Rosacea Treatment
Redness, Flushing, and Visible Blood Vessels
Subtype: Erythematotelangiectatic type rosacea

Patients with this subtype often have extremely sensitive skin. Any medication applied to the face may cause intense stinging and burning. If this is the case, treatment may begin with skin care that can help repair the damaged skin.

1. Sunscreen and a Barrier-Repair Emollient
   When the skin is extremely sensitive and bright red, therapy may begin with a sunscreen that does not irritate the rosacea and a barrier-repair emollient that is applied twice a day. Patients also may be prescribed an oral (taken by mouth) antibiotic. Once the skin calms, the patient may be helped with one or more topical medication described below. Daily sunscreen use should continue indefinitely.

2. Topical Medication
   The redness can, in some cases, be effectively treated with a topical (applied to the skin) medication that reduces inflammation such as:

• Azelaic acid

• Metronidazole

• Retinoid (A topical retinoid also can help heal the skin.)

• Sodium sulfacetamide and sulfur

Effectiveness: When using a topical medication, it can take a few months to see noticeable improvement. In some cases, long-term use of a topical medication can be helpful in controlling rosacea.

Side effects: These include burning, stinging, itching, and skin irritation when applying the medication. People who have this rosacea subtype are especially prone to these side effects. If the skin feels too sensitive for a topical medication, be sure to let the dermatologist know.

After applying a topical retinoid, the skin may feel warm or sting. Sometimes redness increases temporarily. Peeling of the skin also can occur. When using a topical retinoid, it is important to apply sunscreen before going outdoors as topical retinoids tend to increase sensitivity to the sun. Some patients also experience increased sensitivity to wind and cold.

3. Electrocautery
   Effectiveness: Visible blood vessels can be safely destroyed with this low-powered electrical device. Treatment involves numbing the area, treating the affected skin with an electric current, and then scraping away the treated skin. Electrocautery usually requires more than one treatment.
   
   Side effects: The most common side effects are swelling or redness for a day or two.

4. Lasers and Other Light Therapies
   Effectiveness: The redness, flushing, and visible blood vessels may be effectively treated with lasers and other light therapies. While the number of treatments varies, most people require 4 to 8 treatment sessions per year for a few years to significantly reduce redness and flushing. At least 2 treatments are needed to diminish visible blood vessels. Once the desired results are seen, patients may not need treatment again for some time. A few patients have reported that their redness and flushing did not return for 7 or 8 years.

Side effects: The risk of side effects is low in the hands of a physician who has experience using these devices and in-depth medical knowledge of the skin. With newer lasers, side effects tend to be limited to temporary bruising, redness, or swelling. The redness and swelling can last a few days. With some lasers, bruising may last as long as 10 to 14 days.

Beware: Laser treatments and other light therapies should be performed by or under the direct supervision of a physician who has expertise in the skin such as a dermatologist. Direct supervision means that the physician is on site while the procedure is being performed and immediately available during the procedure.

Insurance usually does not cover the cost of this treatment because the treatment is considered cosmetic. Patients can expect to pay from $300 to $700 per session.

5. Other Treatment Options
   In some cases, rosacea does not respond to the therapies described above. If you have been following the prescribed treatment plan and treatment fails, be sure to discuss this with your dermatologist. Less commonly used treatment may be an option.

References:
American Academy of Dermatology. “Acne and Rosacea Getting You Down? Laser, Light and Cosmetic Treatments Give Patients a Much-Needed Boost.” News release issued February 3, 2008. Last accessed June 4, 2008.

Baldwin HE. “Systemic Therapy for Rosacea.” Skin Therapy Letter.com March 2007; 12. Available at www.skintherapyletter.com/2007/12.2./1.html. Last accessed May 15, 2008.

Crawford GH, Pelle MT, James WD. “Rosacea: I. Etiology, pathogenesis, and subtype classification.” J Am Acad Dermatol 2004; 51: 327-41; quiz 42-4.

Pelle MT, Crawford GH, James WD. “Rosacea: II. Therapy.” J Am Acad Dermatol 2004; 51: 499-512; quiz 3-4.

All content solely developed by the American Academy of Dermatology