Rosacea – Triggers, Causes, and Treatments

Rosacea – Triggers, Causes, and Treatments

Thank you for your question. You submitted a question without a photo and
you’re asking or you’re stating that you have rosacea and you’re asking is microneedling
okay for your skin. Well, I can certainly give you some ideas
of how I approach patients like yourself in my practice and where microneedling may fit
in the treatment scheme. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long
Island for over 20 years. We have the full complement of lasers and
microneedling and other devices for cosmetic dermatologic procedures. And so certainly, the question arises when
someone has rosacea about the things that they can do. Now, rosacea is actually much more common
than people realize but within rosacea, there is a spectrum of appearance as well as degree
of inflammation. It is important to understand that when people
have rosacea, there are some things they are very interested in helping. And one particularly important thing is the
redness or the flush of the skin. In addition, there are a lot of little vessels
called telangiectasia. This is often referred to as broken blood
vessels or broken capillaries. In addition, the skin tends to have or tendency
to have an appearance of large pores that are a little bit thickened. So rosacea is first a condition that needs
to be maximally medically managed and unfortunately, there are limits in what can be done. Essentially, it’s a combination or the use
of oral antibiotics such as doxycycline and the use of topical creams such as metronidazole
gel or metronidazole cream. Keeping the rosacea calm is one thing and
understanding what are the triggers of rosacea is another. A lot of times, people are advised to make
a diary and see if there are any food, is it alcohol, is it stress, is it chocolate. There are certain triggers that make rosacea
worse. When it comes to the solutions for patients,
I tend to, after being sure that the patient is stable, I tend to lean towards the treatments
that help reduce the flushing and that is the treatment of the vessels. And for that, there are strategies that we
typically employ such as lasers and pulsed light treatments depending again on the specific
optimal choice for the patient but I also tend to start very conservatively and making
sure that the person doesn’t have too much of an inflammatory response. Although, it certainly can be said just simply
that microneedling can be safe when you have rosacea, you also want to discuss with your
doctor what type of outcome are you looking for. Why is microneedling a better option compared
to something else. You know, if someone were to say that you
were going to have a resurfacing procedure, well then, that’s a different story. Now, there’s a different issue of the skin
healing and rosacea falls into the spectrum of an oil gland dysfunction syndrome. And so, you have to be careful because that
can also have a negative impact in healing after resurfacing. So, I think that you need to discuss with
your doctor where microneedling fits and to what level microneedling will be done. You can do microneedling as low depth as half
a millimeter, you can do it as high as a depth of two and a half millimeters. In addition, it may be of value to do a combination
with platelet-rich plasma (PRP). We routinely use microneedling with platelet-rich
plasma because when we do microneedling, we’re inducing an injury. We want the body to generate collagen and
improve the skin quality and contour. We often refer to it as dermal remodeling. Well, when you add platelet-rich plasma, you
are actually assisting and enhancing the skin’s ability to do all those things you are trying
to induce through a trauma or injury model. And that’s a lot of dermatologic intervention
when it comes to aesthetics. Whether you’re using a needle or various
types of lasers, you’re trying to induce the type of injury or even radiofrequency
or microneedling, radiofrequency hybrid type of device. You are inducing a certain amount of injury
and you’re inducing the body to generate collagen and these are all very effective
treatments. But when combined with PRP, I think that we
take it to another level but that’s a separate discussion. What’s more important is establishing your
level of sensitivity and as well as what to do preemptively, proactively to minimize a
response that can be controlled so that you don’t have too much inflammation with any
kind of intervention. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


  • Ainsley Spencer says:

    Thanks Dr

  • Ainsley Spencer says:

    Can a cream with vitamin A palmitate and peptides used after the treatment to enhance the thickness of the epidermis

  • Natasha Bassill says:

    Hello Dr. Prasad, my name is Natasha. I developed rosacea about 9 months ago after a month and a half treatment of prednisone. I had a terrible reaction to a spray tan and had severe chemical dermatitis. The Urgent Care Dr put me on a 10 day dose of pred, but 5 days after I got off of it, I had a GNARLY rebound reaction. My derm then put me on a 6 week tapered dose of prednisone. While I was on it for the second time, I began to experience serious flushing. My doctor said that facial flushing was a very common side effect of prednisone and would go away when I was no longer on the meds. However, I took my last dose in June of 2018 and the flushing hasn't gone away. Since then, I have become incredibly sensitive to heat, I flush from the onset of intense emotions, and sporadically alcohol triggers the flushing. Obviously, this sucks and I am trying to figure out what to do. While I have struggled with sensitive skin and eczema since adolescence, the flushing can actually be really painful and distracting. I hate it! There are times my face feels like it's on fire or has a severe sunburn. My local derm in SD, CA recommended a combo of V-Beam and IPL @ $2200 a session. She said I could need up to 10 sessions. That isn't money I have laying around. At the same time I don't want to have to live with this discomfort forever. So my brother's gf directed me to her Uncle who is a derm in LA, CA. He is doing some test spots using the Cynergy laser. I've never heard of this laser and am I'm wondering, how does this laser compare to the Vbeam? Should I get positive results? I'm not sure if you'll ever happen to see this but if you do, I would love some additional guidance. Thank you so much! Natasha

  • Badrang Halak says:

    I used night creams and scrubs my skin starting burning and red one year before now my skin is very sensitive and red is this rosecea…. Did microneedling is good or not good for my skin please replay I am very worried about my skin 😞

  • Miss Marilyn says:

    What size needle would one use for rosacea?

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