Rosacea

What is Rosacea?

Rosacea is a chronic skin condition that affects mainly the face. Some will also get involvement of the eyelids and the eyes themselves. Although anyone can develop rosacea, it is more common in those with fair skin and light eye color. There is often a family history of rosacea.

In most cases rosacea begins in young adults. It often will begin as a flushing or redness of the cheeks, nose and chin that comes and goes. With time this redness becomes permanent and fine blood vessels occur in the areas of redness. Without treatment these blood vessels tend to become thicker and more noticeable with time and in later stages can develop a purple color.

Other signs of rosacea include papules [bumps], pustules [small pimples similar to those seen in acne], nodules [larger deeper lumps]. These tend to come and go with time. Sebaceous hyperplasias [yellowish bumps, often with a small central depression] and sebaceous hypertrophy [a thickening of the skin, usually of the nose, caused by enlarging sebaceous glands] once present, are permanent.

Treatment of Rosacea

The exact cause of rosacea is unknown and, because of this, there is no cure for it.

There are a number of factors that make rosacea worse and, in some cases, avoiding these aggravating factors will improve rosacea or make it easier to control with treatment. These aggravating factors include: sun exposure, caffeine, alcohol, hot food, spicy food and stress. The importance of these factors varies from patient to patient. For example, one patient may find that sun exposure is the most important factor while another finds that avoidance of caffeine makes the greatest difference.
Others will find that none of the above factors is relevant to their case.

Treatment of the inflammatory part of rosacea [papules, pustules, nodules and some of the redness] consists of topical agents that contain either metronidazole or very mild topical steroids. Long term oral antibiotics such as tetracycline, are also used. This will control this part of rosacea to varying degrees. Strong steroid containing creams should be avoided as they tend to make rosacea worse in the long run.

Sebaceous hyperplasias are improved with light electric needle or laser treatment.

Laser Treatment for Rosacea

Over the past number of years, treatment of the vascular part of rosacea [redness and blood vessels] has been revolutionized by the development of various lasers that selectively damage the abnormal vessels and improve the appearance of the patient with rosacea. The early devises tended to cause significant purura [bruising] that resulted in down time for the patient of up to 10-14 days but newer technology has made it possible to get even better results with little or no bruising.

Most patients require multiple treatments and see gradual improvement after each treatment. Every patient is different, but on the average, 3 treatments are needed the first year and 1-2 treatments are needed per year after that. The red color and abnormal blood vessels rarely go away completely but the condition stops getting progressively worse and almost all patients get significant improvement.

On the day of treatment drugs that effect clotting such as coumadin, aspirin, ibuprofen, vitamin E etc should be avoided. The treatment causes some discomfort but is tolerated well by most patients.
After the treatment there will be increased redness and some swelling. Occasional patients will develop some bruising that lasts a few days. Aftercare is quite easy as the surface of the skin is not broken. The area should be treated with an ice pack wrapped in a towel a few times per day. For the first couple of days, the patient should sleep with their head elevated on a couple of pillows to decrease swelling of the eyes. The treated areas should be washed very gently and sun exposure should be avoided The vast majority of patients return to work immediately after treatment. Make up can be applied immediately after treatment.

The patient is assessed about 1 month after each treatment.

What Should I Do if I Think I Have Rosacea?

Please call the office at [416]698-5521. Make an appointment with Dr. Shiffman for an assessment of your problem. The assessment will be covered by OHIP. Our office looks forward to seeing you and helping you with your concerns




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