woman receiving treatment for rosacea

Rosy, but Not Bloody Red: Tips for Staying on Course After Rosacea Treatment

Rosacea is a chronic skin condition affecting around 16 million Americans. Central facial redness, inflammatory lesions, spider veins, and broken capillaries are characteristic, though some patients have symptoms needing more than just skin care.

The persistent flushing, visible blood vessels and skin lumps can make people look sickly. Some worry if they can ever look flawless again.

woman with rosacea

Rosacea has no cure, but current treatments can help you control flare episodes and remove stubborn lesions effectively. This article discusses recommendations for a smooth rosacea treatment recovery and relapse prevention.

But to understand how rosacea therapy works, you need to know why you have symptoms in the first place.

What Is Rosacea?

Rosacea is a chronic skin condition marked by facial flushing, branching or broken facial blood vessels, and inflammatory skin lumps called “papules” and “pustules.”

Papules are small, typically red bumps that do not contain pus. They become pustules when pus builds up from within.

Rosacea patients may also develop “secondary symptoms” that can impact treatment decisions. They include:

  • A burning or stinging sensation in affected areas
  • Facial swelling
  • Skin plaques
  • Skin dryness
  • Severely thickened skin (phyma) on the nose, chin, forehead, ears or eyelids
  • “Peripheral flushing” or redness in areas outside the center of the face, such as the scalp, ears, jawlines, neck and chest
  • Eye involvement

Patients experience rosacea breakouts when exposed to a trigger factor. Proper treatment helps suppress flare symptoms and prolong remissions.

The condition can affect any skin type, though fair-complexioned individuals are most vulnerable. Both men and women can develop rosacea, but hormonal factors influence its manifestations. It can present as early as childhood, but symptoms more commonly appear after age 30.

How Do You Get Rosacea?

The cause of rosacea is unclear. However, susceptible individuals are thought to have the following:

  • Heightened reactivity of the facial blood vessels, making them prone to inflammation and damage
  • Abnormalities in skin connective tissue composition

Connective tissue breakdown in the deep layers of the facial skin, weakening its barrier function and the blood and lymph vessels. Barrier defects make the skin irritable. Fragile blood vessels dilate easily, producing a ruddy appearance. Leaky lymph vessels cause facial swelling. Chronic sun damage, immune dysfunction and retention of proinflammatory substances contribute to connective tissue loss. 

  • Structural defects of the hair follicles and oil glands
  • Hypersensitivity to microbes, which is thought to be linked to papule and pustule formation

Factors known to aggravate rosacea symptoms include the following:

  • Extremes of temperature
  • Excessive sun exposure
  • Wind
  • Hot beverages
  • Vigorous exercise
  • Spicy food
  • Alcohol
  • Emotional stress
  • Harsh beauty products
  • Menopausal flushing
  • Some medications
  • Dairy products
  • Other environmental irritants

Since the exact cause of this problem cannot be identified, treatment focuses on trigger avoidance, symptom control and religious skin care.

What Are the Subtypes of Rosacea, and Why Does It Help to Know?

Correct diagnosis and classification are crucial—they help you and your doctor figure out your best treatment option. The National Rosacea Society (NRS) Expert Committee classifies the condition into four subtypes and one variant. 

  • Erythematotelangiectatic Rosacea

The following symptoms are predominant in this subtype:

  1. Facial redness 
  2. Spider veins and broken blood vessels (known medically as “telangiectasias”)
  3. Central facial swelling
  4. A burning or stinging sensation on the involved areas
  5. Roughness
  6. Scaliness

Medications and vascular laser therapy help improve this condition.

  • Papulopustular Rosacea

As the name suggests, papules and pustules are the primary skin manifestations of this subtype. Central facial redness and telangiectasias are also typically present, though less pronounced. Burning pain occurs but less commonly.

Antimicrobials help with inflammation and possible infection. Visible blood vessels are treated with topical brimonidine or laser surgery.

