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Thoughts On Rosacea

Posted by Will Richardson on
Rosacea is a condition that causes flushing and redness in a characteristic distribution affecting the central face (cheeks, nose, chin and forehead), followed by the skin behind the ears and chest, the latter two of which are often forgotten about.  The disease is made worse by any condition that would increase blood flow to the vessels of the face including hot liquids, red wine and alcoholic beverages and spicy foods.  


There are four stages.  The first is the flushing, followed by development of acne-like lesions in the aforementioned distribution.  The third stage ensues with development of phymatous changes, or hypertrophy of sebaceous glands and soft tissue of the nose, ears, chin and forehead.  The final stage is development of ocular rosacea often manifested as redness of the sclera and sensation of sand being in the eye. 

It is more often than not the case that individuals present with concerns for redness at stage one with the embarrassment of facial flushing.  Occasionally the patients present at the pustular, or acne-like stage, desiring management.

The most important treatment is sunscreen as there is tons of data that demonstrate UVA worsens rosacea.  For this purpose one has to look beyond just the SPF on the bottle as that is a reflection of UVB protection.  A UVA addictive must be sought out such as zinc oxide, titatanium dioxide, which allow for protection against this most impactful type of sunlight.  

Second line therapy includes oral antibiotics, tetracycline, doxycycline, minocycline, and topical agents such as azaleic acid or metronidazole. 

Laser surgery is a more definitive resource to remove facial redness dramatically and rapidly with resultant prevention of progression to stage 3 or stage 4.  There have been discussions at national meetings that simply by treating the skin with laser therapy you can get an improvement in ocular rosacea.    

Lastly surgical reduction of enlargemed hypertrophic tissue is a way to improve cosmesis for these patients affected with enlarged nose, ears, chins, or foreheads.  

The effects of sunscreen are immediate in preventing progression of the disease.  

Oral antibiotics combined along with topical agents will require up to 3 months of therapy. 

Laser therapy can improve the condition substantially in as little as three to four weeks.  

Any surgical therapy otherwise is fairly immediate

It is very likely that a patient will respond over time with proper therapies noted above and proper dietary elimination. 

Depending on the treatment.  For example, sunscreen use currently has no substantiated side effects in medical literature.  Oral antibiotics can cause heartburn, diarrhea and in some cases headache and photosensitivity.  Topical therapy may cause irritation.  

Do not be discouraged if your choice is medical therapy and you don’t clear in month 1.  Use sunscreen that is labeled as broad spectrum.  Give laser therapy a lot of consideration as it will give you the best chance for normal radiant skin. 

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