Rosacea - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Rosacea or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Treatments:a topical and oral medication, PDL (VBeam), photodynamic therapy, CO2 laser therapy.
Most individuals with rosacea experience blushing or flushing over the central face with trigger factors such as sun exposure, drinking hot beverages or alcohol, or eating spicy food. Persistent central facial redness is often present. The underlying enlarged vessels can very efficiently be treated by vascular lasers, greatly improving background redness as well as diminishing flushing with rosacea triggers.
Inflammatory rosacea presents with red papules or pustules and requires topical or oral anti-inflammatory agents, or when recalcitrant, photodynamic therapy. Men may develop an overgrowth of tissue on the nose in response to long-standing rosacea that can be corrected by CO2 laser ablation.
Ocular rosacea may be misdiagnosed if rosacea does not affect the skin. Oral anti-inflammatory antibiotics may be crucial to prevent the possible destruction of eyesight.
Dr. I apologize that this is somewhat off topic but seemed a reasonable place to ask this question. I’m currently being seen in Haverford for poikioloderma. Propanolol has helped somewhat with flushing but I’m interested in taking a more aggressive step. In your experience would you recommend vbeam or IPL? I realize a consultation is necessary, but I’m interested in the overall success of this approach. Thank you
PDL and IPL both work for most types of poikiloderma. Occasionally, an alexandrite laser might have to be added for best results. If poikiloderma does not improve after 2-3 treatments, we do not continue treatments. Most people who are responders gradually clear in 4-5 treatments.
Your practice did a phenomenal job with my daughter’s adult acne. Thank you!
Now it is my turn – I have rosacea and lots of sebaceous hyperplasia lesions and 2 dermatologists in the area said there was no treatment. I am worried particularly about the sebaceous hyperplasia – new lesions are popping up every month. Is there a way to 1) remove the ones I have, and 2) prevent new ones from popping up? Is this a virus or bacterial infection?
Thanks so much for your consideration.
The only effective treatment for sebaceous gland hyperplasia is the Smoothbeam laser. It targets oil glands and destroys them. The treatment causes a small blister of the enlarged oil gland that then scabs and resolves in about 6 days. One to 3 treatments will effectively and permanently destroy the sebaceous hyperplasia in fair skinned individuals. Unfortunately, there is no preventative treatment yet for sebaceous gland hyperplasia. The ability to develop these over time appears to be a genetic trait. It is unclear if reduction of oil glands, for example with photo-dynamic therapy, can reduce the rate of new sebaceous gland enlargement.
You may schedule your treatment.
Rosacea cannot yet be cured. If skin is predominantly red, laser and IPL treatment is available to subdue this. In inflammatory rosacea that goes along with small red bumps and pustules, anti-inflammatory treatment is available. In all types of rosacea, hydration of skin is key and I strongly recommend Neutrogena Hydroboost gel for oily skin or gel cream for dry skin as a baseline moisturizer.
I am interested in receiving laser treatment for my rosacea. I understand the lasers are very effective. I’m had 3 laser treatments (in the past 9 months) from dermatologists in the area that cost me a lot of money. However, these lasers did little to improve my situation. I need a program of more treatments and I’m on a limited budget. How much would (4) V-beam laser treatments cost? While cosmetic in nature, I longgg for the doctor who realizes what we patients go through. Would you consider offering people who suffer from chronic long standing a discount on monthly/yearly treatments? I would hope that more patients would loyally follow a doctor who sympathizes with suffers who are forced to live with this horrible condition who need repeated treatments living on a fixed income. The insurance companies are horrible. I don’t know what it is like to go out without makeup. I have many girlfriends and family members who suffer as well. I won’t consider swimming because I am so ashamed of my face. I know about Carecredit, (pay on it all year long) but hope there is something more for the long term, meaning people who would be long-term patients at a more reasonable price. I certainly would. Please respond. I know that are many people who feel the same way. : ( Not living life at the fullest….
I agree that many people suffer from the noticeable redness of rosacea and find it extremely bothersome. Pulsed dye laser treatment is the gold standard for fair skinned individuals and most people need 3-5 treatments to achieve significant reduction in their redness. The results after this series of pulsed dye laser treatments should last about 7 years. Rarely, redness associated with rosacea is stubborn and does not respond to 3-5 treatments. I have cared for individuals who needed up to 10 PDL or any combination of laser and IPL treatment to get to these results. We do make financial adjustment in those who do not respond like the average and we do not exceed a certain fee while continuing treatment. Without knowing your skin type and the types of laser you have been treated with, I am unable to provide a fair assessment of your case. I urge you to make an appointment for medical evaluation with one of our dermatologist so that we can decipher the shortcomings and develop an appropriate treatment plan.