  • Phymatous Rosacea

Patients with this condition present with enlarged pores and disfiguring skin contours in some parts of the face, most frequently the nose. Skin thickening persists despite topical treatment and responds only to surgery. Phymatous rosacea patients are usually male, though mild skin overgrowth and pore dilation may also occur in female patients.

  • Ocular Rosacea

Aside from the skin manifestations, people with ocular rosacea experience symptoms of eye damage. The eyelids and eyes may be inflamed. Light sensitivity and visual changes are likewise common.

Skin treatments are the same as in the other subtypes. Eyelid cleansing, artificial tears, warm compresses and ophthalmic medications help improve the eye symptoms. Patients may be referred to an ophthalmologist for co-management. 

  • Granulomatous Rosacea

This is the only rosacea variant recognized by the NRS. Patients have firm, red and yellow-brown lumps on the cheeks and around the eyes and lips. It is the most challenging to treat, but lasers, phototherapy and medications can alleviate the symptoms.

These conditions overlap rather than progress in stages, and different subtypes can exist in the same individual. Symptoms may be mild, moderate or severe.

What Helps Rosacea Go Away?

The first line of therapy for rosacea flare episodes consists of topical medications and non-ablative light-based procedures.

  • FDA-approved topical rosacea drugs include the antimicrobials metronidazole, azelaic acid and ivermectin. They are used more for their anti-inflammatory than antimicrobial action. Brimonidine is another, and it normalizes blood vessel size.
  • Non-ablative light-based procedures include intense pulsed light (IPL) and vascular laser treatment. They are further explained later. 

After starting topical treatment, your dermatologist will observe your response for several weeks. When you see a significant improvement, you may be advised to keep using the medication for at least six months. Otherwise, your doctor may combine first-line remedies or start you on a second-line form of therapy, such as the following:

  • An alternative topical medication like the antimicrobial sulfacetamide/sulfur. Retinoids like tretinoin and calcineurin inhibitors like tacrolimus may be given to combat inflammation. Retinoids also accelerate connective tissue repair.
  • Low-dose oral antibiotics like doxycycline
  • An oral retinoid, particularly isotretinoin

For extremely resistant cases, third-line treatments include high-dose oral doxycycline and injectable drugs like Botox and secukinumab. Botox blocks acetylcholine release, preventing the multi-action nerve chemical from dilating the blood vessels. Secukinunab modulates the immune response.

Except for topical sulfacetamide/sulfur and oral doxycycline, these alternative treatments do not have FDA recommendation for rosacea therapy. But a skin care specialist may use them off-label to induce remission.

Facial swelling may improve with “manual therapy.” Your doctor will instruct you to press your fingers in a sweeping motion toward the jawlines. This pushes the leaked fluids in the direction of the neck’s bigger lymph vessels.

If this is the first time you’re thinking of getting a laser procedure for those unsightly marks, then this article is for you. Here, we discuss how age spots develop and the different ways doctors get rid of them. We also explain why lasers effectively remedy this skin issue and what you can do to make sure they stay gone after therapy.

woman receiving light treatment for rosacea

Is Light Treatment Good for Rosacea?

Light-based surgical procedures get rid of telangiectasias, which cause aberrant facial blood and fluid flow. They are essential in rosacea therapy.

The most recommended light treatments for telangiectasias include:

  • Pulsed dye laser (PDL) therapy, e. g. VBeam, which uses yellow-green light energy
  • Near-infrared laser surgery, which relies on a type of powerful, invisible radiation
  • IPL treatment, which uses filtered light instead of laser

These light treatments are non-ablative—they do not cut the skin surface. Rather, they selectively burn abnormal blood vessels while sparing most of the surrounding normal tissue.

Complete rosacea remission generally requires multiple sessions spaced 4-8 weeks apart. The number depends on the problem’s severity and the patient’s treatment response.

For individuals with phymatous rosacea, radiofrequency and ablative laser resurfacing can burn away excess skin and improve the appearance of the affected areas. Aside from light therapies, dermabrasion, electrocautery and simple excision are also used to treat phymas. 

