Rosacea Treatment in NYC

Rosacea is a common skin condition characterized by flare-ups of acne, facial redness, and prominent facial blood vessels. According to the American Academy of Dermatology, five percent of the population of the United States, or 14 million individuals, are affected by rosacea. The National Rosacea Society has reported that the majority of individuals with rosacea have struggled with their self-confidence as a direct result of their skin condition. Although there is currently no cure for rosacea, patients can manage symptoms and prevent their rosacea from worsening by understanding what triggers their flare ups and taking advantage of various treatment options.

The symptoms of rosacea are usually quite apparent, however, the underlying triggers and environmental causes can be far more complex. Every individual with rosacea presents with their own unique set of symptoms, skincare needs, and personal ideal aesthetics. Achieving and maintaining your cosmetic goals is safe and effective when you have the expert guidance and rosacea treatment from a board-certified dermatologist, such as Dr. Michele Green in New York City.

Dr. Michele Green is a board-certified dermatologist and expert in the treatment of rosacea. Dr. Green is an internationally renowned leader in the field of cosmetic dermatology, with over 25 years of experience providing her patients from around the globe with the best non-invasive treatment options available, including her carefully developed MGSKINLABs line of gentle skin care products, laser treatments, oral antibiotics, chemical peels, and medical-grade facials, among others. For her dedication to her patients and practice, she is consistently identified as one of New York’s best physicians by Castle Connolly, New York Magazine, and Super Doctors. If you’re frustrated by the appearance of redness, bumps, or broken blood vessels, board-certified dermatologist Dr. Michele Green is here to help.

What is Rosacea?

Rosacea is one of the most common skin problems, and chronic skin condition, with more than 3 million new cases diagnosed each year in the United States alone. Rosacea can cause redness, visible bumps or pimples on your skin, and broken blood vessels. The primary sites for rosacea are the cheeks, nose, forehead, chin, and chest. Some patients also complain of a burning and itching sensation. Additionally, rosacea can commonly manifest with redness or irritation of the eyes as ocular rosacea. 

The average age for the development of rosacea is typically 30 to 50 years of age, according to the American Academy of Dermatology. Additionally, female patients outnumber male rosacea patients, and the majority of patients have fair skin tones, according to the NIH. The correct diagnosis of rosacea is important, as many of rosacea cases get diagnosed incorrectly as eczema, psoriasis, or allergic contact dermatitis. Proper, immediate diagnosis by an expert health care professional, such as Dr. Michele Green in NYC, is essential in order to properly treat this skin disease. When you consult with Dr. Green, she’ll be able to assess your skin, review your medical history, analyze possible environmental triggers, and determine which treatments will be best for you.

Before & After photo: Male VBeam for Rosacea

Do I have Rosacea?

The hallmark of rosacea is persistent redness in the central portion of the face which persists for at least three months. Facial redness may be associated with flushing, broken capillaries and telangiectasias, and an acne-like skin eruption. However, unlike acne, the skin eruption in rosacea does not typically have any comedones, whiteheads, or blackheads.

Patients often find that the first symptom of rosacea is a tendency to flush or blush easily. The condition generally starts in the center of the face and then extends to involve the cheeks, forehead, chin, and nose. Over a long period of time, potentially years, the condition can progress to involve persistent redness with visible blood vessels along with pimples and pustules. With time, the redness can become ruddier and more persistent. In more severe cases, the nose may grow swollen and bumpy, a condition known medically as rhinophyma. (It is believed that W.C. Fields had rosacea which caused a rhinophyma on his nose.)

What are the Symptoms of Rosacea?

Rosacea symptoms may vary widely from patient to patient. For example, some patients may only experience facial redness and flushing, while others may present with bumps, pimples, thickened skin, pruritus, a burning sensation, or eye involvement. For this reason, Dr. Green always provides a customized treatment plan based upon your individual needs.

