PracticalDermatology

Even though many patients are “staying home,” they are still going outdoors for fresh air and exercise. What are some of your top recommendations for SPF for patients with rosacea?

Jennifer Deaver Peterson, MD: Sun is a known trigger for rosacea patients, making sunscreen an essential part of their skincare regimen. I recommend patients use a mineral based (zinc oxide and/or titanium dioxide) sunscreen to provide broad spectrum coverage and to reduce the incidence of irritation that may occur with chemical based sunscreens. New, cosmetically elegant, mineral based sunscreens in cream, lotion, powder, and stick based formulations are available that blend beautifully into the skin and have high levels of patient satisfaction. I often recommend Colorescience Sunforgettable Total Protection Brush-On Shield SPF 50, Colorescience Total Protection Face Shield SPF 50, and Coola Mineral Sun Silk SPF 30.

Of the different classes of drugs used to treat rosacea, which are intended for regular use and which might patients best view as “as-needed”?

Dr. Deaver Peterson: There is no cure for rosacea, but there are a variety of effective topical and oral medications available to control and manage it. Many rosacea treatments are directed toward reducing the papulopustular lesions of rosacea and require long-term use. This includes topical azelaic acid (Finacea), metronidazole (Metrogel and Metrocream), and ivermectin (Soolantra), and oral antibiotics in the tetracycline family, such as Oracea. Topical alpha-adrenergic agonists, such as brimonidine (Mirvaso) and oxymetazoline (Rhofade), typically reduce the facial erythema of rosacea for about eight hours.

Are there any new OTC products or ingredients you recommend for patients with rosacea?

Dr. Deaver Peterson: Sensitivity and irritation to facial skincare products, such as exfoliating cleansers and over-the-counter acne products, are common in rosacea patients. I recommend using a gentle skincare regimen. Patients should wash their face with a gentle, mild, non-abrasive cleanser and blot their skin dry. They should avoid alcohol-containing skincare products, witch hazel, fragrances, abrasive skincare products, and skin scrubs, as these can cause redness, burning, stinging, and irritation.

My favorite cleansers for my rosacea sufferers include CeraVe Hydrating Cleanser, Caudalie Gentle Cleansing Milk, and Avene Micellar Lotion Cleanser. A variety of soothing and calming products are available to reduce facial erythema, such as SkinCeuticals Phyto Corrective Gel, Neocutis Peche Redness Reducing Serum, and Colorescience AllCalm SPF 50. Ingredients vary between lines but are often based on a variety of botanical ingredients, niacinamide, and antioxidants.

With more down-time, patients may be tempted to try at-home peels or other interventions they wouldn’t use if they knew they’d be seen out and about. Do you have any cautions? Any products that can be used?

Dr. Deaver Peterson: Abrasive skincare products, chemical exfoliants, and mechanical scrubs can all cause redness, burning, stinging, and irritation in rosacea patients. Chemical peels are generally not recommended, as they have the potential to worsen redness and the appearance of blood vessels.

For patients looking for home treatments, I recommend soothing and calming masks that do not exfoliate the skin and are devoid of ingredients like alpha hydroxy acids, beta hydroxy acids, fruit acids, and retinols. These include SkinCeuticals Phyto Corrective Gel and Avene Antirougers Calm Soothing Repair.

When the time comes, to return to work, school, etc. , what are your recommendations to jump-start treatment so patients can look their best?

Dr. Deaver Peterson: My best advice to rosacea patients is to maintain their gentle skincare regimen, continue their rosacea prescription medications, minimize their individual rosacea triggers, and minimize stress level. Also, make sure patients are aware they can visit their dermatologist via telehealth during the COVID crisis to get more help in controlling their triggers and symptoms.

Are there aesthetic services/procedures patients can consider once they are able to get into the office?

Dr. Deaver Peterson: Absolutely! A variety of vascular lasers and light devices, such as intense pulsed light (IPL), pulsed dye laser (PDL), and KTP laser, can all improve the signs of rosacea by decreasing facial erythema and telangiectasias. These treatments are performed at monthly intervals followed by maintenance treatments every six to 12 months.

As many rosacea patients also have visible signs of photoaging in the form of facial lentigines, I prefer to use IPL (with the Lumenis M22) in order to simultaneously address redness, telangiectasias, and lentigines. If the photodamage extends down the neck and chest, I also recommend to treat these areas to produce a more uniform and aesthetically pleasing result.