Best Course of Treatment for Mild-Moderate Rosacea

I have mild-moderate Rosacea. I have telangiectasias on my nose, constantflusing in my cheeks, and a few spider veins on my cheeks and the area between my nose/ upper lip. Several weeks ago, my doc prescribed Finacea (once/day). I have not noticed improvement, and I now have several acne papules on my cheeks -- I am worried it is getting worse. I am wondering whether specific antibiotics, IPL, a pulsed-dye laser, or some combination of all of the above should be used to help my condition?

Doctor Answers 5

Consider Treating Rosacea with Laser Therapy

Telengiectasias ( tiny broken capillaries) can be a result of sun-damage or Rosacea and are more prevalent in some skin types than others. These can easily be treated with vascular lasers or IPLs but they will return over time with additional exposures ( sun, spicy foods, altitude, etc) and aging!

We advise monthly IPL treatments with LimeLight until clear ( usually 2 or 3 ) and then maintainence IPL treatments every 3-4 months to minimize correction. You'll be surprised how easily laser treatments such as Cutera's Limelight or Genesis can help to eliminate the broken blood vessels!

San Juan Capistrano Physician
5.0 out of 5 stars 1 review

Of course you seem to be troubled principally by the erythrotelangiectatic type of

rosacea...the likelihood of finacea working is relatively small since it's primarily directed at a different form of rosacea...the papulo-pustular type...however both improve with VBeam laser treatment...the pulse dye laser...should provide a large degree of improvement from your skin condition...antibiotics probably won't offer much benefit either...they work on the papulo-pustular type...good luck with your treatment...just need to get the one that's meant for your type or stage of disease...

Ken Landow, MD
Las Vegas Dermatologist
4.6 out of 5 stars 9 reviews

Combining medical and laser therapy for rosacea

Rosacea is a chronic condition that can present with variable symptoms.  Most people with rosacea turn red or flush easily, especially with exposure to sun, heat, exercise, alcohol, or spicy foods.  Repeated flushing and sun damaged skin can result in the appearance of enlarged blood vessels (telangiectasias) on the skin.  Some people with rosacea also may develop acne-like papules (usually on the nose and cheeks) and thickening of the skin with the appearance of enlarged pores on the nose and mid-face.  The exact cause of rosacea is unknown, but there are many factors involved so there is usually not one treatment that works for everyone.  Sun protection and avoiding the triggers that make you flush is essential, but medications are often needed to keep the disease under control.  Finacea and Metrogel are the most popular topical treatments for rosacea and may reduce the acne-like breakouts and decrease the redness slightly.  If they are ineffective alone, I usually will add a low-dose antibiotic such as doxycycline.  The medical treatments will not remove the telangiectasias, however.   That can only be achieved with a vascular laser or IPL device.  Most people require 3-5 treatments with the laser or IPL to achieve the best results, but because rosacea is a chronic condition, occasional touch-ups may be necessary.  Studies have shown that treatment with the laser does not affect the course of the disease (i.e. it is not a cure), so I always combine lasers with medical therapies and sun protection. 

Nancy Samolitis, MD
West Hollywood Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Pulsed Dye Lasers For Rosacea

   While there is no cure for rosacea, there are many things you can do to manage this frustrating condition.  One viable option for rosacea treatment is Pulsed Dye Laser therapy.  Unlike topical modalities, pulsed dye lasers are addressing the superficial vessels that are responsible for redness, flushing, and teleangiectasias.  The goal is to use laser energy to shut down the walls of these vessels.  Laser therapy provides improvement in texture as well.   

   If you choose to move forward with laser therapy, it is important to discontinue the oral antibiotics (i.e Finacea) as these are photosensitizing.  Do your research to ensure that your provider is using the appropriate type of laser for your skin and condition.  For many patients, pulsed dye laser therapy is an effective,  longer lasting option for managing rosacea.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Rosacea Treatment

Since Finacea isn't helping,  your doc probably has other treatments in mind. MetroGel is the other most commonly prescribed topical for rosacea. You should pair whatever topical medication with a non-irritating cleanser and sunscreen.

A very effective way of improving almost everything you describe is one of the tetracycline antibiotics by mouth. They go by names such as doxycycline, minocycline, and Oracea and have proven the most powerful tool in fighting rosacea.

Lasers and IPL's certainly would be the best way to get rid of the telangiectasia (red line type small blood vessels). 

To help with flushing, keep some ice water handy for sipping. The cold water in the back of the throat will help tone down the flushing. Hot drinks usually make flushing worse. Call your doc for some help and good luck finding what works for you!

T. Wayne Day, MD
Nashville Dermatologic Surgeon
5.0 out of 5 stars 1 review

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.