What’s The Story With Those Pesky Breakouts? Part 2


By: Dr. Francesca Lewis MD, FAAD Special to the Boca and Delray newspapers

As discussed last month, rosacea affects more than 14 million Americans. Often mistakenly referred to as adult acne, there are some important differences that distinguish rosacea from acne vulgaris. Rosacea has several subtypes that can co-exist at the same time. Often the first presentation is what is referred to as the erythematotelangiectatic stage. In this case, patients have background redness and broken blood vessels (telangiectasias) on the nose and cheeks, that may worsen (flush) with certain triggers such as spicy foods, caffeine, heat, sunlight and alcohol. Papulopustular rosacea is diagnosed when the patient also has pink pimple bumps or pus-bumps (pustules). Unlike in traditional acne, patients with rosacea do not have blackheads and whiteheads. The third subtype is phymatous rosacea. This typically presents as a “bulbous” nose, bumpy and enlarged. Historically, this was often attributed to alcohol intake, but we now know that this is actually a subtype of rosacea. The fourth subtype is ocular rosacea. Rosacea can in fact involve the eye with varied presentations, including redness of the white of the eye or the eyelid rim, dryness, a “scratchy” sensation, among other symptoms.

Rosacea is classically more common in fair skinned patients, often of Eastern European descent, between the ages of 30-50. However, I have diagnosed many patients with rosacea even in darker skin types, starting in their 20s or maybe not until their 60s. A board-certified Dermatologist can diagnose rosacea with a visual examination, and a biopsy is not usually warranted except in severe or resistant cases to confirm the diagnosis.

Many treatment options exist for rosacea, some geared to treat the acne component and some for redness. Topical prescriptions such as sulfur based washes and topical creams with metronidazole, azelaic acid, or ivermectin may be used to control the acne component. There are now prescription creams that can decrease the redness of rosacea for a 12-hour period, but must be used consistently as the effects are not lasting. Oral antibiotics are often employed for more resistant cases of acne rosacea or for ocular rosacea.

The most effective treatment for the redness of rosacea is laser treatments. As we have discussed previously, IPL, intense pulsed light, and is a broad wavelength that can target both brown spots as well as the blood vessels and redness of rosacea. Typically for rosacea, we recommend a monthly treatment for 3 months. Further treatment varies person to person but may be needed every few months or twice a year to prevent the redness from recurring. It is an affordable, quick procedure with little to no discomfort, and very little downtime. I can tell you from personal experience that these treatments are very effective for rosacea.

Another important consideration in patients with rosacea is the use of appropriate skin care products. We know that the skin barrier is compromised in patients with rosacea, so it is important to use gentle, unscented hypoallergenic products, as well as to moisturize twice a day with a moisturizer containing ceramides, and use a zinc based SPF of at least 30 every morning.

Unfortunately, we do not have a cure for rosacea, but with these measures we can control it and make living with this condition much easier.  See a board-certified Dermatologist to come up with a personalized treatment regimen for your rosacea and start seeing a difference in your skin.

For more information about Delray Dermatology + Cosmetic Center or to make an appointment, visit  delrayskin.com or call 561-440-8020.