Individualized treatment options for rosacea

Many individuals who are struggling with redness, pimples and visible blood vessels on their face may incorrectly diagnose their condition as acne, sunburn or sensitive skin.

However, they probably have rosacea, a skin condition which if not treated early, can continue to flare or begin to worsen. Therefore, it is important to visit a dermatologist who can make the correct diagnosis and recommend treatments and skin care products that will control the rosacea and keep the skin healthy.

Speaking at the 64th Annual Meeting of the American Academy of Dermatology, dermatologist James Q. Del Rosso, D.O., clinical assistant professor in the department of dermatology at the University of Nevada, Las Vegas, spoke about the individualized treatment options that are helping patients with rosacea manage their condition.

"Rosacea can have devastating effects on self-esteem because it is so noticeable on the face," said Dr. Del Rosso. "When it affects teenagers and young adults, it can cause feelings of isolation and self-consciousness. Adults with rosacea often are caught unaware because they assume they would have outgrown skin conditions. But rosacea treatments are more effective than ever, offering a variety of therapies that are having successful results."

Rosacea is a chronic and often progressive skin disease that causes redness and swelling on the face. As many as 14 million Americans have rosacea, most between the ages of 30 and 50. Rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually affect the cheeks, forehead, chin and nose. As the disease progresses, the redness becomes more severe and persistent, and small blood vessels, acne-like pimples and nodules may become visible on the surface of the skin. Rosacea can be exacerbated by exposure to extremes of hot and cold, sunlight, emotional stress, hot beverages, alcohol, spicy foods and certain skin care products.

"Since what triggers rosacea in one patient may not trigger it in another, dermatologists often recommend that patients with rosacea keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors," said Dr. Del Rosso.

Topical treatment options such as metronidazole and azaleic acid can reduce redness, red or pus-filled bumps and other symptoms associated with rosacea. With topical medications, individuals are instructed to be consistent with the application of the product and to be patient, as it may take four to eight weeks to see noticeable improvement.

Oral tetracycline antibiotics, such as doxycycline or minocycline, are the most common oral medications used to treat rosacea. A new form of doxycycline, called anti-inflammatory dose doxycycline, is currently under review by the U.S. Food and Drug Administration (FDA) for the treatment of rosacea. This form of doxycycline reduces inflammation without any "antibiotic effects," such as antibiotic resistance. "Whether or not an oral antibiotic is recommended for treating rosacea depends on how severe the case is," stated Dr. Del Rosso.

Glycolic acid peels often are used in conjunction with antibiotics to hasten the control of rosacea. A series of peels are performed every two-to- four weeks and may be used in combination with low concentration glycolic acid washes and creams. Glycolic acid peels for rosacea are timed and generally take three-to-five minutes. The peeled facial skin will be red for a few hours following the treatment and makeup should be avoided during this time.

While topical or oral therapies do not remove the redness on the face or reduce the appearance of dilated blood vessels associated with rosacea, vascular lasers and intense pulsed light therapy are now being used to treat these symptoms.

Vascular lasers emit specific wavelengths of light targeted for the tiny visible blood vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to collapse. The newest generation of vascular lasers does not produce any bruising, but may cause redness and minimal swelling that lasts approximately 24-to-48 hours.

Intense pulsed light therapy is used to treat the persistent redness caused by rosacea, destroying the dilated blood vessels with multiple wavelengths of light.

Both treatments, laser and intense light, take 15-to-30 minutes and are performed at six-to-12 week intervals. Patients may require several treatments initially, and may return annually for treatment of new blood vessels.

In advanced cases of rosacea, rhinophyma may develop, a condition that occurs when oil glands enlarge on the face and a bulbous, enlarged red nose and swollen cheeks develop. This condition usually occurs in men over 40. The excess tissue can be surgically removed using lasers, dermabrasion or electrosurgery to sculpt the nose back down to a more normal shape and appearance. These procedures may be performed on an outpatient basis using local anesthesia, and healing generally takes seven-to-10 days.

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