Rosacea and flushing treatments

Rosacea is a chronic disorder of the skin and may maifest in various forms such as acne- like lesions in addition to flushing, persistent redness,blushing and prominent facial capillaries. Rosacea usually affects the cheeks, chin and nose area and is often characterized by episodes of flare ups and remissions.

Unlike acne, rosacea is usually seen after teenage years- usually in the late 20s thru to 40s.  It is more common in patients with fair skin type ( especially of Celtic and Anglo-Saxian descent). Topical steroid use (such as Elocon ) may also predispose to rosacea.

Many factors play a role in the cause of rosacea, most importantly is a genetic predisposition. Rosacea may flare with certain factors such as UV exposure, hot foods, spices, alcohol (especially red wine), as well as incorrect skin care products. Stress and anxiety will also flare up rosacea in most patients.

For an over view of trigger factors implicated in rosacea, click here.

General skin care and avoidance of trigger factors - The foundation of rosacea management is identification and avoidance of triggers. Patients will have individual trigger factors unique to their disorder. Common triggers include UV radiation, alcohol, hot drinks, spicy foods, stress and anxiety.

Incorrect skin care is NOT a cause of rosacea, however the use of irritaiting creams may flare up the condition.  Cleansers should be gentle and non- abrasive, toners should NOT be used. Anti acne creams that contain Vitamin A  and Benzoyl Peroxide should be avoided, as they may cause skin irritation. We recommend cetaphil or QV Gentle Wash as a facial cleanser.

Non irritating sunscreen should be worn on a daily basis- physical blockers such as titanium dioxide or zinc oxide are recommended.

Mineral make up may also assist in reducing the severity of rosacea.

For more information on Skin Care and Cosmetics in rosacea patients, click here.

Creams

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Prescription creams used for the treatment of rosacea include Erythomycin, Rozex (metronidazole gel), and Azelaic acid.  Creams may decrease inflammation and reduce flare ups of rosacea, however they are of limited value in treating flushing or redness seen in this condition.

Washes

In certain subtypes of rosacea, your dermatologist may elect to prescribe a compounded solution of Sulfur as a daily wash. This compounded solution may act as an anti-inflammatory soothing wash.

Tablets

Tablets, including antibiotics, function as anti-inflammatory agents and are best suited for papular-pustular rosacea (acne like rosacea.) They are of limited value in treating redness, flushing and blushing of this disease.  Antibiotics are prescribed over a period of several weeks to months.

In severe cases of rosacea not responding to oral antibiotics, isotretinoin (Roaccutane) may considered.

Laser Treatment /IPL (intense pulse light) treatments

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The redness, flushing and blushing commonly experienced by rosacea patients maybe treated with vascular laser andBBL. Treatment is aimed at decreasing the size and amount of superfical blood vessels and capillaries seen in rosacea. Visible broken capillaries can be treated with sclerotherapy or vascular lasers, whilst the background redness can be reduced with a series of BBL treatments.

IPL/ BBLTreatments take 20-30 minutes to perform. Redness maybe seen after each treatment, but this usually settles down within a  few hours, swelling is occasionally seen, and may take a day or so to settle. Patients will often note a 20-30% improvement with each treatment. Several BBL/ IPL treatments are recommended for optimal results.

More on  IPL/BBL treatments

More on Vascular laser

More on sclerotherapy

Unlike acne, the course of rosacea is often chronic- the aim of treatments is to enable the patient to gain insight into their condition, address individual flare factors, and reduce flare ups of their disorder. The aim is to place rosacea into ‘remission’, though recurrencance are commonly seen.