Facial redness, however, is the hallmark of rosacea. It is defined by persistent redness along the central facial skin, with small blood vessels often appearing around the nose, cheeks, and chin. These blood vessels can swell and become more visibly prominent and warrant treatment. Red papules or pustules are similar to acne lesions, and can be warm, painful or swollen. In some cases, these pustules become infected and exude pus, which may require antibiotics to effectively control. When the eyes are affected, it is called ocular rosacea.

Does Rosacea Itch?

Yes. Many patients who deal with rosacea also, unfortunately, have some accompanying itchiness. This typically comes in tandem with facial redness, and is described by many patients as a sense of dryness or stinging along the surface of the skin. There are treatment options, including topical and oral treatments that can help alleviate this pruritus. When you consult with a board-certified dermatologist, like Dr. Michele Green, she will prescribe medications and treatment options that can help alleviate itching and other symptoms of rosacea.

Does Rosacea Burn? Does it Hurt?

In severe cases of rosacea, rosacea can cause a burning sensation. This burning sensation is typically accompanied by the characteristics of flushing and facial redness that is commonly classified as subtype 1 rosacea, or erythematotelangiectatic rosacea (ETR). Because of this flushing reaction, many patients experience this as painful and need to treat the rosacea to relieve side effect of the condition.

What causes Rosacea?

Although the precise cause of rosacea is unknown, several contributing factors are known to play a role in its development. For example, the condition is more common in women than in men. In addition, the condition may be inherited, which suggests a genetic component. Evidence also suggests that sun exposure is also a contributing factor in the development of rosacea.

Rosacea is a complex condition whose exact etiology is still unknown. However, there are a few possible explanations for rosacea that are currently being researched:

• Genetic predisposition: patients with a family history of rosacea have been observed to have an increased risk of rosacea
• Immune System: Rosacea may be caused by an overactive immune system as well. Testing with a peripheral blood monoclonal proliferation assay, it was discovered that a bacteria, Bacillus oleronius stimulates an immune response in 79 percent of 22 patients with subtype 2 (papulopustular type) rosacea.
• Microscopic mites on the human face, demodex folliculorum, have been associated with an increased propensity of rosacea. Dr. Michele Green was featured in Web MD discussing this in “Are Mites Causing Your Rosacea?” 
• Helicobacter pylori (h. pylori) is a type of bacteria which normally lives in the gut.  It is believed that this bacteria can cause rosacea to flare by producing an enzyme which causes facial flushing.

Is Rosacea contagious?

Rosacea and symptoms of rosacea are not contagious. Though rosacea affects millions of patients each year, it does not spread from person to person, and each individual patient will have different environmental factors and triggers that aggravate their symptoms.

How do you get Rosacea? What are the common triggers for Rosacea?

For many patients, rosacea can be aggravated or triggered by certain dietary, lifestyle, or environmental factors, including:

• Stress
• Heat
• Genetics
• Diets with hot or spicy foods 
• Caffeine and caffeinated hot drinks, like coffee
• Dairy products
• Spices and seasonings with such ingredients as cayenne pepper or red pepper
• Foods containing cinnameldahyde, such as citrus fruits, tomatoes, and chocolate
• Smoking
• Wind
• Hot baths
• Exercise such as hot yoga 
• Extreme heat or cold weather
• Steam rooms
• Intense exercise
• Sun exposure
• Wind exposure
• Alcohol
• Hormonal or endocrine problems, such as thyroid diseases or menopause
• Hypertension
• Medications which dilate the blood vessels, such as certain blood pressure medications such as blood pressure medications
• Certain skin care or cosmetic products such as Retin-A creams or creams that have fragrance or alcohol based

It is very important to identify these “triggers” which can exacerbate your rosacea and avoid them to keep your rosacea under control and avoid flare-ups.

What is Ocular Rosacea? 

Ocular rosacea is defined by pruritic, dry, irritated, and red eyes. In some cases, the eyes can also be photophobic. Many patients complain of eyelid irritation, also called blepharitis, or eyelid swelling, which can lead to serious vision problems if left untreated. Ocular rosacea can be associated with conjunctivitis, which can cause redness and inflammation of the eye itself. Steroid eye drops, such as Blephamide, may be prescribed. Styes are also a common occurrence with ocular rosacea. Almost half of the patients with rosacea suffer from ocular rosacea.