IPL and vascular laser treatment belong to the first line of therapy for rosacea, but their cost is a huge downside. Despite being a medical problem, most insurance companies cover only the FDA-approved rosacea medications, not the procedures.

Is Rosacea Light Treatment Safe?

IPL and lasers are generally safe. But since they are minimally invasive procedures, they are not for everyone. Severe immunosuppression, connective tissue disease, blood clotting problems, nutritional deficiencies, advanced age and blood sugar control issues can make surgery unsafe for some patients. Such individuals are better off sticking to topical medications.

The most common side effects of light therapies are redness, swelling and pain. They may worsen rosacea symptoms transiently, but these inflammatory reactions are normal after surgery. Vulnerable individuals may observe slight bruising after IPL or laser therapy.

Rarely, complications arise from light treatments. They include the following:

  • Excessive bleeding
  • Hypersensitivity
  • Abnormal pigmentation
  • Cold sore reactivation
  • Infection
  • Scarring

But the odds of developing these side effects become insignificant when you entrust your rosacea treatment to a good laser dermatologist. You may check out one of our previous articles to learn more about finding the right laser dermatologist

Does Laser or IPL Treatment for Rosacea Hurt?

IPL and vascular laser therapy may cause discomfort, which most patients can tolerate even without pain medication. The laser equipment releases a cold mist that numbs the target area. IPL devices have the same cooling mechanism, but they make cooling gels necessary since they are used in direct contact with the skin.

Post-surgical pain may be mild to moderate. It can be remedied by icing the treated site or taking acetaminophen. 

Topical steroid creams help control inflammation, though they may trigger rosacea flares. Use them only upon your doctor’s advice.

How Can You Make the Most Out of Your Rosacea Light Therapy?

Working with your doctor throughout the process will help ensure the best results. You may be advised to do the following:

Before Your Appointment

Some drugs and skin care products can sensitize your skin to light, making you prone to laser burns. Retinoids, tetracycline antibiotics and many others have this effect. Additionally, blood-thinning medications like aspirin and similar painkillers can increase your risk of bleeding or bruising during surgery. Your doctor may recommend avoiding these treatments days before your appointment.

Light-based surgical procedures can reactivate cold sores. You may be advised to take cold sore medication days before and after your session. 

If you are being treated for another chronic condition, you may have to get medical clearance before undergoing a cosmetic procedure.

During Your Session

IPL and lasers make the skin infection-prone. Your doctor will clean the problem area at the start of the procedure. But leave your face free of cosmetics before coming in for your appointment.

Rosacea treatment involves the skin near your eyes. Eye injury can result from accidental IPL or laser exposure, so using protective eyewear during the session is crucial. 

After Your Therapy

The rosacea laser treatment recovery time usually takes no more than a few days, owing to inflammation. But you may do the following to ensure speedy and complete healing:

  • Cleanse your face with a mild skin cleanser twice a day. Moisturize afterward.
  • Use sun protection when going outdoors.
  • Hydrate adequately. This helps clear the tissue fragments in the treated area quickly and shorten the inflammation phase.
  • Some people recover fast, but others can feel sore for days. Do not use makeup in the presence of significant inflammation, as this will further irritate your skin.
  • Avoid vigorous activities while in recovery. This helps prevent rosacea symptom aggravation and trauma to the treated site.
  • Sleep on your back with your head elevated in the first few nights after your procedure. This reduces swelling and bruising. Supplements like arnica and bromelain can also help minimize bruising.
  • Avoid smoking and drinking, which can delay the healing process.
  • Don’t scratch or pick at the treated site.
  • Call your doctor for problems that you think could be related to your surgery. 

Patients who have undergone ablative laser skin resurfacing have special post-treatment needs. You may read our article on ablative laser recovery for more information.

rosacea laser treatment before and after

But of course, the most important thing you can do to get excellent treatment outcomes is to choose the right dermatologist. Only board-certified skin doctors can guarantee the safety and effectiveness of your therapy.

How Soon Can You See Results After IPL or Laser Treatment for Rosacea?