If rosacea is untreated, the resulting inflammation may damage the lymphatic vessels in the skin, resulting in permanent thickening of the skin. ‘Phyma’

BBL/ IPL treatment:  $370

Vascular laser- Clear Scan – V beam

A Medicare rebate may apply for the treatment of capillaries by V Beam or Clearscan laser.There are certain criteria that must be met to qualify for a  rebate e.g facial/neck capillaries must be visible from 3 metres. An example is for the treatment of broken capillaries/redness on the face; for those qualifying, there is a $117.05 rebate from Medicare for each treatment. Upto 6 treatments can be claimed in one year. Also treatments that attract a Medicare rebate also count towards the Medicare Safety Net. Once the threshold on the Medicare Safety Net is passed, 80% of the out-of-pocket fee is refunded to you by Medicare. Your Dermatologist will inform you whether you qualify for any rebate prior to treatments.

Rhinophyma is a form of rosacea characterised by excessive tissue on the nose. It is usually seen in men between the ages of 40-60 and can be socially and emotionally debilitating. Treatments are very effective in reducing the deformity. Our laser specialists use a combination of surgery and CO2 laser in the one procedure to offer excellent results in almost all cases of rhinophyma.

The causes of rhinophyma

Rhinophyma is a common condition seen in men and a form of rosacea. It is caused by recurrent swelling of the nose characterised by pimples, swelling, flushing, blushing and visible blood vessels. Over time the tissue of the nose thickens, leading to enlarged pores and deformity of the nasal areas. Patients who suffer from rhinophyma may also have signs of rosacea- namely flushing, blushing, and sensitivity to sunlight, UV exposure and hot spicy foods. Rhinophyma is often associated with an unfortunate condition termed ‘alcoholic’s nose’. Alcohol can worsen rosacea but is NOT the cause of rhinophyma.

Treatments for Rhinophyma

Unfortunately rhinophyma does not respond well to creams or tablets used for the treatment of rosacea, however it can be markedly improved with a combination of surgery and CO2 laser. Once treated, rhinophyma rarely recurs.

What is involved in laser surgery for Rhinophyma

Surgery and laser for rhinophyma is highly successful if it is performed to the highest standards. This procedure is conducted in a laser surgical suite under partial sedation. We use a special injection technique to numb the nose, called a nasal block. Patients are awake throughout the surgery, however we give a mild sedation for additional comfort. Dr Lim will then reshape your nose with a combination of surgery and CO2 laser. Rhinophyma surgery takes between 30-60 minutes, depending on the level of nasal deformity and excess tissue.

The recovery process

Recovery following rhinophyma laser surgery takes 7-14 days, depending on the extent of rhinophyma correction and pre-existing nose deformity. Following surgery, we prescribe a special healing balm, as well as a course of antibiotics for a period of 4 weeks. Even though the skin on the nose completely heals over a period of a week or two, the antibiotics can help reduce pimples that may occur immediately following laser surgery. Patients are seen for post-laser checks following rhinophyma surgery.

• More on rosacea rhinophyma treatments

Specialists at Westside are involved in community rosacea forums. These forums provide a wealth of information for rosacea patients, including tips from other rosacea sufferers.

Westside Dermatology supports the Australian Rosacea Support Group

• More on the Rosacea Support Community

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Dr Davin S. Lim. Consultant Dermatologist

Rosacea is a common disorder often misdiagnosed as ‘adult acne’. To date no cure has been found, however with  correct skin care, and patient insight, this condition can be controlled in the vast majority of patients. Identifying and correction of flare factors is paramount in the management of rosacea. The use of non irritating skin care, and avoidance of UV light can not be overstressed. IPL/BBL and laser can reduce the redness and flushing of this condition in the majority of patients. Remission varies from 9 months to several years.

For more information on rosacea visit the Rosacea Society forum.

"My rosacea is under much better control thanks to the team at Westside Dermatology. Flare ups are less, and the redness decreased after only 2 laser sessions."   Garry I.  Norman Park

"The facial veins have virtually gone after 2 sessions of V Beam laser. Very happy with the outcome."  Anne R. Toowong

"Laser only is one small aspect of rosacea management, understanding fare factors, and the daily use of a simple cleanser- sunscreen- moisturiser is the foundation of control."  Dr Davin S. Lim, Dermatologist.