Rosacea Treatment Options

What is Rosacea?

A chronic inflammatory skin condition most often characterised by facial flushing. And depending on the severity the condition can resemble acne with erythem, papules and pustules.

Diagnosis is based on it’s appearance and history.

Treatment options depend on severity but will often include topical antibiotic gels and in some cases isotretinoin. Other gentle options are also worth considering including chemical peels and low level laser therapy.

Etiology

The etiology of rosacea is unknown, but some studies suggest:

An bnormal vasomotor control

Impaired facial venous drainage

Increased follicle mites

Increased angiogenesis, ferritin expression, and reactive oxygen species

Dysfunction of antimicrobial peptides

Symptoms

Rosacea is limited to the face and scalp and develops sequentially in 4 stages:

Pre-rosacea

Vascular

Inflammatory

Late

In the pre-rosacea phase, patients describe flushing and blushing, often accompanied by uncomfortable stinging. Common triggers are sun exposure, emotional stress, cold or hot weather, alcohol, spicy foods, exercise, wind, cosmetics, and hot baths or hot drinks. These symptoms persist throughout the other phases of the disorder.

In the vascular phase, patients will develop facial erythema and edema with multiple telangiectases.

An inflammatory phase often follows, in which papules and pustules (leading to the designation of rosacea as adult acne) develop.

In the late phase coarse tissue hyperplasia of the cheeks and nose (rhinophyma) develop caused by tissue inflammation, collagen deposition, and sebaceous gland hyperplasia.

Treatment

Naturally avoiding any known triggers is the first step. It is then worth considering topical or oral antibiotics or topical azelaic acid or ivermectin. LED Light therapy and chemical peels including mandelic and azelaic acid help.

For flushing or persistent erythema, usually topical brimonidine is prescribed.

For more severe and persistent cases, oral isotretinoin is usually an option worth considering.

For rhinophyma, dermabrasion and tissue excision are the usually course of action together with laser treatment.

For telangiectasia, CO2 laser excision is often considered.