Moderating the problem of rosacea

Key Points

The options for treating rosacea and getting rid of the redness that develops across the cheeks, nose, forehead and chin are not that extensive. They boil down to preventing it, and treating it.

Jeffrey Weinberg, M.D., F.A.A.D., assistant clinical professor of dermatology at Columbia University, contends, "Getting rid of the redness is the hardest part of rosacea. Some individuals just have that flush-and-blush type of complexion that reacts to a lot of different stimuli in their environment, which cause them to flush.

Different stimuli can have a different impact on various patients, and it may take trial and error for the patient to determine which substances or events provoke a reaction in the skin.

Beyond behavior modification, Dr. Weinberg says the most common method for reducing redness is pharmacologic intervention - both topical and oral.

"My top two topical products are Finacea gel and Elidel (pimecrolimus, Novartis) Cream. The Finacea gel is a 15 percent azelaic acid gel and is made by Intendis. I prescribe that for use twice daily. I will also recommend Elidel Cream 1 percent twice daily because we want to avoid steroid use in rosacea."

Steroids can sometimes reduce inflammation in the short term, Dr. Weinberg says, but steroids can also cause medium- to long-term side effects that can actually counter the results the physician and the rosacea patient are trying to achieve.

"Steroids can be a short-term fix, but they can actually thin the skin and cause dilated blood vessels, which is what we're fighting in the first place. It will exacerbate the rosacea," he says.

A new non-steroidal topical option is on the horizon, Dr. Weinberg says. CollaGenex Pharmaceuticals recently completed a phase 2 study on the effectiveness of COL-118 in reducing the erythema that can occur with rosacea, according to a recent press release from the company.

In addition to the topical, Dr. Weinberg says oral antibiotics can also be useful sometimes.

"I will prescribe Oracea, also from CollaGenex, 40 mg once a day. That, or a traditional antibiotic alternative can sometimes help reduce erythema."

Dr. Weinberg often refers patients for laser treatment in advance of starting antibiotic treatments.

"I find that laser treatment with a pulsed dye or other vascular laser can be helpful, especially if the patients have a lot of telangiectasias. For patients who have a lot of dilated blood vessels, it's not necessarily permanent, but in the short term, the laser can certainly provide a good therapeutic option."

Dr. Weinberg reiterates that there is no "magic bullet" for eliminating skin redness in rosacea patients, but that long-term behavior modification is probably the best place to start.

"This is a chronic condition, and you have to assume that, even when rosacea seems to be under control, it will return.

"Sometimes lifestyle changes are not sufficient. People may react whether they've removed the triggers in their lives or not. You're looking for things to cover all your bases. You can't cure rosacea; you're just looking for ways to moderate the problem."