A Dermatologist’s Answers to my Top Rosacea Questions

Hi everyone!  I’m sorry for the prolonged silence.  I have lots of excuses but I’ll save you the bother of hearing about them and will get right to the point about something exciting that has recently happened to me in my progress to learn about and treat rosacea.

Dr. Nisith Sheth , MBBS, FRCP(UK), CCST(Derm) Cedars Dermatology

In honour of Rosacea Awareness Month (April), Dr. Nisith Sheth from Cedars Dermatology Clinic invited me to speak with him via email so that he could answer some of the questions that continue to plague me with regards to my skin condition.

Naturally, I jumped at the chance! Dr. Nisith Sheth (MBBS, FRCP(UK), CCST(Derm)) is a consultant dermatologist and dermatological surgeon who is an expert in the treatment of rosacea as well as acne, eczema, psoriasis, discolouration, scars, moles, skin cancers and ageing skin. His dermatological training was in the United Kingdom, the United States and Canada.  This is an expert whose opinion I wanted to hear!

Now that I’ve received Dr. Sheth’s opinions and answers, I’m immensely impressed with his insight as well as his willingness to be frank with me. I appreciate the fact that he spoke of both published evidence and the types of things he and his colleagues have seen among their own rosacea patients.

Now I’m thrilled to be able to share my questions and Dr. Sheth’s answers with you, my Rosy Friends!

As Dr. Sheth is located in the United Kingdom and I am in Canada, I was not able to consult with him in person. Therefore, I provided a little bit of information about myself and my case of rosacea in order to offer some context to my questions.

I provided my age, offered some pictures and explained that I’ve had rosacea for at least 16 years.

Here is the background information I provided about my rosacea

I have subtypes 1 and 2 of this skin disorder, with symptoms including redness in the entire area of my cheeks, right up to my temples. When the condition flares up, I also experience tiny whitehead-like pimples in the apples of my cheeks, deeper flushing, burning and sometimes stinging or itching.

For the first five years of that time, I was diagnosed with acne and was using acne treatments such as topical prescription medications which only caused my condition to worsen.  Since then, the redness has never fully cleared in my face, regardless of trigger avoidance or successful treatments.

I have unsuccessfully tried metronidazole (as Metrogel, Metrocream and Noritate) and did not have positive results from oral antibiotics.  I was unsuccessful with several over-the-counter and “natural” treatments, including one based on vitamin C and caffeine.  For a while, seabuckthorn seed oil did wonders for my skin, despite the fact that it was slightly tinted orange on my very-pale skin but over time that stopped working, too.  I’ve tried a large number of different options throughout the last decade, giving them all time to work in a careful trial-and-error process.

Recently, I have been using a combination of red and amber high power LED (HPLED) daily treatments from Smarter Lights (formerly Light Therapy Options).  That method has been the most successful of everything I have tried for controlling the condition.  Most of my symptoms are gone although some redness remains.

My triggers include: heat, sunlight, certain foods, certain topical product ingredients, stress, lack of sleep, hormonal changes, seasonal allergies, among others.

My rosacea symptoms progress over the last 10 months

Here are the rosacea questions I asked and Dr. Sheth’s replies.

Question 1

Julie “I understand that no single treatment helps all rosacea patients, even when it comes to the best products and therapies. It’s my understanding that the treatment methods that are considered most likely to be effective are still ineffective for more than half of people with the condition.  In your experience, what is the most effective method of treatment for someone like me – who has unsuccessfully tried many things – and, to your knowledge, what is the approximate success rate of that method? (please note that I will not consider this a medical recommendation. I will use this for only informational/educational purposes).

Dr. Sheth: Probably still the most effective treatment where simpler treatments have not worked are light based devices such as intense pulsed light (IPL) or lasers (such as pulsed dye laser).  Published literature suggests you can get a 75% improvement over 2 treatments.  In reality most people need at least 4 treatments leading to a 60-80% improvement.  100% improvement is possible but not common.  Published literature suggests improvement in symptoms for 3-5 years but again in reality most practitioners I speak to say 1-5 years with many patients needing a top up treatment annually or every 2 years.  Whilst they are not cures IPL or lasers can dramatically improve quality of life.