Rhinophyma

Rhinophyma is characterized by red, large, bumps on the nose, which tend to increase in size and become bulbous. Rhinophyma is a manifestation of severe rosacea, and can often be associated with ocular rosacea. It gradually forms over many years, classical when rosacea is improperly treated or untreated. The large mass that is formed at the end of the nose is a very serious cosmetic concern. 

Rhinophyma tends to occur more commonly in men than women, and the after the onset of disease, gets worse with age. As rhinophyma clinically gets worse, typically you see an increase in facial redness, a thinking of the skin, a rough and waxy appearance to the epidermis, enlarged facial pores, and an increase in the number and size of oil glands. The treatment of rhinophyma is difficult, since typically once it develops, it responds poorly to oral or topical antibiotics. Isotretinoin (Accutane) can be employed to help decrease the increase in sebaceous glands and inflammation.

Surgery is the most effective treatment of rhinophyma, as the overgrowth of blood vessels and tissue classical cause facial disfigurement around the nose. The main restorative surgical approaches to rhinophyma consist of traditional surgery, laser resurfacing with CO2 lasers, cryosurgery, and dermabrasion. Through the use of these surgical and laser modalities, the shape of the nose can be restores and the overgrowth of tissue be improved cosmetically.

Before & After photo: VBeam laser to treat Rosacea

Rosacea Subtypes

Because rosacea is a complex condition, it has been divided into subtypes, which are determined based on the appearance of the skin. This subdivision helps classify rosacea. However, patients may have symptoms of more than one subtype at the same time.

Subtype 1 – Erythematotelangiectatic Rosacea

Subtype 1 is characterized by persistent facial redness (or erythema). Broken blood vessels, called telangiectasias, may be present, and the skin may feel irritated, sensitive, and uncomfortable, akin to a sunburn.

Subtype 2 – Papulopustular Rosacea

Subtype 2 is characterized by facial redness and acne-like bumps and pimples. Patients with subtype 2 rosacea tend to experience more oily skin texture, as well as raised skin patches.

Subtype 3 – Skin Thickening

Subtype 3 (medically called phymatous rosacea) is characterized by skin thickening and enlargement, especially around the nose. When the nose is involved in this manner, it is referred to as a rhinophyma. It is believed that W.C. Fields had this type of rosacea involving his nose.

Subtype 4 – Ocular Rosacea

Subtype 4 is characterized by the presence of eye symptoms, including watery eyes, red eyes, foreign body sensation, eye burning, dry eyes, styes, and blurred vision. Ocular rosacea should be treated by an ophthalmologist. 

Can Rosacea Go Away?

Unfortunately, for those affected by rosacea, it is not a skin condition that tends to go away on its own. Rosacea tends to go into remission, at which point symptoms will not be visible, and then return later on in the form of a flare-up. For this reason, it’s typically classified as a chronic skin disease, and should be monitored and treated by an expert dermatologist. Dr. Green works with patients who are new to rosacea as well as those who have dealt with flare-ups for years, and will be able to develop a sustainable treatment plan that best fits your current needs.

VBeam for Rosacea – 4 months

Can you pop rosacea bumps?

If you suffer from red papules or pustules due to rosacea, it is important that you do not attempt to pop these bumps, as this can further aggravate the affected area. However, there are several topical and in-office treatments that can help to heal these papules or pustules which are discussed in detail below. Attempting to pop an inflamed lesion on the skin can result in exacerbating the irritation or, even worse, scarring. A scar forms when inflammation of the skin creates irreparable damage to the underlying tissue, and is often more difficult to treat than the original lesion itself. The best first step in managing any bumps on the skin is consulting with a board-certified dermatologist, such as Dr. Michele Green in NYC.

