Rosacea (cont.)

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 for long periods of time 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.

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.

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.