Rosacea treatment

Establishing the subtype

Rosacea presents in several patterns and they do not respond to the same treatment. Erythematotelangiectatic rosacea is dominated by flushing, background redness and visible vessels. Papulopustular rosacea produces inflammatory spots and is frequently misdiagnosed as adult acne. Phymatous rosacea causes thickening of the skin, most often on the nose. Ocular rosacea affects the eyes and is commonly missed entirely.

Several conditions mimic rosacea, including seborrhoeic dermatitis, lupus and, importantly, steroid-induced rosacea caused by topical steroids applied to the face. Distinguishing these is a diagnostic task, and getting it wrong means treatment fails.

Medical treatment

Depending on subtype, treatment may include topical agents such as ivermectin, metronidazole or azelaic acid, topical brimonidine for flushing, and oral therapy including low-dose doxycycline used for its anti-inflammatory rather than antibacterial effect. Prescribing is matched to your pattern of disease and reviewed rather than left running indefinitely.

Trigger identification

Common triggers include heat, alcohol, spiced food, sun exposure, stress and certain skincare ingredients. Identifying yours does more for long-term control than any single prescription, and costs nothing.

Laser for persistent redness

Fixed background redness and visible vessels do not respond well to creams, because the vessels are structural. Vascular laser targets them directly and is often the most effective option for this component. It does not treat the inflammatory element, so it usually sits alongside medical therapy rather than replacing it.

Realistic expectations

Rosacea is controlled rather than cured. The aim is fewer flares, less background redness and skin that is comfortable. Anyone promising permanent resolution is not describing this condition accurately.

Risks and limitations

No treatment is without risk, and you are entitled to the full picture before you decide rather than a summary afterwards. These are discussed with you individually at consultation, in the context of your own history.

• Irritation from topical treatments, particularly early on
• Photosensitivity and gastrointestinal upset with oral doxycycline
• Bruising, swelling and crusting after vascular laser
• Flare-ups continuing despite good treatment
• Rebound worsening if topical steroids have been used and are stopped

Where you would be seen

Consultations and minor skin surgery take place at CLNQ Manchester on the ground floor of the South Tower at Deansgate Square, and at CLNQ Knutsford on King Street in Cheshire. Patients travel from across Greater Manchester and Cheshire — Altrincham, Hale, Bowdon, Wilmslow, Alderley Edge and Didsbury are all within easy reach of one or other site.

Where a lesion needs a theatre rather than a treatment room, the procedure is arranged at Deansgate Hospital, a CQC-registered private hospital a few minutes away in Manchester city centre. Any specimen requiring histology goes to a UK histopathology laboratory and the result is discussed with you directly.

• CLNQ Manchester — Deansgate Square 11 Owen Street, Manchester M15 4YB Ground floor of the South Tower at Deansgate Square, Manchester city centre.
• CLNQ Knutsford — Cheshire 49-51 King Street, Knutsford WA16 6DX King Street, Knutsford, serving Cheshire and the surrounding area.
• Deansgate Hospital Madison House, 37 Little Peter Street, Manchester M15 4QJ CQC-registered private hospital in Manchester city centre, for procedures needing a theatre.

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