Rosacea treatment in Wrocław – diagnosis and therapy
Recurrent flushing, persistent redness, visible vessels, papules, pustules or burning of the skin do not always mean the same problem. At HappyDERM the doctor identifies the dominant features, excludes diseases with a similar picture and draws up a plan covering dermatological treatment, skin care, sun protection and – after proper qualification – treatment of the vascular changes.
Is it certainly rosacea?
The diagnosis is usually clinical: the dermatologist analyses the distribution and character of the lesions, the sensory complaints, the eyes, the history of flares, the medicines and the skin care. There is no single laboratory test that confirms the disease. Additional tests or a biopsy are needed mainly when the picture is atypical or another diagnosis has to be excluded.
Acne vulgaris
Comedones speak for acne vulgaris, although the two diseases may coexist. The word “pustules” alone is not enough to choose the treatment.
Seborrhoeic dermatitis
Redness and scaling in the eyebrows, beside the nose, on the scalp or behind the ears may indicate seborrhoeic dermatitis. It may also coexist with rosacea.
Perioral dermatitis
Small papules around the mouth, the nose or the eyes, particularly after using glucocorticosteroids on the face, require a separate diagnosis and a different kind of treatment.
Contact eczema or irritation
Burning after a cosmetic does not prove rosacea. What matters is the time of onset, the area of contact, itching, scaling and the composition of the preparations used.
Autoimmune diseases
Facial redness may also occur in other diseases. An atypical distribution of the lesions, photosensitivity or general symptoms may call for wider diagnosis.
Demodicosis and other inflammations
An increased number of Demodex mites may take part in the inflammation in some patients, but it does not explain every case of redness. Treatment should follow from the full clinical picture.
Important: a glucocorticosteroid used on the face without a clear medical recommendation may temporarily mask the symptoms and then worsen the redness and the inflammatory lesions. Do not stop abruptly a medicine prescribed for another indication – discuss how to proceed with your doctor.
What symptoms can rosacea produce?
Present-day classification concentrates on the dominant features rather than on assigning a patient permanently to one subtype. In the same person the picture may change over time, so the treatment plan also needs updating.
Flushing
Sudden redness may appear after heat, exertion, stress, alcohol, spicy food, selected cosmetics or other individual stimuli.
Persistent redness
Constant redness of the central part of the face may be the background for periodic flares. Redness alone requires different management from active papules and pustules.
Telangiectasias
Visible, dilated vessels may remain despite the inflammation being controlled. Treatment directed at the vascular component may then be considered after a consultation.
Papules and pustules
The inflammatory lesions resemble acne, but they are usually not accompanied by typical comedones. The severity and the extent influence the choice of topical or systemic treatment.
Burning and hyperreactivity
The skin may sting, be dry and tight and tolerate previously used cosmetics poorly. Restoring the barrier is then part of the treatment and not merely cosmetic care.
Eye symptoms
Dryness, a gritty sensation, watering, recurrent styes, inflammation of the eyelid margins or redness of the eye may precede clear skin changes.
Hypertrophic changes
Thickening and an uneven surface of the skin, most often of the nose, require early diagnosis. Established remodelling of the tissues may require surgical treatment.
Facial swelling
Transient swelling may accompany a flare, but persistent or asymmetric swelling should prompt a review of the diagnosis.
A different picture on different skin phototypes
On darker skin the redness may be less obvious, while burning, swelling, papules or a change in skin colour predominate. The examination should not rely solely on the intensity of the redness.
How does the dermatologist assess redness and inflammatory lesions?
The doctor combines the examination of the skin with the time course of the disease. Earlier diagnoses, the response to medicines, eye symptoms, skin care, working conditions, sun exposure and triggering factors all matter. The aim is not to find one “forbidden” thing, but to establish which mechanisms matter in a particular person.
History of flares
We establish the onset of the complaints, their seasonality, how long the redness persists and the connection with heat, exertion, drinks, meals, stress, the hormonal cycle, medicines and cosmetics.
Examination of the skin and the eyes
We assess the redness, the vessels, papules, pustules, scaling, swelling, the skin barrier and any hypertrophic changes. We ask about dry eyes, photophobia and complaints from the eyelids.
Differential diagnosis
If the picture is not typical, the doctor may propose tests or a consultation in another speciality. We do not perform a vascular procedure on an undiagnosed lesion.