How to Treat Facial Rosacea

When it comes to treatment for rosacea, there are three major goals to consider. The first is to control inflammation and irritation caused by rosacea. The next is to treat the appearance of flushed skin, redness, and/or broken blood vessels in order to improve the look and feel of the skin. Lastly, Dr. Green always wants to leave her patients with healthy and glowing skin. When it comes to rosacea treatment, the best possible care should leave patients feeling and looking even better than before the onset of symptoms.

In order to contain, heal, and reduce the appearance of symptoms due to rosacea, patients typically rely on a combination of medications, photodynamic treatments, and laser treatments. These treatments may include common topical treatments such as antibiotic gels or vitamin-C serums, oral medications, laser treatments such as the VBeam laser, or light therapies such as Red and Blue Light therapy. By combining several skin care modalities, Dr. Green can effectively treat and control every case of rosacea.

Best Topical Skin Care Treatments for Rosacea

The best dermatologists, like Dr. Michele Green in NYC, start by first analyzing your basic skin care regimen. Since patients with rosacea have some of the most sensitive skin, Dr. Green will suggest gentle cleansers and toners to clean your skin, and non-comedogenic, oil-free moisturizers to treat your skin. Next, she will prescribe some topical medications and antibiotics to treat your rosacea. 

• Metrogel, or Metronidazole cream, is a classic topical antibiotic cream which both prevents and treats facial rosacea and its accompanying redness.

• Soolantra (Ivermectin) is an excellent choice to treat the inflammatory component of rosacea as well as the redness.

• Mirvaso (Brimonidine) gel is a topical cream which reduces the blood vessels from rosacea and is used once a day.

• Rhofade (Oxymetazoline) is a topical cream that is similar to Mirvaso in that it causes blood vessels to narrow to reduce facial redness. Rhofade should be used only once a day, too.

• Azelaic acid– is a gel that treats the papule, pustules, and inflammatory component of rosacea. 

• Vitamin C Serum-is an excellent antioxidant serum, reduces facial redness and rejuvenates the face. Dr. Green’s best-selling Vita-C-Serum is available online here.

Oral treatments/ oral antibiotics for Rosacea

One of the primary treatments for rosacea is oral antibiotics, such as doxycycline, minocycline, or tetracycline. Dr. Green traditionally prescribes Doxycycline, Oracea, or Flagyl (Metronidazole) for facial rosacea and its associated breakouts. The main side effects of chronic oral antibiotic usage are yeast infections, gastrointestinal upset, and photosensitivity. 

In some cases, Dr. Green may recommend the use of isotretinoin (Accutane) in order to treat chronic papules or pustules caused by rosacea. Although isotretinoin is typically used for traditional acne, it can be successfully used to treat rosacea. Ocular rosacea can be treated with oral antibiotics as well as various eye washes and antibiotic drops. In more severe cases of ocular rosacea, Dr. Green will refer you for consultation with a board certified ophthalmologist.

Laser Treatment for Rosacea

Vbeam Pulsed Dye Laser

The Vbeam pulsed dye laser is the gold standard for rosacea treatment. The Vbeam laser therapy is extremely effective at removing the redness and visible blood vessels associated with facial rosacea. The Vbeam laser is a pulsed dye laser which selectively absorbs and treats anything “red”. This means that not only does the Vbeam effectively treat rosacea, but it can be used to diminish the appearance of stretch marks, post-inflammatory hyperpigmentation, acne scars, broken capillaries, surgical scars, and more. Following each laser pulse, the laser energy is transmitted to the blood vessel wall, which leads to a narrowing of the blood vessel and shrinks the size of the blood vessel.

The Vbeam laser treatment also reduces the surrounding redness from the rosacea, giving you beautiful and clear skin that lasts. There is zero downtime involved with the V-beam treatment, which can completed in minutes. As an added bonus, no numbing cream is required for the treatment. The laser is equipped with a patented Dynamic Cooling Device, which emits a burst of cool air prior to each laser pulse, making the treatment comfortable for the patient. Typically, patients require between four and six treatment sessions to eliminate the appearance of their rosacea and achieve their ideal cosmetic results.

