New ways to deal with rosacea, a skin disease with a deeper impact

Dr. Camille Introcaso consulting with rosacea patient Kathleen Parker

Kathleen Parker used to enjoy an occasional glass of wine or beer, but after just a couple of sips, her face, ears, and neck would turn bright red and start to itch. The same thing happens when she eats spicy food.

“It’s so obvious, lobster red, like I have a horrible sunburn,” said the Westmont, Camden County, woman, who has rosacea. “My other big triggers are wind and heat.”

At age 52, Parker has skin that sometimes breaks out in what looks like acne, but that, too, is rosacea. She keeps the breakouts under control with daily doxycycline, an oral antibiotic, and she’s about to start laser treatments.

Having to adjust her lifestyle – no alcohol, sunblock every day of the year, and avoiding being outdoors on windy days – has been stressful.

“My face is not just red, it’s red hot and uncomfortable, like I have my head in the oven,” she said.

Parker also suffers from ocular rosacea, “so my eyes are always bloodshot and dry,” she said.

Camera icon , Wednesday, May 9, 2018. STEVEN M. FALK / Staff Photographer
Physician Camille Introcaso consulting with rosacea patient Kathleen Parker.

It isn’t clear what exactly causes rosacea. The redness, flushing and visible blood vessels that many patients experience suggest it is a vascular disorder. Because stress is a potent trigger, the nervous system — and how it communicates with blood vessels — also has been implicated.  It affects about 16 million people in the United States, predominantly women in their 30s, 40s and 50s, said Estee Williams, a New York dermatologist and spokeswoman for the National Rosacea Society.

Although the condition is more common in women, in men it may be more severe. Rosacea mostly affects people with lighter complexions, though in patients with darker skin tones, it’s harder to diagnose. The most common symptoms are facial redness, ranging from minor flushing or blushing to red bumps that look like pimples. Skin can feel tight, dry and itchy.

The tendency to develop rosacea often runs in families, though most people who have it aren’t properly diagnosed, Williams said. Though it’s not curable, there are treatments for it.

Traditionally, treatments focused on the acne-like pimples, but in the last few years, new creams have been introduced to fight persistent redness, flushing and visible blood vessels. Laser treatments to reduce cosmetic signs of rosacea have gotten more popular.

“They’ve been available for about a decade or so, but are growing much more in popularity over the past few years because they’ve become safer and more affordable,” said Camille Introcaso, a physician with the Pennsylvania Center for Dermatology.

Vascular lasers, providing a very focused beam of light, target dilated blood vessels, the source of the redness.  Intense pulsed light (IPL) – sometimes called a photofacial – is a light-based treatment similar to a laser, involving very bright light on your face that feels like little zaps. A full course of therapy generally is comprised of two to three treatments at about $250 each.

Pulsed dye lasers provide one specific wavelength of light so specifically targeted that they can trace blood vessels on your nose or cheeks. Typically, a patient requires three sessions one month apart and then twice a year for maintenance, also costing about $250 each. Recovery time is quick – generally, there’s some pinkness for a day or so.

In the last few years, the U.S. Food and Drug Administration approved three topical creams that have been introduced for rosacea. Soolantra fights bumps and blemishes and has led to improvements in as little as four weeks. It is both an anti-inflammatory and an anti-parasitic — a microscopic mite found on everyone’s skin is more numerous in rosacea patients. Mirvaso and Rhofade reduce redness by causing blood vessels to shrink temporarily, lasting eight to 12 hours from when the product is applied.

Dermatologists can almost always find a treatment to improve a person’s symptoms, but insurers may consider some therapies cosmetic rather than medical. Plus, many people have high-deductible insurance plans, so cash prices matter more than ever.  For instance, a 30-gram tube of Soolantra cream costs around $500, Mirvaso weighs in at $438, and Rhofade is well over $500, according to GoodRX.com.

>> READ MORE: $13 or $464 for the same statin drug? This Pa. site shows where the deals are

“Pharmaceutical companies are charging more and insurance is covering less, so it’s becoming more time consuming and challenging for me to get my patients affordable medication,” said Introcaso.

Her office has partnered with a compounding company to make and provide topical medications at a more reasonable cost.

About five years ago, Julie Chelius, 57, saw a dermatologist about what she thought was adult acne. It tuned out that she had rosacea, a condition her mother also had. Chelius doesn’t have pain or itching, but when her cheeks flush she becomes self-conscious.

“I have to stay on top of it, with a routine of using special soaps, taking doxycycline, and using creams to keep it from worsening,” said Chelius, of Haddonfield. Avoiding the sun and spicy foods helps prevent flare-ups. “You never know what’s going to trigger you on a certain day.”

Seeing a dermatologist is important, Williams said, because when not properly diagnosed, sufferers often “buy all sorts of creams and makeup to try to make it better, and often those things have chemicals that can make it worse.” Left untreated, rosacea can lead to scarring, and in rare cases, it can be disfiguring if it causes the nose to look bulbous due to skin thickening.

Rosacea is a chronic condition so you have to keep up with it, Williams said. While it most noticeably affects the face, research suggests it may be a harbinger of other issues.

“It’s thought that people with rosacea have a higher risk for other conditions, including migraines, Parkinson’s disease, and some forms of cardiovascular disease, because of the underlying inflammation,” said Williams. “Rosacea could be a marker for internal involvement.”

There’s also a strong emotional component to the condition, especially for some patients with severe rosacea. “It’s very hard to cover up something that’s staring you in the face,” she said.

Of course, that could lead to more stress – a major trigger for rosacea.

“It can be paralyzing for people who are self-conscious and choose to take time off from work or reschedule meetings because they’re having a bad flare,” said  Introcaso. “That’s the cosmetic part, but it can also be itchy and irritated and people can have symptoms of eye discomfort.”