What doctors often get wrong when treating Rosacea

Understanding the complexities of rosacea is essential for effective management and treatment. This episode clarifies common myths surrounding rosacea treatments, the importance of medication formulation, and the ideal skincare routine for individuals with this condition. 

- Clarifying misconceptions about rosacea treatments 
- Discussing the importance of topical vs. systemic treatments 
- Highlighting the benefits of combined therapies for rosacea 
- Addressing skincare products that can hinder treatment progress 
- Reviewing the role and timing of laser and IPL treatments 
- Offering practical advice for patients seeking effective rosacea management

Dr Stefanie Williams is a renowned dermatologist and the medical director of Eudelo Dermatology & Skin Wellbeing (www.eudelo.com), a multi-award-winning skin clinic in Central London. With over 28 years of practice, Dr Stefanie is an international key opinion leader in cosmetic dermatology and aesthetic medicine, having authored two Amazon No-1 bestselling books. 

Eudelo offers a comprehensive range of treatments for both medical and aesthetic skin concerns, combining the latest scientific advances with a personalized approach to skincare. The clinic's commitment to excellence has earned it accolades such as "Best Clinic in London" and "Best Dermatologist" in the Marie Claire awards. 

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Disclaimer: The information presented in 'Dermatology Debriefs' is for educational and informational purposes only. The content does not constitute professional medical advice. Stefanie Williams and/or Eudelo do not establish a doctor-patient relationship through this content. Always consult a licensed healthcare professional for personalized medical advice specific to your individual health needs. The content represents personal opinions and perspectives of Stefanie Williams, and may not reflect current medical consensus or standard medical practice. Content may become outdated and should not be considered current guidance. By listening to this content, the listener acknowledges and agrees that: i) The information is provided 'as is' without warranties. ii) Stefanie Williams and Eudelo bear no legal responsibility for any actions taken or omitted, based on this content. iii) Stefanie Williams and Eudelo bear no legal responsibility for any direct, indirect, incidental, consequential, or special damages arising from or related to this content. iv) Individual health decisions and medical conditions require personalized professional medical assessment and treatment. Listeners should never use this content to diagnose, prevent, treat, or manage any health condition.

Transcript

Speaker 1: 0:01

Dermatologist debriefs. Join no-nonsense dermatologist Dr Stephanie Williams as she debunks myths and shares non-dermatology doctors make when treating rosacea.

Speaker 2: 0:29

But before I get into that, let me give you a little bit of background on rosacea. So rosacea is a chronic inflammatory skin condition and the clinical symptoms include papules. The clinical symptoms include papules, which are red bumps on the skin, often on the nose and the cheeks pustules, as well as redness of the skin and flushing. Occasionally the eyes can be involved and they might feel gritty, or the eyelids might be inflamed, and sometimes, in particular in men, the skin on the nose may become very red and thickened and bumpy as well. Rosacea symptoms typically peak between the age of 30 and 50 years and the condition is most common in fair-skinned women, but all skin types, ages and genders can get rosacea. Because rosacea is an inflammatory skin condition, one of the treatment strategies often used are topical or sometimes systemic anti-inflammatories, and one of the topical anti-inflammatories that we use on prescription is called metronidazole. You might have heard of it under one of the brand names Rosex. What's really interesting to me is that when I see rosacea patients in clinic for the first time and we talk about metronidazole, they often say that they've tried that already from their GP and it didn't work. But when I convince them to give it another try and they come back for review after two or three months, suddenly the rosacea is clear, and the reason for that often is that GPs tend to prescribe the metronidazole gel and not the cream, and that really shows the importance of the base formulation. And the reason why the gel often doesn't work for rosacea patients is that it's simply too irritating because rosacea skin is that. It's simply too irritating because rosacea skin is typically very sensitive and reactive, and the gel-based formulation simply adds to that irritation, so that the active ingredient can't actually do a good job. However, when we use the cream of the same ingredient in the same concentration, suddenly it is actually effective. And that brings me to the second thing I often see happening in rosacea treatment, and that is that non-dermatologist doctors tend to prescribe a single cream for treatment, whether that might be metronidazole or a different active ingredient. What works much better, though, is to combine two different active ingredients, typically one to be used in the morning and the other one to be used in the evening. So, in addition to topical metronidazole, I may prescribe, for example, topical ivermectin or azelaic acid, and that, in combination with imetronidazole, does a really good job in the vast majority of rosacea patients that I see. Of course, there are occasional patients which may be resistant to this treatment, or maybe patients with very severe rosacea, and in those cases I may combine this with a systemic anti-inflammatory that is taken in tablet form, and in those cases I typically prescribe the systemic anti-inflammatory for maybe 8 or 12 weeks and then see the patient back in clinic, and we maintain the clear skin with topicals only. So maintenance is really important in rosacea because it is a chronic condition. It's not like a chest infection which you treat and then it's gone.

Speaker 2: 4:42

Finally, I'd like to speak about the importance of skin care in rosacea. This is something else that I often see is done incorrectly. So the patient may be prescribed a prescription cream, but their skin care is not discussed, and then they are using the wrong type of skincare and undoing all the benefits from the prescription treatment. So, in general, although rosacea may feel dry and tight, this is more a sign of micro-inflammation. So, rather than overloading the skin with very lipid-rich, thick, occlusive skincare, I recommend for rosacea skin to use skincare that's low in oils and also low in silicone derivatives, because what we want to do is to reduce the inflammation with those anti-inflammatory creams, and then the patient suddenly doesn't feel the need any longer to use those really rich skincare products, and that's a good thing, because if you use rich skincare on rosacea skin, it will really slow down the treatment progress and it might even trigger a breakout of inflammatory rosacea lesions.

Speaker 2: 6:07

Before I finish, I just wanted to say a couple of words about laser and IPL treatments. So those are used very commonly in rosacea patients, especially in aesthetic clinics, and they certainly have a role to play. However, they only address redness and broken vessels. They cannot treat inflammatory relation lesions like papules and pustules, but those have to be treated first and that typically happens with a prescription cream like the ones we discussed earlier. So another very common mistake is to treat rosacea with lasers or IPL when the patient still has inflammatory lesions, and that should not happen. We should only treat with laser and IPL once all papules and pustules are cleared.

Speaker 2: 7:04

So, in summary, the next time you see your GP for treatment of your rosacea, and if they prescribe metronidazole, then check whether it's the gel or the cream they put on the prescription. Make sure to ask for the cream, and it may make sense to combine this with a second active ingredient, and you'd use one in the morning and one in the evening. Lastly, do not get tempted to have laser or IPL treatment until your inflammatory rosacea so that's the pustules and papules are completely clear. I hope this all makes sense. Speak to you again next week.