Rosacea (cont.)
How is rosacea cured?
Rosacea is currently not considered a curable condition. While it cannot be cured, it can usually be controlled with proper, regular treatments.
There are some forms of rosacea that may be significantly cleared using laser, intense pulse light, photodynamic therapy, or isotretinoin
(Accutane). Although still not considered a "cure," some patients experience long-lasting results and may have remissions (disease-free period of time) for months to years.
What about using acne medicine?
Since there is some overlap between acne and rosacea, some of the medications may be similar. Acne and rosacea have in common several possible treatments including (but not limited to) oral antibiotics, topical antibiotics, sulfa-based face washes, isotretinoin, and many others. It is important to seek a physician's advice before using random over-the-counter acne medications since they can actually irritate skin that is prone to rosacea. Overall, rosacea skin tends to be more sensitive and easily irritated than that of common acne.
What is used for treating rosacea?
There are many treatment choices for rosacea depending 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.
Mild rosacea may not necessarily require treatment if the individual is not bothered by the condition. More resistant cases may require a combination approach, using several of the treatments at the same time. A combination approach may 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.
Topical creams
With the proper treatment, rosacea symptoms can be fairly well
controlled. Popular methods of treatment include 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.
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).
Oral antibiotics
Oral antibiotics are also commonly prescribed to patients with moderate
rosacea. Tetracycline, doxycycline, minocycline, and amoxicillin are among the
many oral antibiotics commonly prescribed and they actually help reduce
inflammation and pimples in rosacea. The dose may be initially high and then be
tapered to maintenance levels. Common side effects and potential risks should be
considered before taking oral antibiotics.
Short-term topical cortisone
(steroid) preparations of minimal strength may in occasional cases also be used
to reduce local inflammation. There is a risk of causing a rosacea flare by
using topical steroids. Some doctors may prescribe tretinoin (Retin-A) or
isotretinoin, prescription medications also used for acne, or
permethrin (Elimite) cream, which is also used for the mites that cause scabies.
Isotretinoin
Isotretinoin has been prescribed to patients with severe
rosacea. However, close physician monitoring and blood testing are necessary
while on isotretinoin.
Cleaners
In addition, prescription or over-the-counter sensitive 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.
Laser and intense pulsed light
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 physician 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. The use of PDT in rosacea is considered off-label use to some extent, since it is primarily designed for regular acne. PDT
is thought to work at reducing the inflammation, pimples, and also improving the
skin texture. PDT is an in-office procedure performed in your physician's
office. The treatment takes anywhere from one to one and a half hours to complete. Strict sun
avoidance for approximately one to three 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
(disease free periods) 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 to improve and control rosacea in
some patients. 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
patients.
Sun protection
Sun exposure is a known flare for some rosacea sufferers. Sun protection
using a wide-brimmed hat and sunscreens are generally encouraged. Because
rosacea tends to occur in mostly fair-skinned adults, the use of an appropriate
daily sunscreen lotion and overall sun avoidance is recommended. Zinc-based
sunscreens (SPF 30 or higher) may provide adequate sun protection.
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