Is It Possible in Anyway to Permanently Stop Rosacea Facial Flushing?

Question

Since 18 I have started to to get a deep red, hot facial flush every time I get too hot, too cold, embarrassed, aroused or when I am exercising which is deeply humiliating for my especially in public. If that wasn't bad enough the flushing also highlights my acne scars and makes them painfully obvious. I have also read that rosacea worsens over time if untreated. I am 20 now and desperate to find the best solution since this has had a massive impact on my life. Please Help.

Harold J. Kaplan, MD · Answer

Hi OR.  Unfortunately Rosacea is not a condition that can be cured or stopped completely.  The best way to slow it's development is to avoid the common triggers below:

	Alcohol, spicy foods, caffeine, heavy exercise, saunas, hot tubs and sun and wind exposure.

	While I would never suggest that you stop exercising, understanding that this is a trigger for flushing is important.

	For treatment, you should consider oral and topical medications first and if those are not working, consider pulsed dye laser treatments.  Good luck.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Mitchel Goldman, MD · Answer

Unfortunately, there is no permanent solution for curing rosacea, but there are several effective treatments available that can minimize rosacea symptoms. I suggest you visit an experienced dermatologist for treatment, as you may be a good candidate for oral and/or topical medications, or laser treatment such as Intense Pulsed Light therapy or photodynamic therapy to reduce the redness and put the symptoms in remission.

Bruce Saal, MD · Answer

Dear OR.Nelson,
Rosacea is a very complex condition, varying in it's severity, it's responsiveness to all forms of treatment, it's inheritance
 and even it's presentation. Ask ten doctors "do I have rosacea, or something else" you will likely get ten different
 answers and ten different treatment recommendations. This isn't the doctor's fault or his lack of knowledge, but because
 in the real world, the distinctions between conditions are subtle, and may not be apparent when he or she is examining you.
 The history that you try your best to recount accurately may, unfortunately misdirect the doctor. The easiest answer for
 most happy and successful doctor patient relationships is to simply lump them all into one convenient package and call
 everything red on your face rosacea. Almost all redness will respond to topical cortisones, but the prolonged use of these
 otherwise valuable drugs can make your skin "addicted' to the cortisone and then make it that much more difficult to
 control your symptoms. At that point your doctor may suggest using a laser, the magic tool of the 21st century, but
 the use of the wrong tool in the "slightly less experienced hands" of a doctor who may be well meaning, but lacks the
 years of knowledge and skill to understand and truly treat your underlying problem, may lead you down a very expensive
 and unhappy rabbit hole. Facial flushing, which is perhaps one of the more embarrassing components of rosacea can
 usually only be partially controlled with a topical vasoconstrictor. The only one on the market today is "Mirvaso" and is a
 prescription drug which usually lasts about 6-8 hours after application. See your dermatologist for more detailed instructions.
 Oral drugs have too many side-effects (at least those available at this time) to recommend to most patients. Again see
 your dermatologist to see if you are a candidate for these chemicals. There is no cure, but with consistent use of the right
 meds for you, use of sunscreens and possibly the use of lasers for some of the smaller blood vessels that may be bothersome
 your level of control can be more than satisfactory. See a real expert before wasting your time and hard earned money.
  
Hope this helped!
Dr. S

Joshua L. Fox, MD · Answer

The best treatment for rosacea is
laser in conjunction with topical prescription medications. The V-beam and the
Excel V are two lasers that a dermatologist can use to treat your condition. A
dermatologist can also prescribe topical medications, such as Finacea, to help
maintain your results. To circumvent flushing you can try taking
over-the-counter Allegra before an important event.

Ken Landow, MD · Answer

treatment on a regular basis...especially when you're so young...but that's the current reality of the type of rosacea you seem to be suffering with...but make the best of it...try to avoid whatever triggers the flushing...less hot coffee, limit alcohol, cooler showers, etc...and avoid getting too cold during the winter months...and consider at least temporarily switching to walking or exercise in front of a fan and stop every ten minutes or so for a glass of cool water...and by far the best option...at present VBeam laser...and you'll probably need periodic retreatments with the frequency dependent on how good you keep your body temperature under control...but things are looking up...new therapies probably will address your concerns within the next year or so...

Ashley R. Curtis, MD · Answer

While rosacea is not curable, there are treatments available to regulate and minimize rosacea outbreaks. Treatments include both oral and topical prescription medications and laser procedures which can reduce inflammation and other symptoms associated with rosacea. It’s important to identify common triggers of flare-ups including sun-exposure and diet. Consult with a board certified dermatologist in your area to determine your personalized treatment plan.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Not in your best interest to have your nerves cut (or ablated) - that is the truth behind YOUR question. Personally there are many other ways to investigate and treat flushing and blushing. 
Rosacea is very complex and a tailored treatment program give the best results. This is because there are many types of rosacea (telengtctatic or capillaries, flushing and redness, acne like rosacea, ocular rosacea and even rhinophyma rosacea.)

To add to the complexity, everyone has different flare factors- Sunlight, stress, foods, chemical irritants, creams, changes in temperature, alcohol. The list goes on. A good website that educates you about rosacea is rosacea dot org

To help treat your rosacea a detailed history, together an examination is needed. Once this is established a treatment tailored according to YOUR type of rosacea will give the best results. As a guide, I use a combination of -

1. Lasers (to treat redness, broken capillaries, rhinophyma, flushing)- best laser is the V BEAM. IPL- BBL  can be used, but usually not as effective. Laser toning using the long pulse Nd Yag at 1064 can help with background redness.

2. Creams - anti inflammatory- Rozex, Azalelic acid, Solantra. Creams are effective in 30% of cases.

3. Tablets -anti - inflammatory and sometimes low dose Vitamin A. Vitamin A cream can be used in very low concentration and gradually titrated. See a medical dermatologist for this.

4. For females- Mineral make up is recommend- paraben and preservative – talc free.

For the best results, be holistic in your approach, start off with the foundations of rosacea management, - avoiding flare factors, use of anti- inflammatory agents, and then progress to

consult a dermatologist for both medical and laser treatment options,

Kind regards.

Dr Davin S. Lim.

Laser Dermatologist.

Brisbane, Australia. Real Self Advisory Board.

F. Victor Rueckl, MD (in memoriam) · Answer

Rosacea is something that is managed, not cured. There are a variety of treatments available - oral and topical products, laser therapies, light treatments, etc. Many times we use a combination of treatments for each person, addressed at targeting that specific patient's triggers. It would be best for you to see a dermatologist who specializes in traditional and cosmetic dermatology.

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