Dr. Ulmer Addresses Rosacea

By Pacific Derm on April 28 2020

Rosacea is a common complex skin condition that affects over 3 million Canadians. Although rosacea is more common in women, we see both men and women routinely in our practice.  At Pacific Derm, we see many patients who come in asking for treatment of their rosacea and just as many who come in without a diagnosis but wish to improve upon the redness, dilated blood vessels and/or pimple-like bumps to even out their complexion.  Thickening and enlargement of the tissues of the nose is a less common problem of rosacea but one we can assist with as well.  Because rosacea affects the face, it can be embarrassing and frustrating and our patients have confided that the features of rosacea make them feel less confident at times. We know the effects of rosacea can be so much more than skin deep. Fortunately, in 2020 we have excellent treatments for all aspects of rosacea.

Gentle skin care, sun protection and avoidance of triggers are steps that all rosacea patients can take at home to improve their rosacea and help prevent progression. Triggers are different for everyone but often include spicy food, alcohol, extremes of temperature, sun and emotional stimuli.  Prescription therapies including topicals and oral medications work well for the pimples and pustules of rosacea. Some patients have symptoms involving their eyes and using eye drops and oral medications can help with these.  There is some new evidence and ongoing research showing that device treatment with IPL (Intense Pulsed Light) of the upper cheeks can also help to improve the uncomfortable eye symptoms associated with rosacea.

The background redness and flushing of rosacea can be transient at first but over time this redness becomes persistent. Blood vessels become visible and with repeated dilation can become more prominent over the years. Although a prescription gel is available for temporary improvement of the background redness it does not improve visible dilated blood vessels. Device treatment with a vascular laser or IPL (Intense Pulsed Light) can be very helpful for both redness and dilated vessels.

 

What is the Technology?

The Excel V/Excel V + are our go-to lasers for background redness and dilated blood vessels. We use a vascular laser so often at Pacific Derm that we invested in a second device. This high energy green light laser is excellent at targeting redness and blood vessels in the skin to seal them closed. We love performing this treatment because of the positive effect the improvement has on our patients (Full disclosure:  It may be equally as gratifying for the person performing the treatment as the results are for our patients. Watching the blood vessels disappear during the treatment is so satisfying and many of our patients have remarked on how much we seem to be enjoying performing their treatment!).

Once we achieve closing unwanted vessels and toning down background redness we often use the Laser Genesis component of the device for maintenance. It delivers more gentle heat that not only helps keep background redness in check but also improves the tone and texture of the skin. Because it has little to no downtime it can be done the day before a big event for an added glow factor. As rosacea is a chronic condition Laser Genesis provides an option for maintenance for patients who wish to keep their redness at a minimum without application of a daily gel.

IPL (Intense Pulsed Light) is not a laser but rather it emits broadband light that is absorbed by not only dilated blood vessels but also by brown spots/pigment. It can be ideal for patients with a combination of both sun damage and rosacea.


Am I a Candidate?

During the consultation your Dermatologist at Pacific Derm will assess you to confirm the diagnosis of rosacea.   A correct diagnosis is essential for proper treatment as rosacea is often confused with conditions such as adult acne. Inadvertently treating a patient for acne when they have rosacea can cause a rosacea flare as patients with rosacea tend to have very sensitive skin and acne treatments can be extra irritating. Although we see an abundance of fair skinned Caucasian patients with rosacea (the condition is most common in those of Celtic descent), rosacea can affect anyone. It is true it is more of a challenge to diagnose rosacea in patients with skin of color but the vascular laser can be safely used in patients with darker skin tones when appropriate settings are selected. The settings must be customized to an individual’s skin and when done properly this is a very effective and safe procedure.


What to Expect on the Day of Your Treatment

On the day of your treatment, consent forms will be reviewed and signed, and photos will be taken to monitor your improvement.  Most patients tolerate the treatment extremely well and describe the discomfort experienced ‘like a hot elastic band snapping on the skin.’ The unique hand-piece has a cooling feature to keep the treatment as comfortable as possible.  A numbing gel is not used for this treatment as it can constrict the blood vessels we want to target. Duration of the treatment depends on the area treated but is typically between 15 and 30 minutes.

 


Downtime and Recovery

Patients leave the clinic with redness and some swelling which typically lasts up to 5 days. If treatment is limited to the chin or the sides of the nose, most often there is no swelling. I instruct my patients to expect 5 days of social/professional downtime when the cheeks or eyelids are treated because of the swelling that occurs. Ice packs and keeping the head elevated are very helpful. Occasionally some minor bruising can occur.

Before and After

Before Before

The dramatic improvement observed in this patient is the result of both  medical management and vascular laser treatments.

 

If facial redness is affecting how you feel about your skin, we are here to help! To find the right treatment for you, call 604-682-7546 for consultation with one of our Dermatologists, your skin care experts!