White hispanic female 32, nursing a baby. I was diagnosed with rosacea when I was 24.I had acne before. I started taking Accutane when I was 20, stopped and went for a chemical peeling, no questions asked about what medicines I'd taken. The result:scarring on my cheeks worse than before. I'm using finacea but only 1 a day b/c I'm afraid it'll hurt my baby. I would like to know what option would be best for acne scars and open pores if I have rosacea (redness and some bumps)
What is the Best Option for Treating Acne Scars if I Also Have Rosacea?
Doctor Answers 1
Resurfacing, Lasers for redness, and Medications
This is a great question! Many patients have concerns of scars and redness (whether or not that redness comes from Rosacea, hormones, etc.). I recommend laser resurfacing for your acne scars. There are gentler and more aggressive options out there, including nonablative fractional lasers (Such as Fraxel Restore Dual, Palomar Artisan, others) for the gentle approach and ablative fractional lasers (Fraxel Repair, Active FX, others) for the more aggressive approach. The relatively gentle lasers do not wound the skin, and leave the treated area pink and sometimes with dry scale for about a week. The aggressive options superficially wound the skin, and leave the treated area oozing and crusty for a few days to a week after treatment and then pink for many weeks. Considering your tendency to be red already, the pinkness could certainly last a bit longer for you than the typical patient, but it shouldn't be unreasonable. I caution you, however, if you choose either of these strategies to work with a laser surgeon with substantial experience, since anyone with hispanic (or asian or black or other darker skin types) could have changes in pigment after treatment, especially if treatment is too aggressive. From what I can make of the photos you posted, I feel you could do very well with the genle approach, but you would have to plan on a series of treatments.
As for your rosacea, there are wonderful lasers available to address the red color and vessels. I recommend thinking about the pulsed-dye laser (such as the V-Beam Perfecta) for the diffuse redness and possibly the Gemini laser to trace out and eliminate any visible vessels. Our offices are working with a few laser companies right now to see if any one laser alone could give such an optimal result, but I still tend to favor the combination approach.
Finally, I would ensure a proper medical regimen for the active rosacea bumps. I understand you are nursing and truly appreciate (and recommend!) your caution when it comes to your baby. I suggest following-up with your dermatologist after nursing to discuss other options for rosacea therapy. This might include oral antibiotics and other topical medications.
In summary, once you are finished with nursing, I recommend starting a more comprehensive rosacea treatment regimen and then discussing combination therapy with nonablative fractional laser resurfacing, V-Beam Perfecta laser, and Gemini laser. After a series of treatments, you should be doing very well! Good luck!
Robert Anolik MD, Dermatologic & Laser Surgeon, New York, NY
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