Question 2

Julie: I have found skin care and light therapy treatment to be highly effective in healing and controlling my rosacea symptoms. Still, there is redness – albeit faint – in my cheeks.  Will I ever see my natural (very pale) complexion again or is it likely that I will always have redness to some degree?. 

Dr. Sheth: The number of blood vessels in the dermis decreases with age probably in part due to something called VEGF  (vascular endothelial growth factor) signalling.  Look out for this as it’s an area that’s being carefully looked at in rosacea patients and a possible treatment target.  However redness and new blood vessels are also influenced by many other factors including hormonal change and the environment so in reality for most people the redness does stay.

Question 3

Julie: Aside from consulting with a dermatologist – which should clearly be the first source of trustworthy information – what other resources would you recommend for someone like me who is seeking to inform herself about her skin condition. There is a lot of misinformation on the internet.  Where can reliable information be found?

Dr Sheth: The National Rosacea Society (rosacea.org) as well as the professional bodies The American Academy of Dermatology (aad.org) British Association of Dermatology (bad.org.uk) Canadian Dermatology Association (dermatology.ca) provide independent and evidence-based reliable advice.

Question 4

Julie: Have you seen any “natural” rosacea treatments work effectively in treating the symptoms of the condition? Please know that I don’t consider your answer to be a recommendation.  I’m just curious as to which options you’ve witnessed in some of your patients throughout your experience with this skin disorder.

Dr. Sheth: I’ve had lots of patients try different things.  Tea tree and witch hazel can work for a short time – they can work in a number of skin conditions by reducing inflammation- but nothing has given long lasting benefit and none of our patients have found them to be significantly better than prescription or light based treatment unfortunately

Question 5

Julie: How can a rosacea patient know if a treatment is working? I understand that every treatment type is different and everyone heals at their own pace, but how much time should I spend on a product/therapy before I decide that it is or is not working? Many people contact me to tell me that something isn’t working after 5 days, but in my experience that is far too short for something like a cream or light therapy to prove itself.  I can’t make recommendations to people, as I’m not a skin care expert, but when it comes to own purposes in testing new things, should I wait 8 weeks? 12 weeks? What timing/signs should I be watching for?

Dr. Sheth: Rosacea is a chronic condition ad so you need to give things time to work- at least 3 months I would say

Question 6

Julie: What is the most common mistake you’ve seen rosacea patients make in attempting to treat their skin?

Dr. Sheth: Trying too many different things at the same time and looking for cures or a single underlying cause. It’s a complex condition which has multiple causes which can be very difficult to measure or control in a practical way at present.

Question 7

Julie: What is the best way to react to a flare-up as it’s happening? I know that consistent skin care and treatments are important, but what would you recommend for cooling and calming the discomforts of inflamed skin when they are actually occurring?

Dr. Sheth: Cold compresses give some quick relief. Some of the prescription treatments you mentioned earlier can help sustain that in some people though I appreciate you haven’t found them successful.

Question 8

Julie: Do you feel that “mineral” makeup is safe for rosacea-prone skin or does it make the situation worse? I’ve read conflicting reviews/opinions about mineral makeup and am not sure if I believe that it is better or worse than traditional foundations and powders. If it is not right for rosacea-prone skin, what alternative makeup type would you recommend for covering the redness?

Dr. Sheth: For many people mineral make up is the best.  A green or yellow tint usually works well. For some people almost anything irritates the skin. Alternatives are any oil-free concealers, which contain UVA and UVB protection if your rosacea gets worse in the sun which is the case for many patients. To be safe use products new to you on a test area for a couple of days first. People with rosacea have a higher incidence of contact allergy to many products and lower threshold to develop irritation. It maybe worth considering patch testing (an test to look for contact allergy) if many products are causing skin problems

I am extremely grateful to Dr. Sheth from Cedars Dermatology for taking the time to answer my questions.  I feel much more confident in my understanding of my condition, which makes a big difference in how I feel about the success of my efforts to avoid triggers and choose the right treatments for me.

I’ll be returning to regular blog posting very soon.  Please feel welcome to keep up with everything else I’m up to over social media (Facebook and Twitter) as well as over my YouTube channel, where I post videos every Sunday and some Thursdays.

Soon, I’ll be posting blogs about my experience in trying out Face Addiction skin care products, Earth’s Berries soap nuts, coming up with cosplay makeup for sensitive/reactive skin, and more!