Rosacea - Triggers, Causes, and Treatments

By: Amiya Prasad, M.D.

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.

Rosacea - Triggers, Causes, and Treatments

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.

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