Tag Archive for: Rosacea

Shining a Light on Rosacea

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By Laura Monaghan, PA-C

April is Rosacea Awareness Month, dedicated to raising awareness about this common condition affecting around 16 million Americans. What exactly is rosacea, and what are its implications?

Rosacea is a chronic inflammatory disorder that manifests as facial redness, flushing, acne-like bumps, skin thickening (rhinophyma), and eye redness or irritation. Many people experience facial sensitivity, dryness, and a burning feeling in the skin. Eye involvement can include light sensitivity, a foreign body sensation, and crust on the base of the lashes. A patient may have a combination of symptoms and these can vary over time.

Triggers vary and include spicy foods, alcohol, extreme temperatures, sun and wind exposure, exercise, emotional stress, and certain skincare and makeup products.1 It typically manifests between ages 30-50 and is more common in light-skinned individuals but has been diagnosed in Asians, Latin Americans, African Americans, and Africans.2 The central face is usually involved with men more susceptible to skin thickening. Early signs are often overlooked, delaying treatment, which can lead to worsening severity over time. Awareness is vital for timely detection and management.

Rosacea Myths

While rosacea does have many appearances, there are also many misconceptions to clarify:

  • Rosacea is NOT due to a lack of hygiene. In fact, heavy scrubbing and exfoliants can further irritate rosacea-prone skin and cause a flare.3
  • Rosacea is NOT infectious, despite the implication of Demodex mites. All humans have Demodex mites on their facial skin. Studies show that patients with rosacea tend to carry more Demodex, but there is no evidence that they are a direct cause of the condition.
  • Rosacea does NOT mean that a person is a heavy drinker. While alcohol can cause a temporary increase in symptoms, it is not a sole cause of the condition. 3
  • A diagnosis of rosacea does NOT mean that a patient is destined for thick, red, and bumpy skin on the nose (rhinophyma). This develops in a small subset of patients with severe untreated rosacea.

Nearly 90% of rosacea patients surveyed by the National Rosacea Society report that this condition has lowered their self-esteem. 41% have even canceled or rescheduled social engagements due to a flare. On the contrary, over 70% report that medical treatment has improved their emotional and social well-being. 3 So, what does treatment entail?

Treatments for Rosacea

A simple place to start is with sun protection and moisturizer as ultraviolet (UV) rays and disruption of the skin barrier are known triggers. Proper sun protection entails using a broad-spectrum SPF 30+ sunscreen and reapplying at least every two hours. Mineral sunscreens that contain zinc oxide or titanium dioxide are preferred because they act as physical blocks. This may help reduce the heat that exacerbates rosacea better than chemical sunscreens.

Gentle cleansers, fragrance-free facial moisturizers that contain niacinamide, and avoidance of irritants such as topical alcohol, witch hazel, and exfoliants can help maintain and repair the skin barrier.4 Some other common treatments include antimicrobial and antifungal agents such as sulfur products, topical ivermectin, topical azelaic acid, topical metronidazole, and oral doxycycline. Other agents including oxymetazoline, brimonidine, and oral beta blockers constrict blood vessels to improve redness.

For severe cases, isotretinoin, or Accutane, or another oral acne medication may also be used. Lasers such as the pulsed-dye laser target redness and dilated blood vessels, providing a longer-term solution. Lasers such as the CO2 and erbium YAG lasers have a role in correcting rhinophyma.5

New Rosacea Treatment Options

There are also several new and exciting rosacea treatments currently in development. First is a series of small injections of Botox® spaced evenly across the face. Preliminary studies show benefit not only in redness and flushing but also in acneiform bumps. Second is oral paroxetine, a selective serotonin reuptake inhibitor typically prescribed as an antidepressant. Evidence shows that serotonin can regulate blood vessel dilation and constriction. Finally, a topical low-molecular-weight heparin sulfate analog (blood thinner) has shown efficacy in reducing inflammation associated with rosacea. These developments are promising for the future of rosacea treatment.6 

If you think you may have rosacea, schedule an appointment for further evaluation. Early treatment is key for preventing progression.

 

 

 

 

Sources

  1. Mayo Foundation for Medical Education and Research. (2023, October 17). Rosacea: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815
  2. Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, Thiboutot D. (2017, January). Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. https://www.jaad.org/article/S0190-9622(17)32297-1/fulltext
  3. Tips for taking action during Rosacea Awareness Month. Rosacea.org. (2022, March 7). https://www.rosacea.org/blog/2022/march/tips-for-taking-action-during-rosacea-awareness-month
  4. Winter woes – tips for skin barrier maintenance. Rosacea.org. (2023, January 11). https://www.rosacea.org/blog/2023/january/winter-woes-tips-for-skin-barrier-maintenance-rosacea
  5. Mayo Foundation for Medical Education and Research. (2023, October 17). Rosacea: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/diagnosis-treatment/drc-20353820
  6. McNamara, D. (2024, March). Rosacea: a neurotoxin, an antidepressant, and more emerging options for treatment. Dermatology News, pp. 1–32.

How Dermatologists Use Lasers and Other Light-Based Devices

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In the half century since Dr. Leon Goldman pioneered the medical application of lasers, they have become integral to state-of-the- art dermatology practices. So how do dermatologists use lasers and other light-based devices?

