Ask Dr. Weiss

Dear Dr. Weiss, my face has a great deal of redness and often appears bumpy, almost like the acne I had as a child. I was told I may have rosacea. Are there any treatments?

Frequent redness, or flushing, of the face is the hallmark of rosacea. Most of the time, the redness is at the center of the face specifically involving the forehead, nose, cheeks and chin. Patients often complain of small red and purple lines, blood vessels that have become larger and are visible just under the skin. Along with the redness, the skin may develop bumps. Sometimes, but not always, the bumps have pus inside, like acne pimples. These bumps may become painful, but are usually asymptomatic.

As the baby boomer generation enters the most susceptible ages, rosacea is becoming increasingly widespread. Now estimated to affect 14 million Americans, rosacea tends to develop between the ages of 30 and 60. It is most common among women, especially during menopause, and people with fair skin. Rosacea is a long-term disease that affects your skin and sometimes your eyes. Although the cause of rosacea is not known, experts believe rosacea is due to a combination of genetic and environmental factors.

In recent surveys by the National Rosacea Society, more than three-quarters of rosacea patients said their condition had lowered their self-confidence and self-esteem, and half reported it had caused them to avoid public contact or cancel social engagements. Nearly 70 percent of rosacea patients with severe symptoms said the disorder had adversely affected their professional interactions, and nearly a third said they had even missed work because of their condition.

According to a study of 1,077 rosacea patients, 87 percent said their rosacea was under control with treatment. Today’s treatments range from topical products and oral medications to treat the papules and pustules, to laser and light therapy for treating visible blood vessels on the face.

The primary topical therapies are antibiotics which exert anti-inflammatory effects. Metronidazole is the primary topical antibiotic prescribed for rosacea along with clindamycin. Azelaic acid, a naturally occurring substance that is present in whole grains and in the skin is frequently used for rosacea in both 15% and 20% concentrations.  In addition, topical non-steroidal immune modulators, like pimecrolimus, can be used to suppress the inflammation.

Because of their anti-inflammatory effects, antibiotics in the tetracycline family are frequently employed to treat rosacea. They are very effective for the lesions (papules and pustules) of rosacea but not the redness. However, because these medicines are antibiotics, there has often been a question of the safety of long term use as well as the impact on the public health. Recently, a doxycycline formulation was introduced that exerts anti-inflammatory activity with no antimicrobial effect.  This avoids the risk of antimicrobial-related effects, including increased risk of resistance and side effects.

Dilated blood vessels are the primary cause of the redness of rosacea. Only laser and light based treatments effectively target the dilated blood vessels. Intense pulsed light emits a broad spectrum of light that reduces redness globally across the face. Vascular lasers, at the 585/595nm and 1064nm wavelength heat up the individual, visible blood vessels, causing them to collapse and to be absorbed by the body. The newer vascular lasers do not cause bruising or scarring, but redness and some swelling may occur for up to 48 hours after treatment.

www.weissskininstitute.com

Stefan C. Weiss, MD, FAAD, is a board-certified dermatologist. For more information, visit www.weissskininstitute.com. Weiss Skin Institute, 9980 Central Park Blvd, North, Suite 124 Boca Raton, FL 33428; 561-372-SKIN .