Rosacea is a skin disease is caused by inappropriate growth and dilation of the superficial blood vessels of the skin, typically on the nose and cheeks, and leads to persistent redness of the skin and a tendency to flush and blush.
Different types of rosacea
The diagnosis of rosacea encompasses a variety of clinical presentations and can typically be broken down into 4 major subtypes.
Inflammatory rosacea typically presents as adult acne, but without the plugged pores that characterize the teenage variety.
In erythematotelangiectatic rosacea, redness dominates the clinical picture and can take the form of visible, dilated blood vessels on the surface of the skin or a tendency towards flushing and blushing.
Phymatous rosacea involves overactivity and enlargement of oil glands the face and typically presents as irregular bumps on the nose.
Finally, ocular rosacea presents with dry, red, and scratchy eyelids. Each type of rosacea has its own unique treatments, and new therapies continue to become available.
Treatment options for rosacea
The mainstay of inflammatory rosacea treatments are antibiotics. Topical antibiotics, such as metronidazole, are a longstanding treatment and often considered first line for inflammatory rosacea treatment. Oral antibiotics in the tetracycline family are some of the most potent treatments for inflammatory rosacea. The development of sub-antimicrobial dosing has revolutionized systemic rosacea treatment by dosing doxycycline at a level that maintains an anti-inflammatory affect, but does not directly kill bacteria, thereby eliminating antibiotic related side effects including stomach upset, sun sensitivity, yeast infections, and development of resistance.
The pending approval of a new formulation of low dose minocycline, Emrosi, may provide an even more effective and safe oral option. Other topical rosacea treatments include azelaic acid, ivermectin, minocycline foam, and tolerable formulations of benzoyl peroxide.
Treatments for erythematotelangiectatic rosacea are much more limited. The topical creams Mirvaso and Rhofade act as vasoconstrictors and limit the ability of flushing to take place when that is the primary presentation of rosacea. Otherwise, light-based procedures are the mainstay of treatment.
Lasers, such as the pulsed dye laser, are the traditional treatment of choice to remove blood vessels from the skin, but they can be expensive and cause a lot of swelling and bruising during recovery. Northeast Dermatology now offers HEROic treatments with the Sciton BBL and it has quickly become our favorite treatment for redness of the face. We think the BBL offers the best combination of value, effectiveness, and limited downtime. Consultations to learn more about the procedure are free if you believe you would benefit.
Phymatous rosacea is typically an inherited trait that develops in middle age. The overactive oil glands can be somewhat improved with the application of topical retinoids. Removal with targeted electrocautery is the mainstay of treatment of the bumps under the skin and can typically be performed as a quick, in-office procedure.
Ocular rosacea is often diagnosed with the assistance of an ophthalmologist. Artificial tears can alleviate some of the symptoms but the condition is consistently controlled mainly with the use of low dose, tetracycline antibiotics, similar to the strategy used for inflammatory rosacea.
If you suffer from any of the subtypes of rosacea, the specialists at Northeast Dermatology can help you with all of the latest and most effective treatments. Schedule your appointment today!
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