I have Facial Telangiectasia and rosacea. What would be the appropriate treatment to address the Telangiectasia. I’m not sure which type of laser treatment would be best to treat my conditions
Thank you in advance,
The best laser for facial telangiectases and redness from rosacea is the V-beam perfecta, a pulsed dye laser. You are a candidate for treatment if your skin is light and if you do not have a tan. If your skin tone is Mediterranean, light Asian or darker than that, an Nd:YAG laser is the best treatment. Please schedule an appointment for consultation.
Hi Dr. Ringpfeil,
Does your office offer Platelet Rich Plasma facial rejuvenation? And is that safe for people with rosacea?
At this time, we do not offer platelet rich plasma treatment.
If you have rosacea, will insurance cover the cost of the laser treatment? What treatments for rosacea are covered?
Laser treatment for rosacea is highly effective for reduction of background redness and enlarged capillaries. While it can temporarily improve breakouts in some with inflammatory rosacea, it is not a standard treatment. Unfortunately, laser treatment is not covered by insurances for either indication. Insurances cover prescription medicines for inflammatory rosacea such as topical and oral antibiotics and ant-inflammatory agents. Some insurances may even cover a topical prescription medicine (Mirvaso) that reduces redness for 8-10 hours during the day.
Hi, I was just diagnosed with possible rosacea from one of your dermatologists. I have a small amount of bumps, but mostly redness on my cheeks. I was prescribed Metrocream and Sumaxin wash. The dermatologist told me this should get rid of bumps, but I was wondering what will get rid of the redness. Also, if I do have rosacea, will it get worse? Is there any tips you recommend for someone experiencing mostly redness. Thanks
Background redness is a very common trait in rosacea. It is not known whether it worsens over time. Several factors influence facial redness, specifically heat, sun exposure, stress and certain foods. Long term reduction of facial or chest redness associated with rosacea can be achieved with a series of 3-5 laser treatments. Intense pulsed light provides excellent short term results when you do not have a lot of time before an important event. Periodic maintenance is needed to sustain results. A topical cream “Mirvaso” provides immediate results that last 8-12 hours. Please note that reduction of facial redness by any of these means does not influence your inflammatory rosacea (small bumps). They are best corrected with stress reduction techniques as well as anti-inflammatoiry topical peels, gels lotions or creams or oral probiotics, oral niacin/mineral combinations supplements and anti-inflammatory medication.
I have two questions regarding pulsed laser dye for rosacea:
(1) I’ve seen photos on the Internet of red blotches/bruising on the skin. Does this indicate stronger and therefore more effective treatments? Or can treatments be just as effective without the bruising?
(2) I am trying to become pregnant. Could I still have the laser procedure?
Also, regarding Mirvosa, I’ve read that it can be extremely effective, but also read anecdotal stories from patients of terrible rebound effects. What is accurate regarding the drug?
Bruising with PDL can be avoided since the V-beam perfecta was created in 2005. However, some people may still develop red blotches can last for several weeks (not bruises).
In general, we discourage any elective treatment during a pregnancy. PDL can safely be performed before you get pregnant.
Mirvaso is indeed very effective as an anti-redness medication. The “rebound phenomenon” described by several who have used it might be true in very few cases. Most of the time, Mirvaso was used at the onset of an inflammatory flare to reduce concomitant redness. The flare progressed because it was not adequately treated by anti-inflammatory agents and the anti-redness treatment cannot treat inflammation.
Hello Dr. Ringpfeil, For the past few years I have suffered with Rosacea with mild acne on my cheeks (I do have some mild scars leftover from acne during my teenage years 15-20 years ago). I’m very interested in receiving pulse dye laser treatment and am curious if this is something that would work on this condition for my current rosacea and cheek redness.
Pulsed dye laser is exactly for the cheek redness with rosacea. After several treatments 4-6 weeks apart, this background redness is much improved and results stay for several years. Pulsed dye laser treats the inflammatory component of rosacea, which are small red bumps with or without pus, only temporarily. Inflammatory rosacea requires proper hydration of your body and skin, proper sun protection and might even require topical oral anti-inflammatory treatments.
I just started used Mirvaso for severe redness and it is working but I am not breaking out with the little pimple like imflamation on my cheeks. I also have used and still use at night the Metrogel which will work when used for a long period of time. I was wondering if I could use these 2 medications together or should I just use the metrogel at night and the mirvaso during the day? Thanks so much for your answer.
Tiny little pimples or pustules on the cheeks in individuals with rosacea are the hallmark of inflammatory rosacea. Common topical treatments for inflammatory rosacea are Soolantra and Metro-Cream in people with dry skin, and benzoylperoxide, Finacea or Metro-Gel in people with normal or oily skin.
Mirvaso or pulsed dye laser treat only the widened blood vessels that show as the red background skin in rosacea. Treatments for the red background as well as for inflammation can usually be used at the same time.