Uses for Laser, Light and Energy-based Devices

Remove unwanted hair

Lasers remove unwanted hair from the face and body by targeting the pigment of the hair and damaging its follicle so that hair growth is slowed. In order for lasers to be effective, the hair must be treated while in its “active growth” phase. This is why multiple (usually six to eight) treatments, spaced four weeks apart on the face, and as much as eight weeks apart on the body, are needed to achieve good results. The same lasers are also effective for excessive sweating or hyperhidrosis. Note: Only specific lasers are appropriate for darker skin types, and those with tanned skin should avoid the treatment.

Do away with those age spots

Sun damage and aging can result in unwanted brown spots, called lentigines, on sun-exposed areas such as the face, chest and hands. Those spots can successfully be treated with Q-switched lasers and IPL (Intense Pulsed Light) devices. Several treatments may be required to achieve optimal results.

Treat redness and broken blood vessels

Lasers are effective at treating skin redness from conditions such as rosacea as well as benign vascular growths such as angiomas and broken blood vessels that can occur from sun damage. The treatment works because lasers at certain wavelengths can target hemoglobin that is found in blood. Typically one to a few treatments may be needed for optimal results. It is important to use a broad-spectrum sunscreen after the treatment.

Banish those breakouts

Lasers and light-based devices can successfully treat mild to moderate acne. While conventional methods to get rid of acne include topical and oral medications, such as antibiotics and retinoids, the use of photodynamic therapy can be effective in achieving long-lasting clear skin. Photodynamic therapy combines the use of a photosensitizing chemical that is absorbed both by the oil glands and the bacteria that produce acne – followed by a light source or laser to activate the chemical. This results in shrinkage of the oil glands and killing of the bacteria.

Refresh and rejuvenate

A newer generation of devices today allows for skin resurfacing that removes the top layer of skin to eliminate signs of aging and photodamage such as fine lines, wrinkles, crepiness and brown spots as well as reducing enlarged pores – all with minimal downtime.

Soften the look of scars

Lasers can improve the appearance of scars – whether they were caused by acne, trauma or surgery. Some devices – like the pulsed dye laser – can help reduce the redness associated with scars. Fractional resurfacing lasers can successfully improve a scar’s texture and tone. Depending on which device is used, there may be a period of downtime following the treatment and a need for several treatments.

Take care of that ‘turkey neck’

With age comes a loss in collagen, which can result in loose skin on the neck and under the chin – affectionately known as “turkey neck.” Fortunately, there are non-invasive technologies that utilize ultrasound and radiofrequency to stimulate collagen production – resulting in skin tightening and lifting. These treatments also can be used for wrinkles on the décolletage, that crepe-paper look on the upper chest.

Rethink the ink

Fortunately there are options for those 20 percent of people who experience tattoo regret. Q-switched lasers have been used for decades to heat up and destroy the tattoo ink particles, usually over multiple treatments. Newer technology using ultra-short bursts of energy can achieve the same results in fewer treatments.

If you think one of these treatments could be right for you, contact us to schedule a consultation. Located in Chevy Chase, MD, our dermatology office serves the greater Washington D.C. area.

Why Rosy Cheeks are Not Always a Good Thing

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Rosy cheeks are seen as a sign of a good thing when considering a beautiful blush, or a good workout.

Permanent redness, however, is evidence a of chronic skin disorder called rosacea.  

Rosacea is very common and yet many people don’t know they have it.  Worst of all it can spread if left untreated — from the nose and cheeks to the ears, eyes, forehead and chin — even to the shoulders and back. It can be disfiguring when accompanied by pimples and thickened skin.

Rosacea is divided by dermatologists into four Subtypes:

Subtype 1:  FACIAL REDNESS – persistent flushing and visible blood vessels.

Subtype 2:  BUMPS AND PIMPLES – often seen with facial redness.

Subtype 3:  SKIN THICKENING – usually around the nose.

Subtype 4:  EYE IRRITATION – watery or red eyes with swollen, irritated eyelids.

Researchers are still trying to discover what causes rosacea. While there is currently no cure we do know that by treating the dilated blood vessels associated with rosacea it can be effectively managed. Recent advances in technology make this possible.

Treatment

Laser therapy has the unique ability to selectively target and treat these dilated blood vessels without adversely affecting the surrounding tissue. The most effective laser available for rosacea is VBeam Perfecta. A course of three or four treatments, each a month apart, can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

During VBeam Perfecta treatment, the mild discomfort associated with all laser procedures, similar to a snapping rubber band on the skin, is countered by a cooling stream of air directed at the area. This cooling also helps to prevent temporary bruising, an unwanted side effect of earlier laser technology. Light pink patches may appear that last for approximately a day. VBeam Perfecta is so safe and effective that it has been fully approved by the FDA for the treatment of infants.

The aesthetic improvements from laser treatments can be dramatic.

Rosacea Subtype 1 – Facial Redness

A course of three or four treatments scheduled a month apart can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

 

With the availability of VBeam Perfecta there is no longer a need to suffer the psychological side effects, such as depression and low self-esteem, which affect many victims of Rosacea. This advanced laser can also greatly improve many other unsightly conditions including angiomas, port wine stains, stretch marks, stubborn warts, bruises and sun damage on the neck and chest.

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.