What is rosacea?
Rosacea
is a common disease that encompasses a broad range of symptoms.
Rosacea usually begins in middle age and is characterized most
commonly by flushing, facial redness, and visible blood vessels.
Some forms of rosacea also cause red bumps, pimples, thickening
of the skin, irregular growths on the face, and eye symptoms.
What causes rosacea?
The cause of rosacea is unknown. Proposed associations
include bacterial colonization, sun damage, neurovascular disease,
chemical exposures, and abnormal oil glands.
What are the symptoms of rosacea?
The most common symptoms include facial redness
- usually on the nose, cheeks, chin and forehead. Visible vessels
(called telangiectasias), facial swelling and burning sensations
are also found. Red bumps or pimples may be seen as well. Rosacea
can develop gradually, as mild episodes of facial blushing. Over
time, flushing may lead to a permanently red face. One form of rosacea,
called ocular rosacea can affect the eyelid and the surface of the
eye. Symptoms can include redness, dry eyes, burning and styes.
How is the diagnosis of rosacea made?
Dermatologists can usually diagnosis rosacea based
on an interview and by examining your skin. There are different
forms of rosacea which look different and are often treated differently.
What rosacea treatment options are available?
Because rosacea is a term that covers a range of
symptoms, treatment options are quite extensive. You and your physician
can find the right treatment/s for you.
Creams (topical therapies):
What over the counter treatments are available?
Sun clearly aggravates rosacea and therefore, broad-spectrum
(UVA/B) sunscreen is recommended. Sunscreens are included in some
of the prescription medications discussed below. Cosmetic cover-ups
with a green tint can cover the redness that is the hallmark of
rosacea.
What are the risks?
Unfortunately, sunscreens can be irritating, especially
in patients with rosacea. Sunscreens combined with certain moisturizers
that contain silicones can counter irritation. Rosacea patients
should avoid irritating chemicals in cosmetics such as soaps, astringents,
toners, menthols, and camphors.
What prescription creams are available?
Three topical medications are FDA approved for
the treatment of rosacea and are available in a wide number of commercially
available formulations: metronidazole, sodium sulfacetamide/sulfur,
and azelaic acid. Several other medications have been successfully
used to treat rosacea and include benzoyl peroxide, erythromycin,
clindamycin, tacrolimus, and tretinoin.
What are the risks?
Each medication has its own side effect profile
but generally, the most common side effect is mild irritation. You
and your physician will decide on the right treatment for you.
What pills are used to treat rosacea?
When rosacea is severe and/or does not respond
to topical treatment, dermatologists will often use pills. The mainstays
of therapy are the tetracyclines (including minocycline and doxycycline).
Some patients can achieve a remission after a course of therapy
but most need to stay on the pills to maintain the response. The
pill form of macrolides (erythromycin, azithromycin) and metronidazole
have also been shown to effectively treat rosacea. The vitamin A
derivative, isotretinoin (also known as Accutane) may be effective
for rosacea but is less commonly used.
What are the risks?
Each pill has its own set of side effects. The
antibiotics are usually well tolerated but run the risk of antibiotic
resistance. Isotretinoin has a long list of side effects, most of
which are reversible once it is stopped. Only you and your physician
can decide which treatment is right for you.
Laser Therapy
• What is it?
Most of the so called “vascular” lasers
used today are called “pulsed dye lasers” and specifically
target the blood cells in dilated vessels. The blood cells in the
vessel absorb the energy from the laser, which selectively destroys
the blood vessel. Lasers are quite effective, especially for conditions
such as rosacea. Usually one to three treatments are required, 4-8
weeks apart.
• What are the risks?
Some of the lasers cause moderate pain during the
procedure but minimal recovery is needed after treatment. The most
common side effect- darkening of the treated area- occurs in less
than 10% of patients and fades gradually. Cost ranges from $200
to $500 per treatment, depending on the size of the area treated.
The risks and benefits of laser therapy need to be discussed in
detail with your physician.
• What is it?
IPL is one of the newer forms of facial rejuvenation.
Unlike lasers, which use intense, focused light, IPL is intense
broadband light. Although IPL delivers energy to both the superficial
and deep layers of the skin, the epidermis is spared from damage.
Thus, there is virtually no recovery time. In the studies that have
been performed so far, IPL can smooth the skin and fade age spots,
freckles, melasma, and dilated blood vessels seen in rosacea. Improvements
usually last for about a year with good sun protection.
• What are the risks?
IPL is safer than laser therapy because IPL does
not damage the epidermis. There may be some pain during the procedure
but no recovery time. Unlike laser therapy, however, you may need
multiple treatments (average is 4-6, at three weeks intervals) to
get the full benefit. The cost is variable, but is usually more
expensive than peels and less expensive than lasers (300-600 dollars
per treatment). The risks and benefits of IPL therapy need to be
discussed in detail with your physician.
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