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Rosacea treatment

Rosacea is a chronic skin disorder of the face in middle-aged and older people (usually between 30 and 60), which affects especially those with fair skin, blue eyes and of Celtic origin (Caucasians). Rosacea (roz-ay-sha) is a very common red, acne-like benign skin condition which includes red or pink patches, visible tiny broken blood vessels, small red bumps, red cysts, and pink or irritated eyes. Common locations for rosacea are mainly the forehead, the chin, and the lower half of the nose. Sometimes rosacea can occur on the neck and upper chest. About 50 percent of the time it involves the eye area as well. Rosacea treatment can be complicated.

Approximately 45 million people worldwide are affected by rosacea. Rosacea is not considered contagious or infectious. There is no evidence that rosacea can be spread by contact with the skin, sharing towels, or through inhalation.

Some people confuse rosacea with acne. Rosacea is basically different than acne, although the two can coexist. It is also sometimes called “adult acne.”

You can discover everything about Rosacea causes, symptoms and prevention measures on previous page.

Rosacea treatment

Rosacea treatment

Rosacea is a chronic skin disorder of the face in middle-aged and older people (usually between 30 and 60), which affects especially those with fair skin, blue eyes and of Celtic origin (Caucasians). Rosacea (roz-ay-sha) is a very common red, acne-like benign skin condition which includes red or pink patches, visible tiny broken blood vessels, small red bumps, red cysts, and pink or irritated eyes. Common locations for rosacea are mainly the forehead, the chin, and the lower half of the nose. Sometimes rosacea can occur on the neck and upper chest. About 50 percent of the time it involves the eye area as well.

Approximately 45 million people worldwide are affected by rosacea. Rosacea is not considered contagious or infectious. There is no evidence that rosacea can be spread by contact with the skin, sharing towels, or through inhalation.

Some people confuse rosacea with acne. Rosacea is basically different than acne, although the two can coexist. It is also sometimes called “adult acne.”

Unfortunately presently rosacea is not considered a curable condition. At the same time it can usually be controlled with proper, regular and effective treatments. Some patients experience long-lasting results and may have remissions (disease-free period of time) for months to years.

There are many treatment choices for rosacea and treatment choice depends on the severity and extent of symptoms. Available medical treatments include antibacterial washes, topical creams, antibiotic pills, lasers, pulsed-light therapies, photodynamic therapy, and isotretinoin.

Rosacea treatment methods

Topical creams
Topical (skin) medications applied by the patient once or twice a day. Topical antibiotic medication such as metronidazole applied one to two times a day after cleansing may significantly improve rosacea. Azelaic acid (Finacea gel 15%) is another effective treatment for patients with rosacea. Both metronidazole and azelaic acid work to control the redness and bumps in rosacea.
Metronidazole cream or gel can be used intermittently or long term on its own for mild cases and in combination with oral antibiotics for more severe cases.

Oral antibiotics
Tetracycline, doxycycline, minocycline, and amoxicillin are among the many oral antibiotics commonly prescribed and they actually help reduce inflammation and pimples in rosacea. They reduce the redness, papules, pustules and eye symptoms of rosacea. The antibiotics are usually prescribed for 6 to 12 weeks, the duration and dose depending on the severity of the rosacea. Further courses are often needed from time to time as the antibiotics don’t cure the disorder. Sometimes other oral antibiotics such as cotrimoxasole or metronidazole are prescribed for resistant cases. A newer low-dose doxycycline preparation called Oracea (40 mg once a day) has been used in rosacea. The dose may be initially high and then be tapered to maintenance levels.

Topical steroids
Short-term topical cortisone (steroid) preparations of minimal strength may in occasional cases also be used to reduce local inflammation. Some mild steroids include desonide lotion or hydrocortisone 0.5% or 1% cream applied sparingly once or twice a day just to the irritated areas. There is a risk of causing a rosacea flare by using topical steroids. Prolonged use of topical steroids on the face can also cause irritated skin around the mouth (perioral dermatitis).

Isotretinoin (Accutane)
When antibiotics are ineffective or poorly tolerated, oral isotretinoin may be very effective. Although isotretinoin is often curative for acne, it may be needed in low dose long term for rosacea, sometimes for years. More often it is used as a daily capsule for four to six months. Close physician monitoring and blood testing are necessary while on isotretinoin. Generally, at least two forms of birth control are required for females using this medication as pregnancy is absolutely contraindicated while on isotretinoin. This treatment has important side effects and is not suitable for everyone.

