The Rosacea Forum: Papulopustular,
Telangiectatic, and Phymatous Subtypes

Every once in a while we find it is a good idea to just remind everybody to wear their sunblock. A high SPF sunblock is the most important thing a person can do to avoid hyperpigmentation, aging skin and rosacea. This isn’t a reminder to wear sunblock when you go to the beach or out to the ballgame, its a reminder to wear it every single day.

Sun damage is sneaky and its effects are cumulative over time. This means that every time you are in the sun without sun protection the clock is running. Sun damage is occurring with every drive to the grocery store and every time you are out front watering the lawn.

To avoid this damage you should be sure that your sunblock is at least an SPF 30 and protects against UV-A and UV-B rays. If you don’t like the oily feeling on your skin from sunblock, you can try using a water-based sunblock, these can feel lighter on the skin.

The information found on this website is not designed to replace the patient/physician relationship.

Intense pulsed light (IPL is a device made popular as an alternative to laser hair removal used in many medispas) is both safe and effective for the treatment of non-aesthetic vascular skin lesions, particularly rosacea and poikiloderma of Civatte, Italian researchers have found.

The study involved 85 patients (64 women and 21 men) with a total of 63 non-aesthetic vascular lesions (35 rosacea and 28 poikiloderma of Civatte lesions), 22 pigmented lesions (UV-related hyperpigmentation of solar lentigo-type) and 4 precancerous lesions. Patients received 4 to 6 IPL treatments at three-week intervals. The patients were clinically evaluated and had before-and-after photographs taken at 2 weeks, 4 weeks, 6 months, and 12 months.

Four independent dermatologists with no prior knowledge of the study’s protocol assessed the outcomes. The dermatologists were asked to divide treatment results into four categories: no results, slight improvement, moderate improvement, and marked improvement. All the patients showed improvements in their overall lesions, with 72 lesions (80.9 percent) showing a marked improvement. Of the 63 rosacea and poikiloderma of Civatte lesions, 51 showed a marked improvement and 10 showed a moderate improvement. Only 2 showed a slight improvement.

“Our study confirms how by minimizing side-effects, time and costs, IPL can be effective and safe for the treatment of non-aesthetic facial and neck vascular lesions,” wrote the study’s authors.

Source: Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Troiano M, Prignano F, Lotti T. Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. 2010: May 7. [Epub ahead of print]

The information found on this website is not designed to replace the patient/physician relationship.

As the baby boomers advance in age the demand for facial redness treatment is increasing exponentially. Many of the other ailments typically associated with aging (ie; spider veins, varicose veins, hand veins, or varicoceles in the testes here) are also on the raise and can be expected to continue over the next 10 or so years.

Many of these treatments are covered by health insurance depending on your provider. In most situations you can be treated at a local clinic that specializes in these procedures rather than going to a hospital. However if you are suffering any of these problems you should contact your doctor as soon as possible.

The information found on this website is not designed to replace the patient/physician relationship.

The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month. The organization has planned a variety of public education activities during April to increase the public’s awareness of this relatively common and conspicuous skin disorder—and the treatments available for it.

Without treatment, the symptoms of rosacea can progressively worsen and can have a profound impact on an individual’s personal and professional life.

NRS will also be encouraging people who suspect they have rosacea to seek out the care of a dermatologist or other physician. For a nominal donation, physicians can request bulk quantities of NRS educational materials for their patients.

An estimated 14 million Americans have rosacea. But the number may actually be higher. In a recent NRS-funded study, 14.4% of people examined in Ireland had rosacea—a percentage that suggests the skin disorder may be much more prevalent than previously thought.

A recent NRS survey found that more than 76% of people with rosacea have lower self-confidence and self-esteem as a result of their symptoms, and 52% say that rosacea causes them to avoid social activities. Among those with severe symptoms, almost 30% report that the condition had caused them to avoid work, and almost 70% say the condition has harmed their professional aspirations.

Source: National Rosacea Society. Rosacea Awareness Month to Spotlight High Incidence and Emotional Toll. February 6, 2009.

The information found on this website is not designed to replace the patient/physician relationship.

In a recent issue of the Journal of the European Academy of Dermatology and Venereology, a team of Danish researchers report the findings of a small case series (4 patients) that evaluated the effect of long-pulsed dye laser (LPDL) alone and in combination with photodynamic therapy with methylaminolevulinate (MAL-LPDL) on the treatment of papulopustular (inflammatory) rosacea.

They found no difference in the efficacy of the two therapies.

LPDL is well established for treating rosacea’s facial redness (erythema) and visible blood vessels (telangiectasis), but not for treating inflammatory bumps and pimples (papulopustular eruptions). Recent preliminary evidence has suggested, howver, that topical photodynamic therapy (PDT) may be useful in treating papulopustular rosacea.

The authors of this case series note that their findings are in contrast to the findings in two retrospective trials that had indicated a beneficial effect of conventional MAL-PDT on the treatment of inflammatory rosacea.

“[Our] limited treatment outcomes are in accordance with our clinical experience with conventional PDT for rosacea,” the authors write. “We find it important to publish these negative results, especially as none of the previously published trials have been randomized or prospectively controlled.”

