce facial redness
Oral Antibiotic Pills
Oral antibiotics (particularly those in the tetracycline class) are a mainstay for more severe rosacea. Examples include doxycycline (Oracea) and minocycline. These are usually taken once or twice daily. Other antibiotics less commonly prescribed include metronidazole and azithromycin. It is not uncommon to require 3 months or more of treatment with oral antibiotic pills to achieve effectiveness. I frequently combine oral antibiotic pills along with topical treatments, and light-based therapies when treating patients with rosacea.
Oral Isotretinoin (commonly called accutane) Pills
In more severe cases of rosacea, or in cases that aren’t responding to other treatments, I have found that isotretinoin can be very helpful. This treatment is often capable of achieving significant improvement with long-term remission for my patients. It is not without some risk however and requires pregnancy testing in females of childbearing potential as well as routine lab monitoring (usually monthly) during treatment. A typical course of treatment lasts about 6 months. The most common side effects of isotretinoin are chapped lips and dry skin, but these can be managed with frequent lip balm (Aquaphor) application and daily skin moisturizer use most of the time.
INTENSE PULSED LIGHT (IPL) OR BroadBAND LIGHT (BBL)
IPL or BBL (photofacials) are a very common treatment offered for rosacea. They use a light source with different filters to treat the blood vessels that are visible on the face to help minimize facial redness. Although good results can be obtained with these treatments, they don’t work quite as well as Pulsed Dye Laser (PDL) when targeting blood vessels in the face, and my preference is always to choose PDL when available.
PULSED DYE LASER (PDL)
PDL is the gold standard in my opinion for treating facial redness that is secondary to rosacea. It uses a specific wavelength of laser light to target the hemoglobin in our blood and eliminate the unwanted blood vessels that are found on the face in patients with rosacea. Treatments can be performed in 30 min or less for the entire face and there is minimal downtime afterwards. No numbing medication is needed prior to treatment. A series of 3-5 treatments spaced 1 month apart initially, followed by maintenance treatments every few months thereafter is a common treatment regimen.
Surgical treatments are typically only needed for those with severe rhinophymatous rosacea. If you suspect you may have rhinophymatous rosacea, you should seek a consult with your dermatologist as soon as possible.
Many different treatment options for rosacea are available at our clinic. To discover which treatment is best for you, schedule a consultation with one of our providers at Feinstein Dermatology & Cosmetic Surgery by calling (561) 498-4407.