As of March 20, 2020 we are no longer seeing patients in our office due to COVID-19. We are happy to continue caring for you during these uncertain times. We are now offering remote appointments for new and established patients although we will no longer be able to see you in person. For some patients, an in person visit is best, but if you feel that your concern could be addressed online, this may be a convenient option for you.
Rosacea is a skin disorder that often begins with redness and flushing on the nose, cheeks, chin, and forehead. People with rosacea may experience flushing, itching, and burning of the skin. It is not uncommon for some people with rosacea to have pimple-like bumps on the skin while others may have thickening of the skin on the nose. Some patients have broken blood vessels that are apparent on the nose, cheeks, and chin. There are several skin conditions, like acne, that sometimes can be confused for rosacea.
Rosacea not only affects the skin; a type of rosacea known as ocular rosacea affects the eyes and creates dry and itchy eyes. There are 4 types of rosacea known as subtypes:
People often have more than one subtype of rosacea.
Rosacea can affect men or women and people of all skin colors but it is more common in individuals with fair skin. Rosacea begins in adulthood. Its cause is unknown but there are theories that are currently being investigated.
Central to the pathophysiology of rosacea is a dysfunction of the innate immune system. Also, neurovascular dysregulation, as well as overexpression of inflammatory mediators, and some triggering factors can play a role.
Triggers vary from person to person and not everyone has the exact same triggers. For some people, it’s sunlight that’s a big trigger. For other people, it’s cold, windy weather. Some might be triggered by exercise or food. Drinking alcohol, exercise, extreme heat or cold temperatures or spicy foods may aggravate rosacea.
Rosacea is not contagious. There is no cure for rosacea but it can be markedly improved with different treatments. Treatments vary and many patients use more than one modality to treat their rosacea. Medicated washes, creams, lotions, gels and pills may be offered to patients with rosacea. Laser treatment can markedly improve the redness of rosacea. All patients with rosacea should wear sunscreen as sunlight can worsen rosacea symptoms.
If you are a patient who suffers from rosacea, your skin is going to need a simple skincare routine, this means gentle ingredients. The physicians at The Dermatology Institute of Boston prefer you use a gentle cleanser, just wash with your hands or a soft cloth, no scrubbing. Use a gentle moisturizer, something that’s bland, avoid any chemical exfoliants, or anti-aging products; and, of course, adding in the sunscreen.
At the Dermatology Institute of Boston, we take our time to fully get to know our patients. It starts with the relationship. Having an open and trusting conversation between provider and client is certainly the foundation for successful control of rosacea. As such, we want to know how much rosacea is affecting the patient, how severe the case is. We also want to look at the rosacea and see, is this the erythematotelangiectatic type? Is this the papulopustular type? Is it a combination of both? After a thorough examination and conversion, possible treatment options can be determined.
Our treatment depends on what subtype of rosacea the patient has. To treat the redness topically, we could use prescription oxymetazoline or brimonidine. Aside from that, we then go to our in-office procedures, such as some of the laser and light-based devices to improve the erythema (redness) and telangiectasias (broken blood vessels).
Learn more at the Laser Treatments’ page: Rosacea Treatment.
Our treatment options for mild-to-moderate papulopustular rosacea are quite varied. We have several different options that we can choose from. There’s topical metronidazole in different formulations, topical azelaic acid, also in different formulations, topical ivermectin cream, and sulfacetamide sulfur in various formulations. And these can all be used in combination rather than just choosing one or the other. You can use a combination of those to treat mild-to-moderate papulopustular rosacea.
For more severe cases of rosacea, there are some additional things that we can use. Oral antibiotics can be very helpful. The tetracycline class, particularly doxycycline can be useful. It has a strong anti-inflammatory mechanism of action. Doxycycline is nice, as well, because we have the option to dose it at sub-antimicrobial dosing, so it is safer to use in the short term and in the long term using low doses to stop the inflammation.
It’s important to point out rosacea is not going to get better overnight. It often takes weeks or months to see improvement, even with daily use of some of these medications. Some form of treatment for this skin disorder is something they’re going to incorporate into their routine for life. This is not a rash that we’re going to fix and cure them of permanently. This is more of a skin type that they’re prone to. Fortunately, we have some great medicines to help them control it.
To set up an appointment at our Boston office with one of our specialists, please call or contact us.
Our goal here at The Dermatology of Institute of Boston is protect the health of our patients and staff. To continue caring for our patients during these uncertain times, while strictly adhering to the guidelines set by the CDC, we will be only offering virtual consultations. For some patients, an in person visit is best, but if you feel that your concern could be addressed online, this may be a convenient option for you.