VBeam, 2 sessions, 2 months before and after

Intense Pulsed Light (IPL) Therapy

Intense Pulsed Light (IPL) is another which Dr. Green treats redness and broken blood vessels for her patients who suffer from Rosacea.  With the Sciton IPL, intense pulsed light is used to reduce redness as well as pigmentation in the same treatment session. 

Red and Blue Light Therapy

Red/Blue Light Therapy in the form of LED light therapy, helps reduce redness and fine lines.  Dr. Green utilizes light therapy as part of a HydraFacial for rosacea with a special treatment with Rozatrol, designed to reduce the redness from rosacea.

Photodynamic Therapy

Photodynamic therapy is an exciting treatment that is commonly used for patients dealing with active acne lesions, rosacea, or psoriasis, among other skin conditions. Photodynamic therapy uses a photosensitizing molecule along with intense blue light in order to heal the skin. Levulan, which is a topical medication is placed on your facial skin for one hour. After one hour, the Levulan solution is removed and you are exposed to the Blue light for 16 minutes. The Blue light will activate the acne/rosacea lesions and help to heal your rosacea and its associated outbreak.

HydraFacials for Rosacea

A HydraFacial is a three-step medical-grade facial that is powerfully effective for improving the health and appearance of the skin, yet gentle enough for patients with sensitive skin, including those struggling with acne rosacea. Utilizing an innovative vortex technology, the HydraFacial infuses potent skincare serums into the skin while simultaneously cleansing and extracting impurities. The HydraFacial first deeply cleanses, then gently exfoliates the skin. The final step is the infusion of beneficial antioxidants and peptides to nourish, hydrate, and protect the skin. The Rozatrol Booster is specifically designed to complement your HydraFacial and improve the appearance of facial rosacea. Not only do HydraFacials treat acne, rosacea, and facial redness, it can also be used to effectively treat an uneven skin tone and skin texture. HydraFacials are recommended as monthly treatments, to improve facial tone, texture, red and brown spots, and reduces enlarged pores.

How to get rid of rosacea permanently? Can rosacea be cured? Does rosacea go away?

Currently, there is no known cure for rosacea. There are, however, a number of treatment methods that can be used to manage symptoms of rosacea and contain, reduce, and eliminate the appearance of rosacea on the surface of the skin. Light therapies and laser treatments are excellent options for patients looking to reduce the likelihood of broken blood vessels and to heal the skin during and after a flare-up. The key to treating rosacea is maintenance, proper skin care, adequate sun protection, healthy diet and exercise, and avoiding the known triggers for rosacea. Many patients with rosacea may be sensitive to certain skincare products, including sunscreens. If sunscreens are too irritating for topical use, pure zinc oxide can be used to protect the skin from sun exposure and prevent rosacea flares. Additionally, there are many topical prescription creams, gels, and lotions that can be used safely in conjunction with other treatments to effectively reduce symptoms of rosacea.

Is Rosacea an autoimmune disease?

Rosacea is not considered a classical autoimmune disease. However, having rosacea makes you twice as likely as being associated with another autoimmune disease. Rosacea is considered an inflammatory skin condition. However, it shares genetic loci with other autoimmune diseases, such as type 1 diabetes mellitus and celiac disease. Recent studies have also associated rosacea with an increase in thyroid disease. Further studies are needed to understand the true mechanism involved in rosacea.

Why rosacea happens: Is rosacea genetic?

Rosacea tends to run in families, and there appears to be an inherited or genetic component to rosacea. The exact cause of rosacea is still undetermined. Individuals who have fair skin and have a family member with rosacea are more likely to have rosacea. Women are also more likely than men to develop rosacea. Other factors that may contribute to the development of rosacea include the immune system, infection of H. pylori, and an overpopulation of a naturally found mite on the skin, among others.

Does H. pylori aggravate rosacea?

Yes, there are some studies which suggest that an elevated level of H. pylori in one’s gut increases the amount of gastrin produced. It is this increased gastrin production which may cause the flushing seen in facial rosacea. There are many people, however, who may have an infection of H. pylori that do not have rosacea.

