Karan Lal, DO, MS, FAAD: Detailing Rosacea Subtypes, Severity, and Treatment

With April being Rosacea Awareness Month, patients and providers alike are using the opportunity to have important discussions regarding the skin condition that currently has no available cure.

In an interview with HCPLive, Karan Lal, DO, MS, FAAD, of the Schweiger Dermatology Group and member of The Society for Pediatric Dermatology provided crucial information regarding variations of rosacea and how providers and patients can treat the skin condition.

Rosacea is believed to affect approximately 5.46% of the global adult population, and the National Rosacea Society estimates the number of patients in the US affected by rosacea to be 16 million.

Lal estimated that among his adult patients, 30-40% struggle with rosacea.

Some patients might be unaware that they have rosacea as it often gets mistaken for traditional forms of acne.

“Now, rosacea is a form of acne, it's an acneiform disorder, so the way we differentiate rosacea from acne is that in acne you have blackheads and whiteheads, also called comedones,” Lal said. “In rosacea, you can have pimples just like you have with acne, but you don't typically have blackheads or whiteheads. That is in the inflammatory part of rosacea.”

Several forms of rosacea, such as papulopustular forms, are defined by pimples and the raising of the skin from pustular bumps.

Other forms such as erythematotelangiectatic and phymatous rosacea present with redness, flushing of the facial cheeks, forehead, and chin, and involve deep-seated swelling of the facial regions.

“There's a lot of different criteria for rosacea, but the big ones are getting recurrent flushing in the central face with certain triggers like spicy foods, alcohol, warm environments, certain cheeses, chocolates, things like that- all the good things,” Lal said. “Also, getting pimples, redness, red bumps, puss bumps, also in those areas that may or may not be associated with those same types of triggers.”

Lal noted that prior to treating rosacea, a condition that currently has no cure, providers should first properly classify it.

“People have a mixed form (of rosacea) where they have redness and they have puss bumps, that's the most common thing that I see,” Lal said. “And it ends up being that you want to treat it from an anti-inflammatory perspective, so we most often start with topical anti-inflammatory agents or topical antibiotics or anti-parasitics like metronidazole, which is often a cream or a gel that we can use to make the pus bumps go away.”

Treatments such as brimonidine and oxymetazoline have been shown to reduce redness for short periods of time, and providers are often compelled to take a “multimodal approach” to treating rosacea that included topical agents, anti-inflammatory medications, and laser light therapy.

Regarding anti-inflammatories, Lal noted that while there isn’t a surplus of new options, what is available tends to work well in reducing complications caused by rosacea.

“We have newer agents like topical minocycline foam, which works very well, and I have used in patients, it's called Zilxi,” Lal said. “I don't think a lot of people know about how effective it is or have used it, but it's a relatively new agent. So , I’d like for people and patients to know that there are new things on the horizon and to just give things a try and see what we can do to make patients better.”