Rosacea is a chronic skin condition that causes facial redness, visible dilated blood vessels, bumps or pimples and irritated eyes. Some cases cause thickened skin especially around the nose. Early treatment of rosacea may help keep it from progressing. A doctor will determine what subtype of rosacea a person has and help decide which treatments may work best. Make sure the doctor explains all the benefits, side effects and risks of any treatments suggested below before starting.
• Subtype 1: Erythematotelangiectatic type rosacea: has redness, flushing and dilated blood vessels.
Non-irritating sunscreens and oral antibiotics are typically tried first. The next step may be the use of topical medications to reduce inflammation such as azelaic acid, retinoids or metronidazole may be used.
Electrocautery can be used to destroy small dilated blood vessels but usually more than one treatment is needed. Lasers or other light therapies are an option but may require several treatments. It is important to note that laser treatments can be expensive and insurance may not cover them.
• Subtype 2: Papulopustular rosacea: has pimples or bumps and pus-filled lesions.
Combination therapy of two or more treatments are usually tried using topical antibiotics, azelaic acid, benzoyl peroxide, retinoid or sulfur lotion. After desirable results are achieved, then a single treatment may be used to maintain the skin.
Oral antibiotics of low dose doxycycline may reduce inflammation or other antibiotics such as tetracycline or azithromycin may speed the clearing of pus-filled lesions. Glycolic acid peels, washes or creams may be used in conjunction with oral antibiotics. Avoidance of the sun is very important if receiving these treatments so sunscreens should be used.
• Subtype 3: Phymatous rosacea: results in thickened skin especially around the nose.
A doctor can use one or more techniques to thin and resculpt the thickened skin.
Newer erbium lasers and fractional laser treatments are used because they are better at smoothing the skin without removing excessive amounts of skin.