ROSACEA TREATMENT OPTIONS USING COSMETIC LASERS
Many physicians are now using a combination of topical, systemic and laser treatments with excellent results.
Patients with irreversible fibrotic changes, such as rhinophyma, may have to be treated with surgery/laser therapy.
Many lasers are made to target a certain pigment, for example, hair removal lasers go after the melanin pigment in the hair follicle, lasers that treat vascular problems of the skin go after the pigment in the hemoglobin molecule, etc. From the point of view of a laser, Rosacea is a vascular problem since there is an increase of capillaries and small blood vessels under the skin. Those lasers that target the hemoglobin molecule found in the blood of those small vessels, are ideal in the laser treatment of Rosacea.
Topical therapy options
The efficacy of topical therapy for rosacea is primarily due to reduction in inflammatory lesions (papules, pustules), decreased intensity of redness, a reduction in the number and intensity of flares-ups and decreased intensity of symptoms, which may include stinging, pruritus and burning. Depending on the severity at initial presentation, topical therapy may be combined with systemic antibiotic therapy (e.g., oral tetracycline derivative). Newer therapeutic technologies have opened the way for improved formulations, which have demonstrated favorable skin tolerability and better cosmetic results.
- Topical metronidazole (cream, lotion or gel) in different
concentrations; most common side effect is irritation.
- Sulfacetamide wash or lotion; side effects: less irritating than
metronidazole; contact dermatitis is possible. Also, people
who are allergic to sulfas should not use sulfacetamide.
- Topical retinoic acid: delayed onset of effectiveness, and it also cause dry skin, erythema, burning and stinging.
- Azaleic acid 20% cream applied on the skin once daily.
- Topical vitamin C with its significant antioxidant effects may
affect free-radical production thus playing a role in the inflammatory reaction of rosacea.
Systemic therapy options
- Tetracyline at a dose of 1-1.5 grams per day divided into 2-4 daily doses until lesions clear; then gradually reduce to 250 mg, twice daily.
- Minocycline 100 mg, twice a day until lesions clear, then gradually reduce to 50 mg, twice daily.
- Doxycycline 100 mg twice a day.
- Clarithromycin 250-500 mg twice a day.
- Oral isotretinoin for individuals with severe disease not responding to antibiotics.
Avoid triggers- both exposure and situations that can cause a flare-up of the flushing and skin changes of rosacea.
- Sun exposure: limit your time of exposure to direct sunlight, always apply nonirritating sun block when outdoors and wear wide-brim hats that will also protect the ears.
- Stress: Stress stimulates the sympathetic nervous system. Stimulation of this part of the nervous system normally causes "constriction" (blood vessels become smaller), throughout the body, except in the face, where it induces potent vasodilatation, making the blood vessels larger and causing the flush we all experience, but which is more prominent and longer lasting in patients with Rosacea, for reasons that are not clearly understood. Lack of sleep, anxiety and increases in internal body temperature, all increase the sympathetic nervous system.
- Alcohol: although not a cause of Rosacea, it may aggravate the condition by causing the distention (vasodilatation) of small blood vessels in the face.
- Spicy foods
- Cleansers, lotions, cosmetics: use nonirritating, hypoallergenic, noncomedogenic (substances that do not plug the pores) oil-free products.
- Avoid rubbing, scrubbing or massaging the face; it tends to irritate already reddened skin.
- Avoid applying corticosteroids to skin without health care providerís specific instructions.
- If exercise results in flushing, continue to exercise in a cool, well-ventilated environment.
- Discipline yourself to keep a log or diary of flushing episodes and the factors and conditions under which they occur.