Is rosacea caused by mites?

The exact underlying cause of rosacea is still largely unknown. It is thought that some cases of rosacea may be due to an overpopulation of mites that can naturally be found on the surface of the skin. Demodex folliculorum is the name for the type of mite which usually lives harmlessly on human skin, with a particularly high concentration being found on the nose and cheeks, where rosacea often occurs. Some patients are highly sensitive to the presence of these mites, which may cause the inflammation associated with rosacea.

Does rosacea affect your eyes?

Yes, 50% of patients suffering from rosacea have some aspect of ocular rosacea, affecting their eyes. Patients with ocular rosacea may experience symptoms such as redness, itching, burning, or other irritation. Ocular rosacea is often confused for allergies, and many patients with this skin condition may be unaware that they do, in fact, have rosacea that affects their eyes. There is potential to develop vision problems should ocular rosacea remain untreated, so it is best to consult with a board-certified dermatologist and follow up with an ophthalmologist should you experience symptoms of ocular rosacea.

How to calm and prevent a rosacea flare-up

• Proper skin care and the use of gentle products, such as Cetaphil, are essential for patients with rosacea.
• Daily high-SPF sunscreen that blocks both UVA and UVB rays, as well as a wide-brimmed hat, are important in preventing flare-ups of rosacea.
• Applying the proper non-comedogenic moisturizers, hydrating creams, and topical medications can control rosacea flares.
• Proper eye care when needed such as re-wetting eye drops (artificial tears) and special eye rinses help with ocular rosacea.
• Avoid spicy foods.
• Avoid extreme temperatures, like very hot or very cold temperatures.
• It’s best to avoid things which exacerbate the effects of rosacea, like sun exposure, irritating make-up, hot beverages, cigarette smoking, and caffeine.
• Try meditation or yoga as a way to manage stress.

Is rosacea acne?

Rosacea is a common chronic inflammatory skin condition that is associated with facial redness, broken blood vessels, and acne breakouts. Although pus-filled pimples may be a symptom of rosacea, rosacea is not the same skin condition as acne vulgaris. Acne vulgaris is another common skin condition that occurs when excess sebum, dead skin cells, and debris become trapped in the sebaceous glands of the skin. Acne lesions form when the pores become clogged with excess sebum and bacteria. Acne patients tend to experience redness and inflammation exclusively in areas that are affected by breakouts, whereas rosacea patients tend to present with diffuse facial redness. If you are struggling with the presence of facial redness and breakouts, and are unsure as to whether you are experiencing rosacea or acne vulgaris, schedule a consultation with Dr. Green in NYC. Dr. Green is a board-certified dermatologist with over 25 years of experience helping patients manage their breakouts to achieve and maintain healthy, clear, smooth skin that lasts.

How to help your rosacea today

For many, the symptoms of rosacea can be a source of great frustration and negatively impact their self-esteem. Although rosacea can not necessarily be cured, there are numerous non-invasive treatment options available that can be used to help manage various symptoms of rosacea so that you can look and feel like the best version of yourself. It can be a challenge to determine which unique combination of in-office procedures, prescription medications, and specially-formulated skincare products are best suited to addressing your particular skin concerns.

Dr. Michele Green is an internationally renowned leader in the field of dermatology with over two and a half decades helping her patients from around the globe manage their rosacea, acne, and other various skin problems. Utilizing the most innovative techniques and cutting-edge treatment modalities, Dr. Green is consistently voted as one of the best dermatologists in New York City by Castle Connolly, New York Magazine, and Super Doctors. When you consult with Dr. Green at her private dermatology office, located in the Upper East Side neighborhood of Manhattan, she will collect a thorough medical history, physically evaluate the condition of your skin, and discuss with you in-depth your specific skin concerns and ideal cosmetic results. Dr. Green will then work with you to create a personalized treatment plan that is best suited to helping you achieve a clear, smooth, healthy complexion that lasts. To schedule a consultation with Dr. Green and learn more about non-invasive treatment options for rejuvenation, contact us online today or call 212-535-3088.