Rosacea

Jeffrey Sassmannshausen, MD

I have recently received several requests to address the topic of rosacea. Rosacea is often looked at as a cosmetic problem, especially by insurance companies. This is an interesting topic as rosacea is a multifaceted disease that can affect each individual differently. I am going to discuss the wide range of symptoms of rosacea and discuss the treatments available.

When I think of rosacea, I picture a patient with a bright red face and pustules. The red face which flushes easily has been termed erythematotelangiectatic form of rosacea. This is the technical term for redness that can be quite severe, being stimulated by alcohol, spicy or hot foods, exertion or stress. Over time, the blood vessels will dilate leaving many persistent telangiectasias (spider veins). Once the vessels form, there is no topical treatment that will make them go away. In some people, the only symptom of rosacea is a red face.

Often times, patients will also have many pustules and red papules. This type of rosacea is called papulopustular rosacea and can be seen in any age group. These pimples are very different from what one sees in a teenager. While they can occur anywhere, they are usually concentrated over the nose and cheeks. What tends to not be present are blackheads which are seen in normal acne.

It is not uncommon for the skin in a patient with rosacea to have increased or enlarged oil glands called sebaceous hyperplasia. This glandular enlargement and oily skin seem to progress unless the rosacea is treated. Left untreated, the glands can develop into rhinophyma (the bulbous nose like W. C. Fields). This phymatous rosacea can be quite severe requiring surgery to correct the rhinophyma.

You may not know that rosacea can affect the eyes. Ocular rosacea presents as a chronic dry, red, sandy, irritated eye. Frequently, the eye may have recurring whiteheads along the eyelashes or many large and painful styes. In severe cases, the ocular rosacea can cause scarring which could lead to blindness.

Rosacea fulminans is a rare but very aggressive form of rosacea. This can present quickly and involves numerous large, deep, painful cysts and significant swelling. Often there is scarring present.

TREATMENT

Most rosacea can be controlled nicely with topical medication. There are four ingredients that are used. The most commonly prescribed is metronidazole. The others are azelaic acid, ivermectin, and sodium sulfacetamide/sulfur. Oral antibiotics can be used for more stubborn disease. The antibiotic is not killing bacteria; it is used to decrease the inflammation which is the underlying driving factor in rosacea.

If you only have a red flushing that is present or that remains, Rhofade and Mirvaso can be used. These prescription topical gels cause the microscopic blood vessels to constrict for 8-10 hours, minimizing the flush. They are very safe and can be very effective. There are several cosmeceutical products that can significantly help the redness as well. Using an excellent moisturizer for the sensitive rosacea-prone skin can help calm and soothe the redness. In addition, All Calm Clinical Redness Corrector SPF 50 by Colorescience is a 3-in-1 formula that instantly neutralizes the appearance of redness, helps soothe and calm sensitive skin, and provides SPF 50.

I get annoyed when someone comes to me after being treated for their rosacea with a laser but not given any medication. Lasers do not treat rosacea itself but treats the results of recurring flushing. You should be on a true treatment before using the laser. There are many laser systems available that can remove the vessels. If you were to have the vessels treated, the key is finding someone who has used lasers enough to understand how to use them. Most physicians in the area really have very little experience. I recommend someone with years of experience in treating the skin.

In the end, rosacea is a complex disease with many different presentations. Choosing the best therapy is determined by what symptoms are present. Controlling the rosacea limits the growth in the size or numbers of telangiectasias. Seeing a dermatologist early is the best approach. To start on your journey to a clearer complexion, stop into Windy Ridge Skin Care Centre and ask one of my skin care specialists for daily skin care recommendations.