Correct diagnosis and early treatment keep rosacea in remission and minimise outbreaks.
Since rosacea symptoms vary among patients, treatment is applied by our dermatologist on an individual basis. There are various medical treatments administered orally, as well as topically applied formulations, which help in minimizing facial redness and to maintain the remission.
Moreover, LASER treatments, with the application of pulsed light and photodynamic therapy can be used to eliminate visible blood vessels, to reduce persistent erythema, and nose swelling. For the treatment of ocular rosacea, oral antibiotics administration may be also necessary.
The most severe cases may require combination treatment protocols, i.e. the application of more than one therapeutic techniques simultaneously.
LASER and medical devices with pulsed light are a safe alternative for the management of redness and visible blood vessels on the face, neck and/or chest. In our clinics, we use vascular LASER and, in particular, Pulsed Dye Lasers (pulse duration 595 nm), for the effective treatment of both inflammation and erythema, as well as telangiectasia. Fractional carbon dioxide lasers (CO2) may also help in dermal collagen remodelling and non-ablative rejuvenation.
The Vascular LASER includes devices that emit short and long wavelengths, with different duration of the pulses. Short wavelength lasers emit light, which is selectively absorbed through the absorption peaks of oxyhaemoglobin, allowing the destruction of surface vessels without collateral tissue losses. Long pulse vascular LASER can eliminate deeper and larger vessels since they target the spectral peak values of oxyhaemoglobin.
Both effectiveness and tolerance of LASER therapy for rosacea treatment have been improved through the modification of pulse duration parameters, and through the advances in skin cooling for more painless therapy. A large pulse duration can provide the same energy at a slower rate, so as to achieve the homogeneous and mild heating of the vessels, minimising tissue injury and purpura formation. Skin cooling with a spray or gel prevents skin damage while providing minimisation of pain, redness and swelling. Moreover, this allows ensuring the safe use of the LASER.
In general, two to four therapeutic sessions with laser are required so as to achieve the best possible result for rosacea, although the number of sessions is always determined individually, depending on each patient’s characteristics.
LASER treatment can be combined with phototherapy to maximise the results. Phototherapy uses clear, visible and an invigorating wavelength of light for the treatment of inflammation and bacteria:
- Inflammation is reduced with the red wavelength (633 nm).
- An antibacterial effect is exerted with the blue wavelength (415 nm) suppressing rosacea.
To maximise the action of phototherapy in some types of rosacea, a special photosensitiser may be applied. Following treatment, sun exposure should be avoided for some days to avoid possible irritation and sunburn.
It includes the administration of specific acaricides, oral antibiotics and isotretinoin (13-cis-retinoic acid) in cases of severe and resistant rosacea. It should also be noted that long-term use of local steroids for areas such as the face may result in persistent erythema and telangiectasia.
→ Topical treatment
They are the most commonly prescribed medications and are especially useful for the papulopustular patients and some patients with the erythrotelangiectatic type. Benzoyl peroxide and topical clindamycin, alone or in combination, are often quite beneficial and well tolerated by the glandular subset of patients. If oral antibiotics are needed, the topical products may be used to maintain remission after discontinuance of oral preparations.
Pimecrolimus or tacrolimus (cream) may also improve selected patients’ erythema, especially those with an accompanying roughness or scaling of the skin surface. They calm inflammation and abate symptoms but require brief pre-treatment with a potent topical steroid to be tolerated initially.
Long-term use of topical steroids on the face may result in persistent erythema, papules, and pustules. Treatment is the discontinuance of the offending drug and institution of topical tacrolimus in combination with short-term minocycline. Additionally, drinking alcohol after application of tacrolimus or pimecrolimus may induce flushing, which may be confused with new-onset flushing related to rosacea.
→ Oral therapy
Oral antibiotics, particularly tetracycline, doxycycline, or minocycline, control more aggressive papular and pustular lesions, and aid in the treatment of ocular lesions.
Oral antibiotics should be discontinued once clearance of the inflammatory lesions is obtained; usually, 2 or 3 months is necessary. Occasionally, an escalating dose of propranolol or clonidine is helpful in reducing symptomatic flushing, but most affected patients find the side effects occur before the beneficial effects are evident.