How I treat rosacea
| 8 min read
Rosacea consultations with Dr Magnus Lynch
- Consultant dermatologist - diagnosis confirmed and look-alike conditions excluded
- Prescription treatment, plus vascular laser and IPL for redness that creams and tablets cannot remove
- In person in Central London, or remotely by video
- New consultation £250 - vascular laser from £500 per session
When to see a dermatologist
Mild rosacea can sometimes be controlled with gentle skincare, sun protection and a cream from your GP. It is worth seeing a dermatologist when:
- Redness, flushing or spots have persisted despite treatment from your GP
- You are not sure whether it is rosacea, eczema, acne or something else
- Redness is constant and blood vessels are visible - creams will not remove these, but laser can
- The skin of the nose or cheeks is becoming thicker or bumpy
- Your eyes are gritty, red or sore
- Rosacea is affecting your confidence, your work or your social life
Treating rosacea early matters, because it tends to progress from flushing to persistent redness and, in some people, to thickening of the skin.
What happens at your consultation
1. Confirm the diagnosis
Facial redness has many causes and treatment only works when the diagnosis is right. Rosacea is commonly confused with facial eczema, seborrhoeic dermatitis, acne and perioral dermatitis, and more than one of these can be present at the same time. I will examine your skin carefully, and if you have been using steroid creams on your face I will check whether these are making things worse - steroids can trigger rosacea.
2. Work out which features of rosacea you have
Rosacea is not one condition but a mixture of features, and each responds to a different treatment:
- Flushing - episodes of redness, heat or stinging, often brought on by triggers
- Persistent redness and visible blood vessels (telangiectatic rosacea)
- Red bumps (papules) and pus spots (pustules), which can look like acne (papulopustular rosacea)
- Thickening of the skin, particularly of the nose (rhinophyma)
- Eye involvement - gritty, red, irritable eyes and eyelids (ocular rosacea)
3. Identify your triggers
Common triggers include alcohol, spicy food, hot drinks, heat, exercise, sunlight, stress and skincare products that irritate the skin. We will go through which are relevant for you and how to manage them without giving up everything you enjoy.
4. Agree a treatment plan
Most people need a combination: a simple skincare routine and daily sunscreen, a prescription treatment to settle the inflammation, and laser or IPL for any redness and blood vessels that remain. After the appointment you will receive a letter summarising my assessment and the plan, and you can contact me if you have questions.
Treatment options
Treatment depends on which features of rosacea you have. Below is how I approach each.
Red bumps and spots
These respond well to prescription treatment.
- Creams and gels: ivermectin (Soolantra) is particularly effective for bumps and pustules. Metronidazole and azelaic acid are alternatives, and are well suited to long-term maintenance.
- Tablets: where creams are not enough, a course of a tetracycline antibiotic such as lymecycline or doxycycline works mainly by reducing inflammation. It is usually taken for a few months, often alongside a cream.
- Low-dose isotretinoin: for rosacea that has not responded to other treatments, or where there is early thickening of the skin. It is very effective but has more potential side effects, and is prescribed under the MHRA regulations.
Persistent redness and visible blood vessels
Redness often remains even after the spots have settled, because the enlarged blood vessels are still there. Creams and tablets cannot remove these vessels, and this is where laser makes the biggest difference.
- Pulsed dye laser: my first choice for diffuse redness and fine blood vessels. The yellow light is absorbed by the blood in the vessels, which then fade.
- Nd:YAG laser: penetrates deeper and is used for larger or deeper blood vessels.
- Intense pulsed light (IPL): uses a range of wavelengths and can treat redness and brown pigmentation at the same time. It is less suitable for darker skin types.
Most people need a course of 3 to 6 sessions, about 6 weeks apart, and an occasional top-up session, for example once a year, to keep the result. Redness and swelling usually settle within a few days. For larger areas I advise a test patch first. You can read how IPL and pulsed dye laser compare.
I perform pulsed dye laser and Nd:YAG laser at 55 Harley Street (Skin55) and IPL at OneWelbeck.
- Vascular laser: from £500 per session for a small area, £550 for a standard treatment (prices)
- IPL: from £545 per session (prices)
- A consultation is needed first to confirm that laser is suitable for you
Flushing
Flushing is often the earliest and most frustrating symptom. Managing triggers helps, and there are medications that can reduce flushing, including carvedilol and other medications for facial flushing. Creams such as brimonidine and oxymetazoline temporarily reduce redness for special occasions, though some people get rebound redness. Treating the blood vessels with laser can also reduce flushing over time.
Thickening of the nose (rhinophyma)
Where rosacea has been present for many years the skin of the nose can thicken and enlarge. This is more common in men. In the early stages isotretinoin can help to prevent progression. Established thickening can be reshaped by removing the excess tissue with the carbon dioxide laser, which I perform at OneWelbeck. Treatment for rhinophyma is from £1475 (prices).
Eye symptoms (ocular rosacea)
Rosacea can cause gritty, irritable, red eyes and inflamed eyelids. Warm compresses and lid hygiene help, and tablet treatment can improve the eyes as well as the skin - see blepharitis, styes and ocular rosacea. If you have a painful red eye, sensitivity to light or any change in your vision, seek urgent advice from your GP, optician or an eye casualty department.
Skincare and sun protection
Whatever treatment you have, the foundations are the same:
- Use a gentle cleanser and a light moisturiser - for example from the Cetaphil or CeraVe ranges - and avoid products that sting.
- Use a broad-spectrum sunscreen of SPF 30 or higher every day - I like the Anthelios XL and Heliocare 360 ranges.
- Introduce new products one at a time and test them on a small area first.
You can read more about ingredients to look for and avoid and sunscreen for rosacea.
Book a rosacea consultation
Rosacea cannot be cured, but in most cases it can be controlled very effectively, and persistent redness that has been there for years can often be substantially reduced with laser. A new consultation costs £250 and a follow up £220. Remote consultations are available and work well for straightforward rosacea, but if you are interested in laser treatment an in person consultation is better so that I can assess your skin directly.
