Accurate diagnosis is crucial, as rosacea can mimic other dermatological conditions such as acne or eczema. At Biscayne Dermatology, diagnosis is primarily based on a thorough review of the patient’s medical history and a detailed physical examination. In certain cases, additional diagnostic procedures, including skin biopsies, may be conducted to confirm the diagnosis and rule out other conditions.

Before developing a treatment plan, it is important to identify the type of rosacea a patient is experiencing. There are four main subtypes:

• Erythematotelangiectatic rosacea, which primarily causes facial redness and visible blood vessels
• Papulopustular rosacea, which causes redness, swelling, and acne-like breakouts
• Phymatous rosacea, which leads to thickened skin and an enlarged, bulbous nose
• Ocular rosacea, which affects the eyes, causing redness, irritation, and swollen eyelids

Because each type of rosacea presents differently, treatments must be tailored to the individual’s symptoms and underlying triggers.

Management of rosacea at Biscayne Dermatology involves a multifaceted approach tailored to the individual’s specific symptoms and severity of the condition. The primary objectives are to alleviate symptoms, reduce flare-ups, and prevent progression.

Topical Medications

Topical medications are often the first line of treatment for managing mild to moderate rosacea symptoms. These treatments are applied directly to the skin and work by reducing inflammation, minimizing redness, or controlling breakouts.

• Topical metronidazole is an antibiotic that targets skin inflammation and particularly beneficial in papulopustular rosacea.
• Topical ivermectin helps reduce the number of demodex mites present and is used in papulopustular rosacea.Sodium sulfacetamide, often used as a cleanser,is an antibiotic that helps reduce inflammation.
• Topical oxymetazoline and topical brimonidine are used for persistent facial redness and flushing. These medications function by constricting dilated blood vessels, thereby diminishing redness.
• Azelaic acid has demonstrated efficacy in reducing inflammation and clearing rosacea-associated bumps.
• Combination compounds: based upon the patient’s particular needs, compounded medication combining several active ingredients are often employed for more efficient and superior results. For example, one of the favorite compounded prescriptions recommended at Biscayne Dermatology combines topical metronidazole, ivermectin and niacinamide, which together work to reduce redness, inflammation and bumps.

Oral Medications

Systemic treatments are considered for moderate to severe rosacea or when topical therapies are insufficient. Oral antibiotics, notably low-dose doxycycline, minocycline, and tetracycline are commonly prescribed to reduce inflammation. In persistent or severe cases, a course of oral ivermectin, followed by oral metronidazole can work wonders. In some very refractory cases, oral isotretinoin can be effective.

Laser and Light-Based Therapies

Biscayne Dermatology offers advanced laser treatments to address various manifestations of rosacea. The DermaV® laser is a significant advancement in the treatment of rosacea. It targets visible blood vessels and redness by using specific wavelengths of light energy, resulting in a clearer complexion. During these treatments energy is preferentially delivered  to the hemoglobin within blood vessels, causing them to collapse and be reabsorbed by the body, minimizing their appearance.

Multiple sessions may be required, but laser and light-based treatments offer long-lasting results and are highly valued by patients seeking clearer skin with minimal downtime.

Management of Phymatous Rosacea

In cases where rosacea leads to skin thickening and enlarged pores, usually on the nose, treatment typically requires a combination of topical retinoids, oral medications, and laser treatments. These interventions aim to reduce tissue overgrowth and improve skin texture.

Ocular Rosacea Treatment

Ocular rosacea is a chronic inflammatory condition affecting the eyes, often associated with skin rosacea, and it can lead to serious complications if left untreated, including corneal damage and vision impairment. When rosacea affects the eyes, leading to symptoms such as dryness, irritation, and swollen eyelids, a regimen including oral antibiotics, artificial tears, and daily eyelid hygiene with gentle cleansers is recommended to alleviate discomfort and prevent complications.

Effective management of rosacea extends beyond medical treatments. Patients are advised to identify and avoid personal triggers that may aggravate their condition, such as sun exposure, spicy foods, alcohol, and stress. Incorporating gentle skincare routines, using non-irritating products, and applying broad-spectrum sunscreen daily are essential practices to minimize flare-ups and maintain skin health.