How to Beat Rosacea
Freaking out over chronic zits on your face? It may not be run-of-the-mill acne but rosacea, a common skin disorder that affects about 16 million U.S. adults, according to the National Rosacea Society. Experts donâ€™t know what causes it, but it typically affects men and women older than 30.Rosacea is easy to ignore at first. Redness and facial flushing â€“ often the disorderâ€™s early stage â€“ is mild and intermittent, so many people donâ€™t treat it. But the redness can get worse, progressing to pus-filled pimples, broken capillary veins, eye inflammation and, rarely, a bulbous nose, like former president and rosacea sufferer Bill Clinton had. Patients can have a single symptom or start with one and progress to another, says John Wolf, M.D., professor and chairman of the dermatology department at Baylor College of Medicine in Houston. â€œWe donâ€™t know why one patient gets a red face and [another] gets an acne-like case,â€ he says.
Thatâ€™s what makes treating rosacea difficult. Different symptoms require a varied arsenal of remedies â€“ including topical lotions, antibiotics and laser procedures â€“ that cost from $12-$2,500 per treatment.Another challenge: No two people respond the same to treatments. For mild cases, over-the-counter creams and gels might work. For others, medication, such as topical antibiotics, will clear up symptoms. But some sufferers might need a combination of therapies, such as topical and oral drugs.Even then, â€œtreatment may not meet all your expectations,â€ warns Diane Berson, assistant professor of dermatology at Weill Cornell Medical College, New York. â€œIt requires patienceâ€¦ We can improve your case, but not cure it.â€ Another key to managing the disorder is early treatment. Hereâ€™s a guide to 4 common rosacea therapies. Find out which is best for you.
Rosacea Treatment #1: DrugstoreRemediesSome over-the-counter products can help early-stage rosacea inflammation, but most have limited results, Berson says. They mainly moisturize and soothe irritated skin.The good: Lotions, such as Zenmed and Booster Blue, diminish redness and irritation. â€œLook for moisturizing and botanical ingredients,â€ Berson says. â€œTry soy, green tea, oatmeal extract.â€The bad: Some ingredients in lotions and cleansers may irritate rosacea. Avoid drying products with vitamin A or C, alcohol and anything with acid and benzoyl peroxide, which are often used to fight acne. Rosacea Treatment #2: Topical Prescription MedicationsTopical drugs typically are used for long- term maintenance once the disorder is under control.Doctors usually prescribe three medications: azelaic acid, which reduces bacterial growth; the antibiotics metronidazole and sodium sulfacetamide; and sulfur, which helps eliminate pimples.
Some sufferers use steroid, or anti-inflammatory, solutions to decrease redness, but many dermatologists strongly advise against them because they â€œultimately make rosacea worse,â€ Berson says. The same goes for vitamin-A- based retinoids.The good: Although not the strongest remedy, surface solutions are effective because they reduce redness, often in 3-4 weeks. More complicated rosacea cases often require a combination of therapies.The bad: Skin can take quite a beating because these drugs may cause temporary burning, stinging, itching and irritation.Rosacea Treatment #3: Oral MedicationsWhen topical solutions fail to clear up redness and pimples, dermatologists reach next for anti-inflammatory oral medications. Here are three common oral treatments: Non- antibiotic dosage of doxycycline (also called anti-inflammatory dosage). At a40- milligram daily dosage, it stops inflammation but wonâ€™t kill bacteria. The good: Itâ€™s very effective for rosacea pimples. Plus, the low dose allows you to take it for several months or longer with few side effects. Most important: Because it doesnâ€™t eliminate bacteria, patients typically donâ€™t develop antibiotic resistance, a worry with long-term use of higher doses of doxycycline. When bacteria and other organisms survive an antibioticâ€™s deadly effects, itâ€™s much harder to treat more serious illnesses, such as tuberculosis, pneumonia and staph infections.
â€œThis low-dose drug is like people taking a baby aspirin daily to prevent a stroke,â€ says Hilary Baldwin, M.D., associate professor and vice chair of the department of dermatology at State University of New York Downstate in Brooklyn, N.Y. â€œIf you have a bad headache, you take more.â€ The low-dose doxycycline is safe for inflammation, not full-blown adult acne, says Dr. Baldwin. The bad: It can be costly â€“ about $150 per month â€“ but is usually covered by insurance.Oral antibiotics: doxycycline at 50â€“100mg daily, or erythromycin, minocycline and tetracycline: These are commonly prescribed for rosacea for 2-3 months or longer.For patients who canâ€™t tolerate the above antibiotics, azithromycin and clarithromycin are substitutes. They are, however, much more expensive. A six- day packet of azithromycin costs $49. A monthâ€™s supply of erythromycin is about $17; minocycline, $42; tetracycline, $15.The good: Oral antibioticswork faster than topical antibiotics for treating rosacea pimples. Youâ€™ll see results after about three weeks. The bad: Antibiotics have many side effects, including antibiotic resistance. You may also experience heartburn and upset stomach, yeast infections, a sensitivity to light, dizziness and lupus-like symptoms, such as muscle and joint pain.
IsotretinoinOften used to treat severe acne, this drug (which comes in 10-dose packs) reduces skin oil production to a normal level and prevents pores from clogging, a common rosacea trigger. But it works slower on rosacea than on acne and often requires a higher dose. The good: Isotretinoin is the most effective therapy to treat rosacea acne. Berson prescribes it â€œwhen patients have rosacea and acne that doesn't respond to treatment.â€The bad: It has some significant negatives. When on the medication, you must have frequent blood tests to monitor potential liver damage and elevated cholesterol levels.Some patients even may experience depression and suicidal thoughts.Women on isotretinoin face another hazard: severe birth defects if they become pregnant. Two negative pregnancy test results are required before starting treatment and one every month on the drug. Also, two effective forms of birth control must be used during treatment.Minor side effects include dry lips and skin, and sun sensitivity.Itâ€™s also expensive: $173 per month for a multi-month treatment that insurance may not cover.
Rosacea Treatment #4: Laser There are two main laser treatments â€“ Intense Pulsed Light (IPL) and Pulsed Dye Laser (PDL) â€“ used primarily for people with redness that doesnâ€™t respond to other treatments. IPL is very effective on mild, diffuse redness and gets rid of small blood vessels by delivering multiple wavelengths of light to affected areas, keeping the top skin layer intact.During the 20- minute procedure, light destroys damaged blood vessels and capillaries. Then the bodyâ€™s natural healing processes remove injured skin layers, resulting in a more even appearance. Three or four treatments usually are needed, about one per month. Results vary: In some, symptoms vanish for long periods â€“ even years. In others, they reappear in six months.PDL treatmentis recommended for patients with larger, visible blood vessels. The extra-long pulse delivers an intense, but gentle, burst of light in a single wavelength, which is absorbed by unwanted blood vessels on the skinâ€™s surface.
The good: IPL and PDL treatments work well, often ridding skin of tiny blood vessels, pustules and redness â€“ permanently, if the patient is lucky. Thereâ€™s little down time after IPL procedures, so patients can head back to work the next day. PDL patients require 7-10 days of recovery.The bad: Think twice about getting multiple treatments over the years. Lasers that chip away at redness and pigment can â€œtake the peach out of a peaches-and-cream complexion,â€ Dr. Baldwin says.Avoid IPL treatments when pregnant because hormones may alter the way skin responds.Otherwise, the negatives are economic: IPL and PDL treatments are costly and arenâ€™t covered by insurance.A consultation alone costs about $350, says Dr. Baldwin. â€œI'd pay $2,500 if it works, but if I have to do it again in six months, itâ€™s not a great deal,â€ she says.
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