Vascular redness comes from wear and tear on the small vessels in the skin caused by repeated flushing. “Spider veins” or telangiectasia: small red-bluish/purple vessels appear, often on the nose, cheeks, and chin (facial prominences prone to more sun damage)
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Causes of Rosacea
Occurs in both genders, mostly in fair skinned Caucasians but can affect Asians and Africans. Onset usually after age 30 but can begin in adolescence. Unmasked by repeated trigger exposure: hot or cold temperatures, exercise, spicy food, alcohol, coffee, tea, chocolate, emotions, cosmetics, topical irritants, some medications, and stress. Aggravating conditions include menopausal flushes, high blood pressure, smoking, and sun damage. While it is impossible to constantly avoid all the triggers, it is helpful to identify your individual triggers and minimize them as much as possible.
Prescription creams/gelsTopical antibiotics applied to the skin help to treat and prevent rosaceous acne pimples. (They do not have an effect on spider veins).
Oral antibioticsSome oral antibiotics are helpful for managing rosaceous acne pimples by having an anti-inflammatory effect. They minimize flushing and treat eye complications.
Pulsed dye laser (PDL)This yellow light laser targets the red pigment hemaglobin and precisely destroys the vessel by heat injury. This injury causes an instant blue-purple bruise, which may last for 7-10 days. As the bruise fades the spider vein is either cleared or less visible. 90% of patients achieve clearance in a single treatment.
KTP laser treatmentA green light laser that clears redness and vessels without bruising. Less effective than the PDL but often selected by patients to avoid bruising but there is some swelling for about 3 days.
IPL(Fotofacial™ treatments)Best suited for generalized redness covering most of the face, with fine spider veins. 3-5 sessions, I month apart, achieves gradual global improvement of redness, spider veins and incidental brown pigmentation, such as freckles and brown spots from sun-damage. Very acceptable for patients who want to avoid bruising. Less ideal for severe telangiectasia than the PDL, where bruising is the price for more efficacy.
- Identify personal triggers and modify behaviour and lifestyle where feasible.
- Stop smoking.
- Use a gentle cleanser like Dove soap for sensitive skin.
- Wear mineral based make-up and avoid alcohol based toners, astringents etc. Wear a zinc oxide sunscreen daily. Avoid chemical/organic sunscreens as much as possible. Protect skin from cold or frostbite.
- For acne rosacea: Topical antibiotics like clindamycin or erythromycin in the morning under the sunscreen with topical metronidazole cream or gel, or azelaic acid at night. Sometimes oral antibiotics are required as an alternative to topical therapy as initial treatment for severe acne or to achieve control when patients are not responding. Avoid retinoic acid when acne is flaring but it may help rejuvenate the skin when acne is quiescent.
You cannot change your genetics but flushing improves with age. Rosacea keeps you honest, as in poker and in life situations, your flushing gives you away every time. Laser and light based therapy now play an important role in addition to medical management and achieve results that were not previously obtained with medication alone.