Rosacea is a chronic condition of the skin which affects the face and occasionally the eyes. Other parts of the upper body can be involved, although this is uncommon. The center of the face (nose and cheeks) is the most commonly involved area, followed by the forehead and chin. The appearance of skin with rosacea can vary. It is characterized by redness, pimples, visible veins, and inflammation which can cause thickening of the skin. Most affected skin appears somewhat chronically reddened. This can be severe. Telangiectasias (small, red colored visible blood vessels in the affected area) may appear. Rhinophyma (a swollen, bulbous, rough appearing nose), mainly found in men, is an advanced finding.
Millions of people in the U.S. have rosacea — a disease affecting more women than men and occurring principally between the ages of 30 and 60. It can occur with any skin color, but is more common in lighter-skinned patients.
People with rosacea suffer embarrassment and social problems, due to the appearance of the disease on the face. Many use makeup to try to conceal the problem, but this is not completely effective. Rosacea can cause patients to change their social schedule or avoid situations where the disease will be most apparent, such as being photographed. Heat, exercise, alcohol, or mild trauma to the affected area can cause flare-ups, although this varies from person to person.

Treatment

Rosacea cannot be cured, but it can be managed and controlled successfully. As with any medical problem, minimizing factors which cause exacerbations or worsening of the condition is the most helpful treatment. Keeping a record of flare-ups to determine their cause is necessary. Using a high quality sunscreen and a mild moisturizer can also be useful. If symptoms are not controlled, other measures may be needed.
Antibiotics, both applied to the outside of the skin and taken orally, can be used. These are particularly useful in patients who have pimples associated with the disease. Antibiotics are less successful in treating thickening or chronic redness of the skin. Other topical preparations have been used with somewhat limited success.
One of the most significant advances in the treatment of rosacea is the use of light therapy, such as lasers, to treat the skin. Among the first lasers to be tried for this condition were ablative lasers. These are still used in some severe cases which do not respond to less invasive measures. They are associated with blistering and peeling, which heal but cause a period of “cosmetic disability.” Phototherapy treatments, usually involving blue light and a photosensitizing medication, are also used, again with a period of expected cosmetic disability. Other, newer lasers are effective without the transient appearance problems and pain associated with the ablative lasers.

There are numerous non-ablative lasers available which can be used to treat rosacea. The latest generation of these includes the Quick Switched 1064 nm Neodymium: Yttrium-Aluminum-Garnet laser, more simply known as the Coolglide® Laser by Cutera. This laser treats the vascular component, as well as the glandular component of rosacea, without the peeling, blistering, or pain of an ablative laser. Treatments are performed two to four weeks apart and three to five treatments are required in most cases. The treatments are painless with only a feeling of warmth in the treated area. The patient can return to work or regular activity immediately following the treatments.

Intense Pulsed Light (IPL), a visible light treatment in the 560 nm to 600 nm range, also can be used to treat rosacea. Although sometimes less effective than non-ablative laser treatments when used alone, it may be used together with the laser to improve the overall success.

Nonablative lasers are the latest in effective treatments for the embarrassing, irritating, and sometimes painful problem of rosacea. Your laser surgeon can advise whether you are a candidate for treatment after consultation and exam. Please visit www.reflectionsmedspas.com to learn more about comprehensive, nonablative laser and light-based treatments.

~ John P. Lundeby, M.D., F.A.C.S. is a general and vascular surgeon who practices at Lake City Surgeons PLLC in Coeur d’Alene and is a co-founder of Reflections Med Spas in Coeur d’Alene. He can be reached at (208) 676-8346.