Treatment of Rosacea

Rosacea is a chronic skin rash that mainly affects the central part of the face. The target age groups are patients between the ages of 30 and 60 years old.

As discussed in a previous post on rosacea, rosacea can be triggered by genetic, environmental, vascular, and inflammatory agents. Chronic exposure to ultraviolet (UV) radiation can also influence skin damage.

Rosacea usually appears in the form of red spots (papules) and, in rare cases, as pustules. These spots have a dome-shaped form. Patients diagnosed with rosacea experience frequent facial blushing or flushing. Sun exposure, hot and spicy food or drinks can also cause increased redness. Individuals with sensitive skin may experience burning and stinging sensations in response to makeup products, facial creams, and sunscreens. Due to affected eye areas, ocular rosacea can be diagnosed, which is characterised by red, sore, and gritty eyelid margins with papules and styes.

General Measures

There are different treatment methods currently available for rosacea, and these are unique to every patient. General measures include avoiding oil-based facial creams; water-based skincare and makeup products are recommended instead. Sun exposure should be avoided, and light oil-free facial sunscreens are advised. To decrease the flushing effect, reduction of hot and spicy foods and alcohol consumption is recommended, as is avoiding hot showers and baths. Some individuals use ice blocks around the mouth area or between the gums and cheeks to reduce facial redness for short periods.

Topical steroids should not be used for treating rosacea. Although short-term improvements have been observed, topical steroids cause rosacea outbreaks to become more severe over time due to increased production of nitric oxide.

Oral Antibiotics

Different oral antibiotics can be prescribed as part of the treatment course. Tetracycline antibiotics, such as doxycycline and minocycline, are often used to treat rosacea. They help to reduce redness, pustules, papules, and eye symptoms. These antibiotics are typically prescribed for a course of 6 to 12 weeks. Duration and dosage are calculated individually for each patient depending on the severity of the rosacea. Further prescriptions of antibiotics are required from time to time, as antibiotics do not cure the condition.

The anti-inflammatory effects of antibiotics are currently under investigation; however, they have shown promising results. These antibiotics tend to inhibit the functions of Matrix metalloproteinases (MMP), which in turn decrease inflammation and cathelicidins.

Long-term antibiotic use carries the disadvantage of developing bacterial resistance. Low doses that do not produce antimicrobial effects are preferred for treating various skin conditions, including rosacea.

Topical Treatments

Topical treatments are also used for managing rosacea. Metronidazole cream or gel is prescribed for mild inflammatory rosacea and can be combined with oral antibiotics in more severe cases. Creams and lotions containing azelaic acid as an active ingredient are effective remedies for mild inflammatory rosacea. Application of these products twice daily is recommended.

Medications to Reduce Flushing

Certain medications such as carvedilol and clonidine help to reduce vascular dilation (widening of blood vessels), which in turn reduces flushing. These medications are generally well-tolerated among patients. Some side effects may include dry eyes, low blood pressure, low heart rate, and blurred vision.

Oral nonsteroidal anti-inflammatory agents such as diclofenac help to reduce discomfort and redness of the affected skin. Serious adverse effects are very uncommon; however, rare occurrences of renal toxicity, hypersensitivity reactions, and peptic ulceration have been reported.

Vascular Laser and Intense Pulsed Light

Vascular laser or intense pulsed light treatment can successfully reduce persistent telangiectasia (cutaneous blood vessels). Light pulses are targeted at the red pigment known as haemoglobin in the blood. The pigment is heated and destroyed without affecting the surrounding tissues and skin.