The plan and the way it is followed up
The plan sets out what we treat first, how we limit irritation, when we assess the response and in what situation we change the method. A procedure does not replace the treatment of active inflammation.
Before the visit it is worth writing down the cosmetics and medicines used, bringing photographs of flares and noting the eye symptoms. There is no need to stop prescribed medicines. If possible, come without covering make-up or be prepared to remove it during the examination.
See the scope of dermatological consultations · Check when an online consultation may be helpful
What can a rosacea treatment plan look like?
There is no single therapy that simultaneously removes redness, vessels, inflammatory lesions, eye complaints and tissue remodelling. The doctor matches the methods to the current picture, the severity of the disease, the contraindications, the earlier response and the patient’s preferences.
Medicines applied to the skin
Depending on the clinical picture the doctor may consider, among others, azelaic acid, metronidazole or ivermectin. The preparations differ in their mechanism of action and in tolerance; they should not be chosen solely on the basis of opinions found on the internet.
Systemic treatment
With more severe papules and pustules, or with insufficient improvement after medicines applied to the skin, the doctor may consider systemic treatment, including an antibiotic with an anti-inflammatory action matched to the clinical picture. The decision requires assessment of the indications, the contraindications and the risk of adverse effects.
Persistent redness
Drug treatment of the redness and treatment of the vessels are separate elements. The doctor assesses whether dilatation of the vessels, active inflammation, flushing or hyperreactivity of the skin predominates.
Eye symptoms
Management may cover hygiene of the eyelid margins, treatment recommended by the doctor and an ophthalmological consultation. Eye pain, photophobia or deterioration of vision require urgent assessment.
Resistant or more severe disease
In selected, resistant cases the specialist may consider other systemic treatment, including isotretinoin. This treatment requires strict qualification, monitoring and safety rules.
Hypertrophic changes
Early activity of the disease requires control of the inflammation. Established thickening of the tissues may require a separately chosen surgical procedure; a cream does not mechanically remove excess tissue.
An antibiotic is not a permanent solution for every patient. The duration and the aim of the treatment are set by the doctor, and the response is monitored. Starting, extending or sharing an antibiotic on one’s own increases the risk of adverse effects and of inappropriate treatment.
Care of skin with rosacea
A cosmetic does not replace dermatological treatment, but well-chosen care can reduce irritation and improve tolerance of the therapy. What matters most is gentleness, regularity and being able to identify the product that caused a reaction.
Gentle cleansing
Wash the face with lukewarm water and a mild preparation, without vigorous rubbing. Dry by applying a towel. Brushes, coarse scrubs and aggressive rubbing may aggravate the redness.
A simple moisturising cream
A preparation supporting the barrier should be well tolerated and free of ingredients that previously caused burning. Introduce new products one at a time, preferably after a test on a small area.
Daily sun protection
Choose broad-spectrum sun protection and supplement it with shade, a head covering and by limiting overheating. It is worth choosing a sunscreen that does not irritate the skin and can be used every day.
Make-up is possible
Well-tolerated products may be used, including green correctors that optically reduce the redness. Gentle make-up removal and clean applicators are important.
A diary of triggers
For several weeks note the flares and the possible stimuli. Do not automatically eliminate all the frequently listed products if you do not see a repeatable connection in your own case.
Exfoliating and active cosmetics
Acids, retinoids, vitamin C, alcohol in a cosmetic or fragrances do not provoke a reaction in everyone, but with hyperreactive skin they require careful selection and a slow pace of introduction.
When should treatment of redness and visible vessels be considered?
Laser technologies and intense pulsed light may be considered with persistent redness or telangiectasias. They do not, however, treat all the mechanisms of rosacea, they do not replace the treatment of active papules and pustules and they do not remove the tendency to relapse.
Control of the inflammation first
With intense inflammation, a damaged barrier or fresh irritation the doctor may first introduce dermatological treatment and skin care and postpone qualification for a procedure.
Matching the method to the type of lesion
Diffuse redness, single vessels and flushing are not the same target. The parameters and the technology should correspond to the type of lesion, the skin phototype and the reaction of the skin.
Assessment after the procedure
The decision about a further procedure depends on the improvement obtained, the healing time, the adverse effects and the current activity of the disease. We do not assume an automatic series for every patient.
Read about qualification for closing facial vessels · Learn about the DyeVL technology used for selected vascular lesions
Why can follow-up improve the safety of treatment?