Cleansers
Skin cleansers may also provide symptom relief and control. Harsh soaps and lotions should be avoided, whereas simple and pure products such as Cetaphil or Purpose gentle skin cleanser may be less irritating. Patients should avoid excessive rubbing or scrubbing the face. Other recommended cleansers are sulfa-based washes (for example, Rosanil) and benzoyl peroxide washes (for example, Clearasil).

Medications to reduce flushing
Nutraceuticals targeting flushing, facial redness and inflammation may be beneficial.
Certain medications such as clonidine (an alpha2-receptor agonist) may reduce the vascular dilatation (widening of blood vessels) that results in flushing. Side effects are usually mild but may include low blood pressure, gastrointestinal symptoms, dry eyes, blurred vision and low heart rate.

Anti-inflammatory agents
Oral non-steroidal anti-inflammatory agents such as diclofenac may reduce the discomfort and redness of affected skin. Although these are uncommon, serious potential adverse effects include peptic ulceration, renal toxicity and hypersensitivity reactions.
Calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream are reported to help some patients with rosacea.

Different approaches
Some doctors may also prescribe tretinoin (Retin-A), tazarotene (Tazorac), or adapalene (Differin) which are prescription medications also used for acne. Rarely, permethrin (Elimite) cream is prescribed for rosacea cases that are associated with skin mites. Permethrin is also used for the body mites that cause scabies.

Laser and intense pulsed light or Vascular laser
Persistent telangiectasia can be successfully improved with vascular laser or intense pulsed light treatment. Where these are unavailable, cautery, diathermy or sclerotherapy (strong saline injections) may be helpful.
Many patients are now turning to laser and intense light treatments to treat the continual redness and noticeable blood vessels on the face, neck, and chest. Often considered a safe alternative, laser and intense pulse-light therapy may help to visibly improve the skin and complexion.
Laser treatment may cause some discomfort. While most patients are able to endure the procedure, ice packs and topical anesthetic cream can help alleviate the discomfort. Multiple treatments are typically necessary, and the procedure is not covered by most insurances. Treatments are recommended in three- to six-week intervals; during this time, sun avoidance is necessary. Risk, benefits, and alternatives should be reviewed with your doctor prior to treatment. Laser treatments may be combined with photodynamic therapy (light-activated chemical using Levulan) for more noticeable results.

Photodynamic therapy
Photodynamic therapy (PDT) is one of the newly available treatments. PDT uses a topical photosensitizer liquid that is applied to the skin and a light to activate the sensitizer. Levulan (aminolevulonic acid) and blue light, commonly used to treat pre-cancers (actinic keratosis) and acne vulgaris, can also be used to treat some rosacea patients. PDT is thought to work at reducing the inflammation, pimples, and also improving the skin texture. The treatment takes 1-1.5 hours to complete. Strict sun avoidance for approximately 1-3 days is required after the treatment. Mild discomfort during the treatment and a mild to moderate sunburn appearance after the treatment is common. Some patients have experienced remissions of several months to years from these types of treatments. Other patients may not notice significant improvement.

Glycolic peels
Glycolic-acid peels may additionally help improve and control rosacea in some people. The chemical peels can professionally be applied for approximately two to five minutes every two to four weeks. Mild stinging, itching, or burning may occur and some patients experience peeling for several days after the peel. Any peel can irritate very sensitive skin and cause flares for some people. Peels should be used with caution in rosacea as not everyone is able to tolerate these treatments.

Surgery
Rhinophyma can be treated successfully by a dermatological or plastic surgeon by reshaping the nose surgically or with carbon dioxide laser.

In many cases rosacea does not need any treatment if the person is not very sensitive and not bothered by the condition. Resistant and/or severe cases could require the combination approach – using several treatments at the same time. The combination approach could include home care of washing with a prescription sulfa wash twice a day, applying an antibacterial cream morning and night, and taking an oral antibiotic for flares. A series of in-office laser, intense pulsed light, or photodynamic therapies may also be used in combination with the home regimen. It is advisable to seek a physician’s care for the proper evaluation and treatment of rosacea.

Some patients elect combination therapies and notice an improvement by alternating metronidazole and azelaic acid: using one in the morning and one at night. Sodium sulfacetamide (Klaron lotion) is also known to help reduce inflammation. Other topical antibiotic creams include erythromycin and clindamycin (Cleocin).


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