Rosacea Treatment & Management

  • Author: Agnieszka Kupiec Banasikowska, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 31, 2011
 

Medical Care

Before the initiation of therapy, the triggering factors that exacerbate the patient's rosacea should be identified and avoided if possible. These factors may be unique to each individual patient. Common triggering factors include hot or cold temperatures, wind, hot drinks, caffeine, exercise, spicy food, alcohol, emotions, topical products that irritate the skin and decrease the barrier, or medications that cause flushing.[11, 12] Some patients find that regular facial massage reduces lymphedema. Rosacea fulminans is treated with moderately high doses of prednisolone (30-60 mg/d) followed by oral isotretinoin.

Sunscreen

The use of daily broad-spectrum sunscreen is recommended for all patients with rosacea.[13] A sunscreen that protects against both UV-A and UV-B light should be selected. Physical blockers such as titanium dioxide and zinc oxide are well tolerated. Additionally, the sunscreen should contain protective silicones such as dimethicone or cyclomethicone. Green-tinted sunscreens can provide coverage of the erythema.

The patient is encouraged to avoid astringents, toners, menthols, camphor, waterproof cosmetics requiring solvents for removal, or products containing sodium lauryl sulfate.

Laser

Nonablative laser is effective against rosacea by remodeling of the dermal connective tissue and improving the epidermal barrier.[14] The major disadvantage of this therapy is its cost because it is not covered by insurance. It requires 1-3 treatments 4-8 weeks apart to achieve the best results.

Vascular lasers are the mainstay of rosacea therapy. These include pulsed dye laser (585 or 595 nm), the potassium-titanyl-phosphate laser (532 nm), and the diode-pumped frequency-doubled laser (532 nm). These wavelengths allow selective absorption by oxyhemoglobin, leading to vessel reduction with minimal damage to surrounding tissue or scarring. To be effective against deeper facial vessels, longer wavelengths of lasers are required, including the diode laser (810 nm), the long-pulsed Alexandrite laser (755 nm), and the long-pulsed Nd:YAG laser (1064 nm).

Intense pulsed-light therapy is a multichromatic laser with different targets, including melanin and hemoglobin. Therefore, it is also useful for facial rejuvenation, affecting vascular lesions, pigmented lesions, and hair.

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Surgical Care

Permanent telangiectasia may be treated by electrosurgery or the 585-nm pulsed dye laser. However, facial erythema is not improved, and new telangiectasias develop with the passage of time. Cosmetic improvement of rhinophyma may be produced by mechanical dermabrasion, carbon dioxide laser peel, and surgical shave techniques.

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Diet

Dietary modulation should aim at avoidance of triggers.

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Contributor Information and Disclosures
Author

Agnieszka Kupiec Banasikowska, MD  Consulting Staff, Georgetown Dermatology, PLLC

Agnieszka Kupiec Banasikowska, MD is a member of the following medical societies: American Academy of Dermatology and European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Coauthor(s)

Saurabh Singh, MD  Staff Physician, Department of Dermatology, Georgetown University/Washington Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Bamford JT, Gessert CE, Renier CM. Measurement of the severity of rosacea. J Am Acad Dermatol. Nov 2004;51(5):697-703. [Medline].

  2. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. Sep 2004;51(3):327-41; quiz 342-4. [Medline].

  3. Dahl MV. Rosacea subtypes: a treatment algorithm. Cutis. Sep 2004;74(3 Suppl):21-7, 32-4. [Medline].

  4. Laquer V, Hoang V, Nguyen A, Kelly KM. Angiogenesis in cutaneous disease: part II. J Am Acad Dermatol. Dec 2009;61(6):945-58; quiz 959-60. [Medline].

  5. Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad Dermatol. Mar 1993;28(3):443-8. [Medline].

  6. Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. Feb 2009;60(2):270-6. [Medline].

  7. Jones DA. Rosacea, reactive oxygen species, and azelaic acid. J Clin Aesthetic Derm. Jan 2009;2(1):26-30.

  8. Cuevas P, Arrazola JM. Therapeutic response of rosacea to dobesilate. Eur J Med Res. Oct 18 2005;10(10):454-6. [Medline].

  9. Schauber J, Gallo RL. Antimicrobial peptides and the skin immune defense system. J Allergy Clin Immunol. Aug 2008;122(2):261-6. [Medline].

  10. Aloi F, Tomasini C, Soro E, Pippione M. The clinicopathologic spectrum of rhinophyma. J Am Acad Dermatol. Mar 2000;42(3):468-72. [Medline].

  11. Greaves MW, Burova E. Flushing: causes, investigation and clinical consequences. J Eur Acad Dermatol Venereol. 1997;8:91-100.

  12. Higgins E, du Vivier A. Alcohol intake and other skin disorders. Clin Dermatol. Jul-Aug 1999;17(4):437-41. [Medline].

  13. Powell FC. Clinical practice. Rosacea. N Engl J Med. Feb 24 2005;352(8):793-803. [Medline].

  14. Lonne-Rahm S, Nordlind K, Edstrom DW, Ros AM, Berg M. Laser treatment of rosacea: a pathoetiological study. Arch Dermatol. Nov 2004;140(11):1345-9. [Medline].

  15. Ceilley RI. Advances in the topical treatment of acne and rosacea. J Drugs Dermatol. Sep-Oct 2004;3(5 Suppl):S12-22. [Medline].

  16. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. Mar 1994;130(3):319-24. [Medline].

  17. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. May 2005;19(3):273-85. [Medline].

  18. Baldwin HE. Systemic therapy for rosacea. Skin Therapy Lett. Mar 2007;12(2):1-5, 9. [Medline].

  19. Chu CY. The use of 1% pimecrolimus cream for the treatment of steroid-induced rosacea. Br J Dermatol. Feb 2005;152(2):396-9. [Medline].

  20. van Zuuren EJ, Kramer S, Carter B, Graber MA, Fedorowicz Z. Interventions for rosacea. Cochrane Database Syst Rev. Mar 16 2011;3:CD003262. [Medline].

 
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