The effects of IPL and non-ablative laser therapy are gradual. The changes may not be significant until 4-8 weeks after your last session. But with continuous collagen production and remodeling, you can expect your skin to keep improving for several months. With a good skin care regimen, the results of your treatment can last for years.

What Can You Do to Prevent Flares After Rosacea Laser Treatment Recovery?

Rosacea breakouts can make it hard for you to keep your skin looking glowingly healthy. The following measures can prevent your symptoms from coming back:

  • Identify your flare triggers and try your best to avoid them.
  • Sun protection is vital. Stay away from the midday sun. Use sunblock (at least SPF 30) when going outdoors. Wearing a wide-brimmed hat and seeking shade also help.
  • Rosacea makes the skin sensitive due to barrier dysfunction, so avoid harsh skin care products.
  • Use a soap-free, fragrance-free cleanser when washing your face, applying it gently with your fingertips. Do not rub your face with abrasive materials. 
  • Put some emollient on your face before using cosmetics.
  • You may be advised to use green-tinted makeup to mask facial redness. Choose the kind specially formulated for sensitive skin. 
  • Patients with ocular rosacea may benefit from increasing their intake of omega-3 fatty acids, e. g. from fish oil supplements. These nutrients help remedy eye dryness. 

Your doctor may prescribe a special skin treatment in addition to these. Adherence to the regimen helps fend off breakouts. 

Why Is It Important to See a Dermatologist for Rosacea Treatment?

Seeing a dermatologist for your rosacea therapy gives you the best possible chance for a quick recovery and longer remission. With their deep understanding of this condition, you can rest assured of the following:

  • Proper Medication Use

Many rosacea patients require extended antimicrobial use. An unqualified provider may give the wrong dose, which can result in drug resistance and other unwanted side effects. A rosacea specialist avoids these problems by using the appropriate dose and formulation.

  • Excellent Results

Inexperience in performing IPL or laser treatment can turn visible blood vessels into ugly scars. But board-certified dermatologists are experts in cosmetic surgery procedures. They can help you manage your symptoms while improving your skin’s appearance.

  • Avoid Unwanted Costs

Your healthcare expenses can pile up quickly with unsafe or futile therapies. Only a bona fide skin care specialist can spare you from complications and unnecessary costs.

  • Accurate Disease Identification and Classification

Not all doctors have ample training in diagnosing and treating rosacea. This condition may be easily confused with life-threatening disorders like leprosy, lupus and skin cancer. Only board-certified dermatologists have a sharp clinical eye for a wide variety of skin issues. Timely treatment is impossible without the correct diagnosis.

When you trust a dermatologist for your rosacea therapy, you put yourself in the most capable hands to handle the problem.

The Right Rosacea Treatment Means Quick Recovery, Long Symptom-Free Periods

Restoring your skin’s radiance after a rosacea breakout is not easy. But it’s possible, thanks to modern medicine.

First-line therapies include topical drugs, IPL, and non-ablative lasers, which help most patients curb their symptoms efficiently. For stubborn lesions, your doctor may include oral medications, injectables, phototherapy and other cosmetic procedures in the treatment plan.

But rosacea has various forms. So correct diagnosis and classification are important in choosing the right therapy for every patient.

Taking care of your skin after recovery is likewise vital. Prolonging your remission makes it easy to keep your complexion flawless despite having this condition. The most important measures that can help you do this are trigger avoidance, gentle cleansing, moisturizing and sun protection.

And as always, delicate skin is best left to a specialist. So trust only a board-certified dermatologist to get the best results from your rosacea therapy.

Tired of That Persistent Redness on Your Face? Talk to a Top LA Skin Care Expert

Not everyone with rosacea will have the same set of symptoms. What works on one patient may be ineffective in another. So before you hurt your pocket—and possibly your skin—trying a scientifically unproven DIY remedy, why not talk to a trusted skin doctor instead?

At BHSkin Dermatology, our rosacea specialists have helped many people manage their symptoms successfully. Come visit us at our Glendale or Encino clinic for a face-to-face consultation or use our telederm portal for an online checkup.

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