Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at

Many Right Ways to Treat Rosacea

Monday, 12 July 2010 01:49 PM

Rosacea is one of the most frequent reasons for consulting a dermatologist, but many people who have small bumps, redness, and prominent blood vessels may not know that these are manifestations of the condition.

In some people, mostly women, rosacea shows up as red bumps around the mouth. Rosacea can also affect the eyes, and it is not unusual for symptoms to include redness and irritation of the eye.

The first step in getting rosacea correctly treated is to see a dermatologist to get the correct diagnosis. Treatments are well tolerated and may vary from lasers to topical medications to oral antibiotics.

Rosacea tends to be most common in light-skinned people, especially those of Celtic background. Visualize W.C. Fields with his red cheeks and lumpy nose. Close inspection of his face would also probably reveal white or red bumps covering his skin. Each aspect of this picture is treated differently and they do not always appear together in the same patient.

Many patients with rosacea have the “telangiectatic” type with small red vessels on their noses and cheeks. Mild cases are seen as rosy cheeks and some people do not mind this appearance. However, when the vessels become more prominent, treatments should be considered.

Lasers and Intense Pulsed Light

Treating the blood vessels should be done with either intense pulsed light or laser; I use the pulsed dye laser, which has a wavelength absorbed by the blood within the vessels. Typical treatments require two to four visits at one-month intervals. Following each treatment there may be bruising that can last for a week. Some laser treatments using low energies may spare the patient the week of bruising, but more sessions may be required. If you are considering laser for rosacea, discuss this with your dermatologist or plastic surgeon.

People who have sun damage in addition to rosacea may benefit from treatments with intense pulsed lights (IPL). Instead of using a single color of light, the intense pulsed lights employ a broad spectrum. IPL can treat the redness as well as some of the brown spots on the skin, with a significant improvement in appearance. However, patients must avoid sun exposure for two weeks before and two weeks after treatment, and several sessions are required.

Topical and Oral Medications

Rosacea is most commonly treated with topical antibiotics and retinoids. Metrogel and Metrolotion, both forms of the antibiotic metronidazole, are frequently prescribed. This drug has been safely and effectively used to treat rosacea for decades. It takes several weeks to see an improvement, and in some instances the topical antibiotic is combined with oral medication.

Retin-A may also be used, but it can cause irritation so it should be added gradually, with applications a few times per week for several weeks. Another topical medication, Finacea, is well tolerated and effective.

Oral antibiotics, including tetracycline, minocycline, doxycycline, and ampicillin, can be used for moderate to severe cases. In my practice, I will prescribe one of these medications for a few months and then taper it off. Topical medications or lasers are used to maintain the remission. Lower dose forms of antibiotics such as Oracea have been quite successful at long-term control with few or no side effects.

Lifestyle Changes Can Help

Modifications in diet and skin care can also help quiet rosacea. Although triggers vary among individuals, in general there are a few things to avoid. Spicy foods, hot drinks, and alcohol tend to cause the vessels in the cheeks to dilate, resulting in blushing. Each episode is thought to make the skin a little more red.

Sun exposure will also increase redness, and chemical-free sun protection should be used whenever one is outside (zinc or titanium dioxide). One other change that can help is to stop using tartar control toothpaste and switch to Tom�s of Maine.

To learn more about Dr. Beer, please visit or

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