From Your Doctor

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Medical Expert Opinion:
Rosacea Treatment

By Published September 17, 2012

  • What is your approach to treating rosacea? 

  • What is the role of medications applied to the skin?

  • What is the role of low-dose doxycycline to reduce inflammation?

  • How long should patients expect to take their rosacea medication? 

  • When are lasers, IPL or other procedures of benefit in the treatment of rosacea?

  • What important tips do you offer to patients with rosacea?

Rosacea, a lifelong and potentially progressive disorder, can be broken down into three main types:

1. ETR (Erythro-Telangiectatic Rosacea) or subtype 1 – Red, blushing, flushing rosacea, with lots of veins, and "broken capillaries".

2. PPR (Papulo-Pustular Rosacea) or subtype 2 – Multiple red acne-like bumps and pimples.

3. Rhinophyma or Subtype 3 – Enlarged "W.C. Fields" like nose.

ETR may be the initial phase of many people's rosacea. Rosacea patients' faces are red, and flush easily from various stimuli such as alcohol, caffeine, or temperature changes. Their skin is often quite sensitive, so using sensitive skin products is important. Sun protection is key to prevent long term progression of this stage, which may progress to PPR. Coverup makeups can be used, and the newer mineral makeups seem to work well and are non-irritating. Topical medicines are generally ineffective for this stage for rosacea.

Generally for ETR, the best treatment is the Pulsed Dye Laser or IPL. These lasers and light sources target the blood vessels that are the cause of this condition. With treatment, we see less redness, flushing, removal of unsightly veins, less sensitive skin, and less potential to break out in pimples. Generally 3-4 treatments are sufficient for excellent results.

Most of the medicines we use for rosacea work on PPR (the type that causes bumps and pustules). These include topicals applied to the skin, such as metronidazole (MetroGel®) and azelaic acid (Finacea®), and oral medicines such as doxcycycline (Oracea®) and minocycline.  They are very effective in decreasing the red pimples and bumps. Long-term treatment for control is the rule, and flares tend to recur as medicines are weaned. Again, treatment with a pulsed dye laser may improve PPR and decrease the frequency of flares.

Rhinophyma is generally only seen in men, and occurs much less commonly today than a few generations ago. Treatment can be with ablative lasers such as the CO2 laser, or with an electrocautery unit. With treatment, many patients find improvement in their sleep and less snoring, as well as an improved cosmetic appearance.

Be sure to consult with your board-certified dermatologist or laser specialist to determine what treatments might be best for your type of rosacea.

Visit Dr. Poole's website at Poole Dermatology.

About Rosacea

Rosacea is a chronic skin condition that affects 16 million Americans that may become increasingly severe without treatment.

Rosacea treatment options include topical medications (azelaic acid, metronidazole), oral medications (doxycycline), dermabrasion, electrocautery, chemical peels, and laser and light therapies (IPL).

The treatment recommended for a particular patient varies depending on the type of rosacea, its severity, the patient’s skin type and other variables. 

About the Doctor

Jeffrey Poole, M.D.
111 Veterans Blvd, Suite 406
Metairie, LA

Dr. Poole earned his medical degree from Tulane University School of Medicine, while on a full scholarship from the United States Air Force. Following medical school, he completed an internship and residency in Pediatrics at Keesler AFB Regional Medical Center. In addition to his private practice, Dr. Poole is also an Assistant Clinical Professor of Dermatology at both the LSU and Tulane Schools of Medicine, acting as their Pediatric and Adolescent specialist, and remains a Board Certified Pediatrician.

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