Rosacea: The Reason I Came To Work In Aesthetics
A lot of people ask me how I came to be working in medical aesthetics. Here’s the answer:
When I was about 35 years old I started to have symptoms of rosacea. I was red, flushed frequently and I had to be careful with what I ate and drank or I’d be blushing uncontrollably. Then I started to break out. I suspected it was rosacea especially since my mother also suffered with it. I visited my family physician and was prescribed Metrocream which worked reasonably well.
Although Metrocream helped with the breakouts and prevented my rosacea from getting worse it did not treat the telangectasias (small red vessels around my nose and on my cheeks) or the background redness I chronically experienced.
I had read that lasers may help rosacea so I attended Laser Aesthetiques in Guelph where BBL was recommended to treat my redness and telangectasias. It worked extremely well and I now do BBL 2-3 times per year for my face, neck and chest. I attended Laser Aesthetiques for years, started working there eventually, and then I bought the clinic!
April is Rosacea month, so it seems a great time to talk about Rosacea and its management.
Rosacea is an extremely common skin condition that most commonly affects women between the age of 30 and 50 years old. It is most common in individuals of northern European descent but its effects are probably under-recognized in dark-skinned patients. Men are affected as well although they may develop it slightly later and often more severely.
So what is rosacea exactly?
Rosacea is a chronic inflammatory disorder of the microvasculature of the skin (skin capillaries). The exact cause of rosacea is not known but there appears to be disordered dilation of these small vessels and possibly impaired drainage of the veins. This leads to the redness and flushing that is visible. Additionally some people also have acneiform or papular rosacea which leads to the appearance of acne. The frequent dilation of these small blood vessels also seems to encourage them to grow which is why people with rosacea tend to develop these small red vessels on their cheeks and around their nose. A recent theory suggests that the inflammation may be due to a patient’s hypersensitivity to a mite that commonly lives on our skin (Demodex folliculorum).
Most rosacea sufferers describe triggers that worsen their symptoms. Common triggers include alcohol, emotional stress, cold or hot weather, spicy foods, exercise, wind, cosmetics, hot baths or hot drinks. Many rosacea sufferers also have family members with the same condition. It’s not genetic, but there can be a family tendency especially in male members of the family suffer from rosacea.
In its most severe form rosacea can cause thickening of the skin especially on the cheeks and nose due to collagen overproduction caused by the chronic inflammation. There can also be overgrowth of oil secreting glands as well. Rhinophyma is a disfiguring late sign of rosacea which causes a large bulbous red nose. This is seen largely in older men who suffer from severe rosacea for decades.
Finally, there is ocular rosacea which causes a type of conjunctivitis (inflammation of the eyes) that leads to itching, burning, redness and swelling of the eyes. Thankfully this complication is quite rare as is rhinophyma.
Treatment Options for Rosacea
Firstly, avoid your triggers.
Secondly, consider a topical prescription cream. The first line treatment option recommended by the Canadian Dermatology Association is a medication called Rosiver. The active ingredient in Rosiver is ivermectin, an anti-parasitic agent. When ivermectin is used topically it has an anti-inflammatory effects. Interestingly, it may help reduce the demodex mite population on the skin which may explain why Rosiver works so well. Rosiver is an odorless, light cream that is applied once daily.
Other prescription topical creams are available including Finacea (azelaic acid) and Metrogel (metronidazole). Neither of these prescription creams works as well as Rosiver, but if a patient isn’t responding to Rosiver it may be worth trying one of these other creams.
Benzoyl Peroxide in addition to Rosiver can be helpful. BPO is also a topical anti-inflammatory and can be used for spot treatment of rosacea acne when used in combination with a prescription rosacea cream like Rosiver.
Individuals with acne-like or more severe rosacea often require treatment with oral medication. Typically we recommend Apprilon which is low dose doxycycline antibiotic. The low dosage found in Apprilon does not kill bacteria so it is safe for the gut, doesn’t cause yeast infections etc. It works very well and has an excellent anti-inflammatory effect.
Onreltea is a prescription gel containing brimonidine, a vaso-constricting medication. Onreltea can markedly reduce flushing and redness for three to six hours. I sometimes prescribe this for rosacea sufferers and recommend they use it for special events. The reduction in redness is very temporary, but very effective, so if you’re giving a speech, going to a wedding, or planning a social event where you’d like to be less red for a while, then onreltea can be helpful. It’s only symptomatic relief, but a useful option to have at your disposal.
Treating the damage caused by Rosacea
While rosacea is a benign condition, like acne it can result in lasting damage. The little red vessels that may develop around your nose, or on your cheeks, and the general redness can be very annoying. This is where laser light therapy can be really useful.
Laser therapy like BBL (broad band light) employs full spectrum white light at high intensity to cauterize or close down those pesky capillaries that have grown and migrated to the skin surface. BBL treatment is fast, has virtually no down time, is relatively inexpensive and it’s very effective to relieve redness and eliminate surface cappilaries in light to medium skin types.
At ArtMed we typically recommend a series of 3 BBLs about 3-4 weeks apart followed by maintenance single treatments one to two times per year depending on rosacea severity. A bonus side effect of regular BBL treatments is the antiaging benefits of light therapy. Research has definitively demonstrated that BBL therapy has marked anti-aging benefits to the skin over time.
A lot of people ask me about my skin and how I keep it looking young and clear. The answer is Rosacea – or rather the treatment of my rosacea has lead me to BBL, pharmaceutical skin care, and owning ArtMed!