What is rosacea?
Rosacea is a chronic relapsing skin condition resulting in a diffuse red appearance the central part of the face. Patients present with redness and telangiectasias, (visible dilated blood vessels). There are different subtypes of rosacea, characterized by the patterns of skin lesions and redness. Stage 1 rosacea patients have diffuse redness and flushing. Stage 2 rosacea patients have the redness and present with red spots known as papules, and can sometimes have small dome shaped pimples known as pustules. Stage 3 rosacea patients have swelling and inflammation that can eventually result in a condition known as rhinophyma, which is characterized by unsightly fibrous thickening of the nose. If you have rosacea, you may also notice prominent pores on the skin of your nose. Some patients also have eye involvement, resulting in irritation, inflammatory changes, and conjunctivitis.
Diagnosis of rosacea
Rosacea can resemble other diseases, including connective tissue diseases like lupus or sarcoidosis. There is no diagnostic test for rosacea, so it is important to see an experienced dermatologist for evaluation of this condition. If you have any unusual skin lesions, your doctor may sometimes perform a biopsy to rule out other diseases.
Avoiding triggers for rosacea
Treatment of rosacea should begin with identification of possible triggers for the flushing and redness. These triggers vary among individual patients, but commonly include exposure to heat, cold temperatures, exercise, hot drinks, caffeine, alcohol, and spicy food. Some patients find that certain medications or cosmetic products result in irritation of their skin. We recommend all patients use a broad spectrum UV-A and UV-B sunscreen.
Medications to treat rosacea
Topical Brimonidine (Mirvaso) was recently approved by the US Food and Drug Administration in 2013 for treatment of the persistent redness of rosacea. Mirvaso is excellent at “whiting out the skin” and is applied in the morning for an effect lasting approximately 8 hours. However, Brimonidine can lower the blood pressure when too much is absorbed in the skin, so patients with vascular insufficiency or low blood pressure may not be candidates for this particular therapy. Another promising topical medication, topical Ivermectin (Soolantra), has only recently been approved by the FDA for treatment of stage 1 or stage 2 rosacea.
Other medications, such as topical metronidazole, are widely used in the treatment of rosacea in patients with pustules and inflammatory papules. Topical application of azelaic acid gel is also an another effective choice for treatment of papulopustular rosacea. Oral antibiotics such as doxycycline and minocycline are excellent for rosacea, especially stage 2. In very severe cases, low dose oral isotretinoin, a medication typically used to treat acne, can be effective.
Laser therapy and intense pulse light therapy
Vascular lasers, including the VBeam, are usually the primary treatment for rosacea, and work by targeting oxyhemoglobin in the blood, allowing reduction of the dilated blood vessels without causing damage to the surrounding tissues. Nonablative laser therapy is a very effective treatment for facial redness and telangiectasias. It works for treatment of rosacea by heating the connective tissue beneath the top layer of skin, which stimulates remodeling and growth of connective tissue. Intense pulsed-light therapy targets hemoglobin and melanin in the skin, and is useful for reduction of dilated blood vessels, facial pigmentation, and facial rejuvenation.
Treatment of phymatous rosacea
Some patients only seek help after they have significant thickening of the tissues on their nose, known as rhinophyma. A dermatologist can treat this deformity by removing and changing the contour of tissue that has been distorted by chronic rosacea. An ablative carbon dioxide laser is most often used, but hot wire loop cautery, dermabrasion, or surgical excision may be helpful as well.
Our experienced dermatologists will evaluate you and develop a treatment plan to refine your skin and reduce further damage from chronic inflammation. Call us today, or request an appointment online for a rosacea consultation at one of our convenient offices in Beverly Hills, Encino, or Glendale.