Rosacea is a chronic and relapsing disease. Repeating visits does not mean repeating an identical procedure. Follow-up makes it possible to assess which symptom has actually diminished, what irritates the skin, whether eye symptoms have appeared and whether the current plan still matches the picture of the disease.
Better matching of the treatment
After the response has been assessed, an ineffective element can be limited, the kind of treatment changed or the care simplified. In this way the plan does not rest on a rigid scheme.
Early detection of changes
Follow-up makes it easier to notice increasing eye symptoms, persistent swelling, remodelling of the tissues or a new picture that calls for renewed differentiation.
Assessment of effectiveness and tolerance
Before a further procedure the doctor assesses the reduction of the redness, the reaction of the skin, the healing time and the adverse effects. On that basis the parameters may be changed or the procedural therapy ended.
Maintenance treatment and follow-up intervals
In some people skin care, sun protection and observation are enough; others require maintenance treatment. The follow-up interval follows from the activity of the disease and the kind of therapy.
Follow-up may be conducted by a doctor who knows the course of the disease so far and the treatment used. The HappyDERM team and the doctors’ qualifications can be checked on the profiles: dr n. med. Małgorzata Micał-Strąk and lek. Ireneusz Pijanowski.
Rosacea: the most frequent questions before a visit
Is rosacea the same as acne vulgaris?
No. Both diseases may produce papules and pustules, but they have a different picture and different mechanisms. Comedones are typical of acne vulgaris, whereas in rosacea redness, vessels, burning and eye symptoms are more frequent. The diseases may coexist.
Can rosacea be cured once and for all?
It is a chronic and relapsing disease. Treatment can reduce the symptoms and lengthen the periods of improvement, but it does not guarantee permanent removal of the tendency to redness or to relapse.
Does a laser cure rosacea?
A laser or intense pulsed light may help with persistent redness and telangiectasias. They do not replace the treatment of active papules, pustules, eye symptoms or the care of the skin barrier.
Can the disease involve the eyes?
Yes. Dryness, burning, a gritty sensation, watering and inflammation of the eyelid margins are possible. Eye pain, photophobia, deterioration of vision or a clearly red eye require urgent assessment.
Can make-up be used?
Yes, if the products are well tolerated. It is worth introducing them one at a time, avoiding strong rubbing and removing make-up thoroughly but gently. A green corrector can optically reduce the visibility of the redness.
Which cosmetics should be chosen?
A short routine usually works best: a mild cleanser, a well-tolerated moisturising cream and broad-spectrum sun protection. The particular ingredients should be matched to the symptoms, the treatment and the earlier reactions of the skin.
Is it necessary to give up coffee, alcohol and spicy food?
Not every stimulus acts in everyone. It is better to keep a diary and to limit what repeatedly provokes your own flares than to apply a broad list of prohibitions without observing the connection.
Does a steroid cream help with redness?
A glucocorticosteroid may briefly reduce the redness, but used on the face without a proper indication it may worsen or mask the disease. Do not stop a medicine prescribed for another reason without a consultation.
Is treatment possible in pregnancy?
Yes, but the choice of methods is then limited and requires separate qualification. Tell the doctor about the pregnancy, breastfeeding and plans for children before treatment begins.
Is rosacea contagious?
No. The disease cannot be passed to other people by touch, by a shared towel or by being together.
Are tests needed before the visit?
Usually not. The history and the examination of the skin come first. The doctor orders additional tests only when the picture is atypical, when there are indications for a particular treatment or when another disease has to be excluded.
How often is a follow-up visit needed?
There is no single schedule for everyone. The interval depends on the severity of the symptoms, the kind of treatment, the tolerance and the risk. Once stability has been achieved the follow-ups may be less frequent, but a relapse or eye symptoms call for an earlier assessment.
What is this guide based on?
- American Academy of Dermatology: diagnosis and treatment of rosacea
- American Academy of Dermatology: identifying individual triggers
- British Association of Dermatologists: patient information on rosacea
- British Association of Dermatologists: management guidelines 2021
- Global ROSCO: consensus on a phenotype-based approach
- NHS: symptoms, treatment and alarming eye symptoms
The content is educational and does not replace an examination or individual medical recommendations.
Consultation for facial redness and inflammatory lesions
Bring a list of medicines and cosmetics, photographs of flares and information about eye symptoms. The doctor will first establish the diagnosis and the dominant features of the disease and then propose an individual plan of treatment and follow-up.