Source: Togsverd-Bo K, Wiegell SR, Wulf HC, Haedersdal M. Short and limited effect of long-pulsed dye laser alone and in combination with photodynamic therapy for inflammatory rosacea. JEADV. 2009;23:169-243.

The information found on this website is not designed to replace the patient/physician relationship.

While there is no “cure” for rosacea, one of the best ways to the redness associated with the condition is through laser. Most people have heard of laser hair removal but many people do not know that many dermatologists and cosmetic surgeon that offer this procedure will likely offer laser treatment for rosacea as well. It is always best to go to a board certified dermatologist for rosacea treatments as they will be the most familiar with the condition and know how to properly treat your skin tone. Unfortunately, laser rosacea treatment is rarely covered by insurance, as it is still considered a cosmetic treatment, and the cost of a treatment would likely be about the same cost as a laser hair removal session for your face. Aside from laser, other clinics will offer IPL as a treatment for the redness, this may also be an effective treatment depending on your specific situation.

The information found on this website is not designed to replace the patient/physician relationship.

In a small, randomized double-blinded study, researchers have found that azelaic acid 20% cream is as effective as metronidazole 0.75% cream and permethrin 20% cream for treating rosacea.

The study, published in the Journal of the European Academy of Dermatology and Venereology, included 24 patients (23 women, 1 man), aged 42 to 61 years, with facial rosacea. Participants were randomly assigned to three groups. Each received one topical treatment on one side of their face and another on the other side. The creams were applied twice daily for 15 weeks. Follow-up occurred at week 3, 6, 9 and 15. To check for recurrence, monthly visits continued for 6 months after treatment was completed.

The results: All three creams were effective in treating erythema (redness) and inflammatory lesions (papules and pustules), but azelaic acid was associated with a lower degree of lesion recurrence. The incidence of mostly transient side effects, such as itching and burning, was not significantly different among the three creams.

The authors also noted that the patients “who used azelaic acid 20% cream were more satisfied than with other modalities.”

Source: Mostafa FF, El Harras MA, Al Mokadem S, Nassar AA, Abdel Gawad EH. Comparative study of some treatment modalities of rosacea. JEADV. 2009:23:22-28.

The information found on this website is not designed to replace the patient/physician relationship.

A new survey of people with rosacea offers new insight into their experiences with different treatments for their skin condition and with their health care providers.

The survey was conducted in 2006 and published in a recent issue of the Journal of Drugs in Dermatology. It included more than 2,800 people with diagnosed cases of rosacea. Participants ranged in age from 20 to 81 years (mean age = 50 years).

Here are some of the findings:

• 80% agreed that medication prevented their rosacea from worsening


• 82% planned to continue using their prescription medication


• 46% had switched at least once from another medication (primarily because
  they had not experienced significant improvement with their earlier
  medication)


• 84% of patients who had switched reported using some formulation of
  metronidazole cream


• 83% agreed that their physician (usually a dermatologist) influenced their
  use of medication


• 61% considered their physician a partner in helping them manage their
  rosacea

Source: Elewski BE. Results of a national rosacea patient survey: common issues that concern rosacea sufferers. J Drugs Dermatol. 2009;8:120-123.

The information found on this website is not designed to replace the patient/physician relationship.

People with rosacea must be careful with their choices of skin-care products, as some can contain ingredients that may trigger a skin reaction and a worsening of their symptoms. Yet there is little data on contact allergy in rosacea patients.

“This is astonishing,” note the authors of a recent study on the topic in the Journal of the European Academy of Dermatology, “as sensitive and inflamed skin may be more prone to contact sensitization, and coexistence of both phenomena in rosacea patients is probably not uncommon.”

To help supply some data, the authors designed what is perhaps the first prospective study on contact sensitization in rosacea patients. Despite the limited power of the study (which included 78 rosacea patients), the authors found positive allergic reactions to several substances, including nickel sulphate (15.4%), balsam of Peru (10.4%), and fragrance mix (5.2%).

In addition, the rosacea patients had a “strikingly high” prevalence of contact allergy to the topical antibiotic gentamicin sulphate (8%), “probably due to antibiotic treatment of rosacea-associated eye symptoms,” wrote the study’s authors.

Source: Jappe U, Schafer T, Schnuch A, Uter W. Contact allergy in patients with rosacea: a clinic-based, prospective epidemiological study. JEADV. 2008;22:1208-1214.

The information found on this website is not designed to replace the patient/physician relationship.

People with rosacea are three times more likely to have a family member who also has the skin disorder, according to new research presented in March at the annual meeting of the American Academy of Dermatology.

The research also showed that rosacea patients are about nine times more likely to have a history of blistering sunburns than people without the condition.

The research was presented by Alexa Boer Kimball, MD, associate professor of dermatology at Harvard Medical School in Boston. It was a case-controlled study and involved 130 participants, aged 18 to 86. Half had rosacea; half did not.

The study was unable to determine if the sunburns contributed to the rosacea or if people with the condition try to “self-treat” by overexposing themselves to the sun. No matter which of these proves to be true, Dr. Kimball recommended that families with a history of rosacea be vigilant about protecting themselves—and their children—from sunburns. She also urged rosacea patients to seek treatment for their condition from a dermatologist as soon as symptoms appear.

Source: American Academy of Dermatology

The information found on this website is not designed to replace the patient/physician relationship.