What is rosacea?

Many patients in Ireland are affected by rosacea. Rosacea is an inflammatory skin condition which manifests in several subtypes described below. Rosacea has different features in different patients. Patients almost always find their symptoms troublesome. We often find patients whose teenage years and early 20s were plagued by acne and then develop rosacea in their late 20s or 30s. However, many patients develop rosacea symptoms without ever experiencing previous skin problems.

How is rosacea diagnosed?

Firstly we should make a definitive diagnosis of rosacea as there are other conditions that look similar. It’s amazing how often rosacea is misdiagnosed. Diagnosis is primarily clinical. Dermoscopy is particularly helpful in the diagnosis of rosacea. Then we determine the particular subtype of rosacea that the patient has. People want to know what has caused their rosacea. Primarily it’s genetic but it involves a complex interplay of immunological, vascular and skin microbiome factors. Additionally we search for triggers of the patient’s rosacea. There are many factors which can trigger rosacea and it’s surprising how little known these triggers are. It’s vital that these triggers are removed from the patient’s lifestyle. Subsequent treatment then depends on the rosacea subtype.

What are the rosacea subtypes?

The first subtype is erythematotelangiectatic rosacea. This subtype is characterised by flushing, redness and sensitivity of the central face. Some patients’ flushing is situational or temporal, occurring at specific times of the day (e.g. late afternoon). Some patients have constant facial redness.

What is the treatment of the erythematotelangiectatic subtype of rosacea?

The treatment of this subtype primarily involves the use of lasers. However, many patients have been disappointed by laser treatment over the years. This usually happens when cheap lasers that lack adequate power are used. At the Skin Clinic in Drogheda we have invested heavily in cutting edge powerful lasers that produce the desired results. In fact over the past 30 years Dr. Joe Murphy has learned that the laser treatment of rosacea is complex and requires a combination of these high grade powerful expensive lasers. In the Skin Clinic in Drogheda we use carefully thought out protocols that include combinations of Sciton’s BBL Heroic and Clearsilk lasers and Candela’s Vbeam laser. Adjunctive topical treatments are also important. Dr. Joe Murphy himself suffered from annoying late afternoon flushing in recent years. He found it embarrassing and it definitely affected his quality of life. It was the combination of Sciton’s BBL Heroic and Clearsilk lasers that effectively and comprehensively treated this condition for him. It was Dr. Campo in Spain who told us about the effectiveness of this particular combination. It was this experience and the recognition that many patients suffer from embarrassing flushing and facial redness that prompted him to acquire the Sciton BBL Heroic and Clearsilk devices. He gets great satisfaction from seeing co-sufferers benefit from these prestigious technologies.

What is the treatment of papulopustular rosacea?

The second subtype of rosacea is the papulopustular variant. This is initially treated in a different manner. Initial treatment involves identification of triggers and their removal. Short courses of low-dose anti-inflammatory antibiotics are utilised in combination with topical treatments. Once the inflammatory phase is subdued it is vital to incorporate laser combination treatments to achieve a longer term solution. Generally patients want to avoid longer term courses of antibiotics as it affects their microbiome and can have unwanted side effects. Nowadays there are very effective treatments that don’t involve the use of antibiotics and it is this approach that Dr. Murphy advocates.

What is phymatous rosacea?

The third type of rosacea is phymatous rosacea which manifests as enlargement of the nose in particular and this is less common. Its treatment involves initially controlling the inflammatory component. The nasal enlargement component can then be treated with a fully ablative laser such as Sciton’s Contour TRL device.

What is ocular rosacea?

The last subtype of rosacea is ocular rosacea which is actually quite common. Sometimes it can be severe and Dr. Murphy has seen cases which could have affected the patient’s vision long term if left untreated.