Rosacea is a disease of the skin and is best managed by a specialist dermatologist who has many years of training and experience in the appropriate medical and cosmetic treatment of this common and troublesome condition. Rosacea can manifest in four different ways and sometimes in combination.
1. Erythemato-Telangiectatic Rosacea (ETR)
This appears as persistent red (erythematous) areas with superimposed, visibly enlarged capillaries (telangiectasia). Other features include easy blushing and flushing, sensitivity to cosmetics and burning / itching sensations. The surface may often have sandpaper-like feel to touch. This type of rosacea characteristically involves the central cheeks, nose, chin and lower central forehead.
2. Papular Rosacea (Acne Rosacea)
Papular rosacea is characterised by the formation of pimples, lumps and pustules. Papular rosacea is usually seen on a background of ETR.
3. Ocular Rosacea
Ocular rosacea is the term used to describe rosacea when it involves the eyes. This typically causes redness and irritability of the eyes. The eyelids may show redness and scaling.
4. Phymatous Rosacea (Strawberry Nose)
Phymatous Rosacea is a subtype of rosacea where excessive overgrowth of the oil-glands occur, usually on the nose. Unsightly disfigurement of the nose can result.
Rosacea tends to be a genetic problem, particularly common in people of Celtic origin. It has been theorised that the persistently increased blood flow allows damage to the skin surface as well as a compromised barrier function of the skin.
Things that trigger flushing are known to worsen the rosacea. Triggers can vary from individual to individual. Common triggers of rosacea include windburn, alcohol consumption, sunburn, spicy foods and hot drinks. Less common triggers of rosacea include sensitivity to certain foods such as matured cheeses.
Treatment varies with the type of rosacea, however, in all cases it is important to identify and avoid flushing triggers. Daily use of sunscreen and hypoallergenic moisturiser is also important, as is avoidance of irritants such as soap and many cosmetics.
The mainstay of treatment of this type of rosacea is skin care and laser or intense light based treatment. At Laser Dermatology, we have many different laser and light systems, each with its own specific benefits. Treatment is based on individual requirements. Our equipment includes the new Candela Vbeam Prima® laser, Candela Vbeam Perfecta™ Pulsed-dye Laser, Cutera™ ExcelV long pulse YAG and KTP laser, and the Ellipse Flex™ IPL. Vitamin A containing creams can also be beneficial. Certain cosmeceuticals such as the Rationale™ range are also helpful.
Dermatological management of rosacea is essential. First-line treatment is antibiotic based. These are usually prescribed orally, often in conjunction with creams and gels.
This is usually managed by Ophthalmologists (eye specialists). Oral antibiotics can be helpful.
Severe distortion of the shape of the nose is treated very successfully with the CO2 Laser. Medical treatment with oral antibiotics is usually necessary to maintain improvement.
Chronic phymatous rosacea can lead to disfiguring tissue overgrowth – a condition known as rhinophyma. Assoc Prof Philip Bekhor treats this condition with the Acupulse™ CO2 laser, carefully shaving layers of tissue overgrowth. The result is restoration of the natural nasal contour.
A pulsed dye laser (PDL) used for the treatment of vascular lesions including port wine stains, haemangiomas in infants, fixed facial redness from rosacea and other facial vessels. Laser wavelength 595nm.