Rosacea: Treatment optionsRosacea: Treatment options Part Two Topically applied formulations:
The principle of these traditional treatments is to deal with both the inflammation and the fragile connective tissue by simultaneously reducing the inflammation and helping to rebuild the connective tissue surrounding the vessel mat.
Good quality formulations will contain therapeutic ingredients, vitamins, anti-oxidants, and anti-inflammatory agents, all helping to maintain the integrity of the blood vessels in the area while supporting and encouraging the collagen network of the skin to strengthen and rebuild it.
This method of treatment is best suited to individuals with milder cases caused by reaction to topical substances. (When use of the aggravating substance has been discontinued!)
In this scenario the rebuilding of the acid mantle and strengthening of the epidermis must also be addressed, and this may require further measures dependant on response.
While the concept of peeling may appear to be quite aggressive for this type of condition, the results have been reported to be quite favourable.
The principle behind the peeling modality is to sterilise the skin surface and stimulate a mild inflammatory response to trigger the regeneration of the connective tissue. The sterilisation of the skin surface is of particular importance in this modality, as it will remove all traces of the Demodex folliculorum mite if present.
Typical peeling agents are Alpha Hydroxy acids, (Ph of 3.5 - 4.5) or a TCA. (2% - 5%) Lactic acid is also used. In most cases, the skin is first prepared with Vitamins A & C to help strengthen the capillaries and connective tissue.
Peeling has been shown to be an appropriate solution in some cases
This type of treatment is ideal for intrinsic types and should only be undertaken by therapists who
are experienced users of acids, as there will be a degree of careful
observation of the reaction required to ensure the acids are applied for
the appropriate time.
With peeling, there will always be a degree of client discomfort, so clients who are not willing to undergo a little pain for gain should be offered alternative modalities.
There are also a number of prescribed consumer Rosacea treatment products that subscribe to the sterilisation/peeling method, with products such as Finacea (an azelaic acid gel, 15%) available from dermatologists.
quick word on Microdermabrasion
Although some technicians and aestheticians employ Microdermadrasion to treat rosacea, I personally would not. While it ultimately attempts to achieve the same goal as peeling, the physical aggression does not justify the quality of result over a period of time.
Laser & Intense Pulsed Light:
The principle of laser and light therapy is two fold: (1) that of selective photothermolysis that denatures the dilated vessels, and (2) the introduction of a controlled inflammatory response to stimulate fibroblast activity to build the fragile connective tissues.
The photothermolysis is similar to the treatment of red veins by thermolysis, and works by light energy with high absorption by haemoglobin and oxyhemaglobin reaching the dermal capillary bed and selectively denaturing the abnormal vessels.
This type of treatment is usually performed with a Pulse Dye Laser or an Intense Pulsed Light source with an output in the 500nm to 1200nm range.
For best results with this modality, it would make sense to first rehabilitate the fragile connective tissue, providing a better foundation for the photothermolysis that will follow.
If the connective tissue has been sufficiently improved before the photothermolysis stage, then the results are usually good.
Pulsed Light treatments
can have satisfactory results
when undertaken correctly
In these cases the fragile connective tissue in the effected areas has reacted badly in the form of purpura, swelling, and blistering, and this may be due to the IPL and laser technicians dealing directly with the photothermolysis aspect of the treatment without the preparatory work first. Summary
Rosacea is a condition that can respond to appropriate treatment over a period of time.
There are no quick cures, and a good result will only be achieved over a months of treatment.
In all cases, treatment is a multi-stage process, and will require a review of progress before the next stage is undertaken.
It must be remembered that in almost all cases of Rosacea, the connective tissue in the effected area is fragile, so steps must be taken to keep the tissue in good health to prevent re-occurrence. Consequently, there may be changes in lifestyle and diet required to keep the condition in permanent check.
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