Treatments for rosacea

Mild rosacea can often be controlled with topical treatments (creams, ointments and gels). Ivermectin (Brand name Soolantra) is particularly effective for inflammatory rosacea where there are bumps and pustules. Metronidazole: is an antibiotic gel or cream that can reduce inflammation and redness. Azelaic Acid can reduce redness and swelling.

Antibiotic tablets work by reducing inflammation. Usually they will be taken for a course of a few months of treatment. Several different classes of antibiotic may be used. Tetracyclines, for example, lymecycline are usually well tolerated. Other antibiotics that can be used include erythromycin.

Isotretinoin, also known as Roaccutane can be an effective treatment for inflammatory rosacea that has not resolved with other treatments, however it has a greater potential for side effects than other treatments.

Vascular lasers are effective treatments for facial redness, prominent blood vessels and vascular lesions such as spider naevi. They can also improve the appearance of red scars. I will most commonly use Pulsed-Dye Lasers. These emit a yellow light, which is absorbed by the haemoglobin in blood vessels. This light energy causes the blood vessels to coagulate and eventually be reabsorbed by the body. Long-Pulsed Nd:YAG Lasers: Nd:YAG lasers have a longer wavelength, allowing them to penetrate deeper into the skin. This makes them suitable for treating larger, deeper blood vessels, however as they target larger blood vessels they are associated with a slightly higher risk of complications such as scarring.

Intense Pulsed Light (IPL) uses high-intensity bursts of broad-spectrum light. Unlike vascular lasers, which use a single wavelength of light to treat redness and blood vessels, IPL uses multiple wavelengths and can also address other skin concerns such as pigmentation.

Ablative carbon dioxide laser treatment (for example the Lumenis Ultrapulse laser) can be an effective treatment for rhinophyma. Ablative means that the entire surface layer of the skin is removed using the laser. Immediately following the treatment the area appears raw and whitish/brown. There will be some bleeding. The area heals over a number of weeks and there can be ongoing blistering, crusting and oozing during this time. The area heals by forming scar tissue. In many cases this can improve the appearance compared to severe rhinophyma, however this is an invasive treatment with significant recovery time and risks and therefore fully ablative resurfacing is not advised for mild rhinophyma where the risks will outweight the benefits.