Was Told I Have Rosacea and Should Take Accutane, Does That Seem Right? (Photos)

my skin is raised on cheeks. i used harsh acne products and this has been there for months now. looks worse after showering and putting moisturizer. it also has little holes like open pores.my derm thinks its rosacea and wants to put me on accutane. it is very frustrating because the swollen part around nose under eyes makes me look like i have deep wrinkles.please help.i feel helpless

Doctor Answers 1

How to treat rosacea

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From your photos you appear to have relatively mild rosacea. I will discuss treatment of rosacea below, but also would recommend starting with some topical medications and avoidance of rosacea triggers before moving on to something like Accutane.  Accutane works well for severe inflammatory rosacea, but for milder cases, start with something less potent.

Rosacea is a skin condition that causes redness, dilated capillaries, red papules and pustules on the face. Rosacea usually starts with easy flushing or blushing and may or may not progress to other lesions like pustules and papules. Rosacea is a chronic condition and some form of treatment/long term maintenance is usually needed.

Rosacea is aggravated by anything that warms the face, such as hot showers, direct sunlight,saunas/steamrooms, wind, spicy foods, hot drinks, alcohol, stress and exercise (more on the exercise below).  Applications of topical steroid creams to the face can actually cause rosacea/perioral dermatitis as well.

Topical and oral medications that treat rosacea usually work for the papular/pustular/inflammatory components, but are not very effective for the dilated blood vessels.

For mild rosacea, I recommend starting with topical medications and avoiding rosacea triggers, those that cause the face to flush or blush (listed above).  One shouldn't stop exercising so that rosacea doesn't flare.  Instead, immediately after exercise, wet a washcloth or paper towel with cool water and hold to your face for several minutes.  That will help shrink blood vessels.

    Topical prescription medications for rosacea include:

  • Metrogel  (topical metronidazole). This also contains some niacinamide which acts and calming and anti-inflammatory medication.
  • Sulfur/sulfacetamide combinations like Rosula, Clarifoam, and others
  • Aczone gel (topical dapsone)
  • Finacea

Oral medications include:

  • tetracycline class antibiotics. These work very well for ocular rosacea, where we cannot use any topical medications.
  • for very resistant cases, isotretinoin (generic of Accutane)

 For persistent redness and/or dilated blood vessels, laser or intense pulsed light treatments are the most effective. Laser treatments help shrink the blood vessels and improve the redness and sensitivity of the skin.

There are some medications that can be applied in a pinch to shrink broken capillaries for a few hours, such as for an important event, but those are usually not part of the regular treatment of rosacea.

Short Hills Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.