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Rosacea and Facial Redness

Author: Dr Naomi / 28 Oct 2015

What is rosacea?

Rosacea is a chronic condition characterised by

* Facial redness (erythema) usually permanent and variable

and often associated with

* Pimples

It most often affects caucasians, and those with lighter skin tones

Rosacea usually starts on the cheeks, nose, forehead and chin with redness. As it progresses other signs and symptoms may occur:

* Facial capillaries (telangiectasia)

* Red papules (bumps)

* Pustules (lumps filled with pus ie pimples)

Some patients have a burning or stinging discomfort associated, or grittiness in their eyes and rarely a red lobulated nose

Causes

Cause is unknown, but many patients are aware of their triggers for rosacea. Possible triggers include:

HEAT CAUSES: Sun exposure, hot weather, hot baths, hot drinks, indoor heat

EMOTIONAL STRESS

COLD,: cold weather, wind

EXERCISE

ALCOHOL CONSUMPTION

TOPICAL SKIN CREAMS OR COSMETICS

FOODS: spicy foods, certain fruits and veges, dairy, marinated meats

Treatment of rosacea

The treatment of each individual case is going to depend on the individual’s signs and symptoms. If redness and capillaries are the main issue, then laser / IPL will be the focus of treatment. If acne and lumps are the main issue, treatments will focus on this. If rhinophyma is present, this will be addressed

TYPICAL ROSACEA PROTOCOL

Patient to learn about triggers and avoid

Over the counter topicals eg AHAs, Finacea

Regular facials including LED

Prescription medications (eg Tretionoin, Rosex gel, oral or topical antibiotics)

Intensive IPL treatment program: including capillary removal 6 treatments of BBL , 2 weeks apart. After that 1 treatment per year usually sufficient

If rhinophyma present, erbium laser treatment

PROCEDURE FOR IPL for Rosacea redness and or capillaries

1. Consultation +/- test patch

Patient is to arrive with no makeup and no history of use of self tan/ spray tan for at least 2 weeks

The doctor will take a history

A. skin type and tanning

B. previous treatments and their success, complications etc

C. discussion of desired outcome

D. Assess risk of PIH

Doctor will examine the patient

Typically if the patient is Fitzpatrick 1-2 (fair skinned) then they can go ahead with the treatment on the day. If they are darker skin toned or at risk for PIH (Post inflammatory Pigmentation) then they will be advised to use topical lightening agents for 8 weeks prior to treatment. These topical agents are sold at our clinic.

Photographs will be taken

There is opportunity to ask the doctor questions about the procedure

Consent form will be given to the patient with a discussion of risks, benefits, pros and cons of the treatment. If the patient signs the consent form, the procedure will go ahead.

With rosacea, typically 6 treatments are required, minimum of 2 weeks apart. After this, the patient should have IPL / BBL at least once every 6 months

The Treatment

The appointment is 30 minutes, but BBL on the face will take about 15 minutes in total.

The patient will lay on the treatment bed

All makeup will be cleansed off the face.

Goggles will be worn by the patient to protect the eyes

Clear ultrasound gel will be applied to the face.

The procedure is painful, but most patients tolerate it very well. I do not like to use any form of anaesthetic when removing capillaries for 2 reasons

1. The laser operator really needs to know that they are not causing excessive damage to the skin. If a topical anaesthetic is used, then the patient is not able to give this feedback, and this could lead to side effects including hypopigmentation or scarring. Typically patients will describe the pain as a 7/10.

The most painful areas are typically where capillaries are common eg the corners of the nose.

After the treatment, the ultrasound  gel is gently cleaned off the skin.

Immediately after the treatment

The patient will feel a strong sunburn-like feeling over the face.

The face will be red and may have raised areas where the laser was used

It is fine to apply sunscreen or makeup immediately after the sciton BBL treatment.

At home care after sciton BBL

The sunburn-like feeling will last several hours and then nearly disappear. It will commonly be brought on again by showering.

On the drive home, it is great to have your car air-con nice and high.

Sun should be avoided. Be aware that while driving one is exposed to the sun

Sunscreen should be applied every morning and reapplied as often as is practical

A hat should be worn.

Soothing gel may be purchased from the clinic and used twice daily.

Do not use acid or antiaging face products for 2 weeks after treatment.

Often on the morning after IPL for Rosacea or capillary removal, the patient will wake up to a swollen face, particularly in the eye area. This usually resolves in the first 48 hours

What should you expect to see on your skin after full face IPL BBL?

The redness will improve in the next few hours-days after the BBL treatment.

The capillaries may disappear immediately after treatment or fine, vein-like “scabs” may appear and then lift off or crumble away. Do not pick the skin

Treatment 2-6

Treatment 2 will be at a minimum of 2 weeks after treatment 1.

Treatment 2 will proceed exactly as treatment 1, except a higher power may be used. And so on for further treatments

Complications/Risks

Facial Redness: nearly always occurs, should resolve within a few days

Facial Swelling: this can occur especially in the under eye area after Sciton BBL. This should resolve within the week.

PIH (post inflammatory hyperpigmentation) ie the laser can cause areas of brown pigmentation due to inflammation and the patient’s susceptibility to this. It is less common in the lighter skin tones.

Patients who are at risk for this are treated very differently to those who aren’t. Prevention is important, ie prelightening  is important, and steroids may be necessary after the treatment.

Blistering: This is very uncommon. If this occurs, the patient needs to call the doctor urgently

Infection: The patient may  notice a combination of the following:  redness, tenderness, swelling, pain and pus. This needs to be treated urgently. The doctor must be contacted immediately

Hypopigmentation/scarring: This is very uncommon, but possible if too high powers are used.

Rosacea on cheeks before treatment

Rosacea on cheeks before treatment

Rosacea after several treatments of BBL This is a typical result after 2-3 treatments

Rosacea after several treatments of BBL This is a typical result after 2-3 treatments

 

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