Red face, red nose, red eyes – 3 Golden rules to control them

Red face, red nose, red eyes… No we are not talking about Rudolf here.

And no, we are not talking about allergies here.

And we are certainly not talking about CNY.

We are talking about ROSACEA.

Commonly known as the English Rose in the West, this condition is known to affect Caucasians.

I have seen quite a number of Singaporeans with this condition, hence I wish to share some information about this, in the hope that you can learn to identify, and manage it.

So what is Rosacea?

Rosacea consists of a set of primary and secondary features. If you have any of the primary features, you may very well have rosacea. Speak to your Dermatologist for further information.

Primary features

1. Easy Flushing
   Intermittent and easy blushing and flushing is often an early sign of rosacea.
2. Persistent Redness
   Persistent facial redness is a strong indicator.
3. Papules, bumps, pimples
   These bumps on the face resemble acne, but the distinguishing feature is the absence of blackheads and whiteheads,
4. Telangiectasia – Visible Blood Vessels
   In many people with rosacea, visible capillaries are seen, on the nose, cheeks, etc.

Secondary features

1. Eye Irritation
   Commonly, watery eyes, bloodshot eyes, can be indicative of ocular rosacea, if you have any of this you might need postoperative ocular steroid treatment to feel better. In these situations it is essential to have great eye care to prevent further complications.
2. Stinging, burning or Itch
   When you notice your skin reacts quite easily to sunlight, and various cosmetic products.
3. Dry Appearance
   A dehydrated skin is common.

So what are the subtypes of Rosacea?

(from rosacea.org)

So what are the usual triggers?

I would like to divide the triggers into

1) Exercise and stress

2) Food, alcohol

3) Sunlight, the elements

So how can we manage Rosacea?

Most importantly, stay away from triggers.

Cleanse your skin gently with soap free cleansers. Minimise overuse of skincare products.

So how can we treat rosacea?

Here I shall outline the measures taken for erythema, telangiectasia, papulo-pustular and phymatous subtypes.

For the common garden condition of erythema and telangiectasia, there are some simple measures to utilise.

Erythema control can be achieved with the following.

1) Brimodinine topical gel ( an alpha agonist which induces vasoconstriction. They work within 30 min, and effects last for up to 12 hours. Clinical studies have shown that a once daily usage of this product can help with rosacea, and it has been safe to use it.)

2) Vit C, Aloe Vera, Licorice, metronidazole topical

3) IPL ( Intense Pulse light therapy, which under a doctor’s supervision, can achieve quite beautiful results)

Telangiectasia control can be achieved with the following.

1) Pulse Dye Laser

2) IPL ( Intense Pulse Light)

3) Long pulse ND Yag Laser ( This works for the deeper vessels)

Papulo-pustular variants (bumps)

These respond to oral antibiotics, tetracycline, well.

Skin thickening variants (commonly on the nose) will require a course of isotretinoin.

======================================================================

So what happens if we dont treat Rosacea? 

(from totalpict.com)

So if you have rosacea, or think you have it, please contact your dermatologist for a consult. 

For those of you who are interested, here is the study on brimodinine.

Improvement in Facial Erythema Within 30 Minutes of Initial Application of Brimonidine Tartrate in Patients With RosaceaMark Jackson MD,^aJoseph Fowler MD,^aAngela Moore MD,^b Michael Jarratt MD,^c Terry Jones MD,^dKappa Meadows MD,^e Martin Steinhoff MD,^f Diane Rudisill BSc,^g and Matthew Leoni MD^gon behalf of the Brimonidine Phase III Study Group

^aUniversity of Louisville, Louisville, KY
^bArlington Center for Dermatology, Arlington, TX
^cDermResearch, Inc, Austin, TX
^dJ&S Studies, Inc, College Station, TX
^eThe Education & Research Foundation, Inc, Lynchburg, VA
^fUniversity of California, San Francisco, CA
^gGalderma R&D, Princeton, NJ

ABSTRACT

BACKGROUND: Brimonidine tartrate (BT) 0.5% gel demonstrated significantly greater efficacy versus vehicle gel once-daily for the treatment of moderate to severe erythema of rosacea.
OBJECTIVES: To assess the 30-minute speed of onset of topical BT 0.5% gel in reducing facial erythema in Phase III studies as measured by subject and clinician assessments of erythema.
METHODS: Two Phase III, randomized, controlled studies with identical design in which subjects with moderate erythema of rosacea (study A: n=260; study B: n=293) were randomized 1:1 to apply topical BT 0.5% or vehicle gel once-daily for 4 weeks. Evaluations included severity of erythema based on Clinician’s Erythema Assessment (CEA) and Patient’s Self-Assessment (PSA) prior to study drug application and at 30 minutes after application on days 1, 15, and 29.
RESULTS: 97.7% and 96.6% of subjects reported normal study completion for studies A and B, respectively. The percentage of subjects achieving a 1-grade improvement in both CEA and PSA was significantly increased at 30 minutes post-dosing with BT 0.5% gel compared to vehicle gel on visit days (day 1: 27.9 vs 6.9%, P<0.001; day 15: 55.9 vs 21.1%, P<0.001; Day 29: 58.3 vs 32.0%, P<0.001 for BT 0.5% gel vs vehicle) in study A. Similar results were shown for study B.
CONCLUSIONS: Once-daily topical BT gel 0.5% is not only efficacious at reducing facial erythema but also exhibits response within 30 minutes of application in a significant number of patients throughout both Phase III studies.

J Drugs Dermatol. 2014;13(6):699-704.

I hope this has been useful. Have a lovely CNY!

Stay bold and beautiful!

Dr Daniel Chang

Making Raffles Place more beautiful, one face at a time.