Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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 the treatment for 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 (Flagyl) 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 (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox), minocycline (Dynacin, Minocin), and amoxicillin (Amoxil, Dispermox, Trimox) are among the
many oral antibiotics commonly prescribed and they actually help reduce
inflammation and pimples in rosacea. 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. Common side effects and potential risks should be
considered before taking oral antibiotics.
Miscellaneous medications
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).
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.
Isotretinoin (Accutane)
Isotretinoin is infrequently prescribed for severe and resistant rosacea. Often it is used after multiple other therapies have been tried for some time and have failed. It is used as a daily capsule for
four to six months. Isotretinoin is not typically used in rosacea, and it is most commonly used in the treatment of severe, common acne called acne vulgaris. 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.
Cleansers
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.
Other recommended cleansers include
sulfa-based washes (for example, Rosanil),
benzoyl peroxide washes (for example, Clearasil).
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 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.
Sun protection
Sun exposure is a well known flare for many rosacea sufferers. Sun protection using a wide-brimmed hat (at least 6 inches) and physical sunscreens (like zinc or titanium) 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) provide superior sun protection.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Blepharitis is inflammation of the eyelids. Acne rosacea, Staphylococcal bacteria, allergies, sensitivities to makeup or contact lens solutions, head lice, or other conditions may cause blepharitis. Symptoms and signs include itchy eyelids, burning sensation in the eyes, crusting of the eyelids, light sensitivity, red, swollen eyelids, loss of eyelashes, and dandruff of the lashes and eyebrows. Proper eyelid hygiene and a regular cleaning routine controls blepharitis.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
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