Dermatologist explains how to treat rosacea redness in 7 minutes: @DrJohnBarbieri

[@wendy2270]

I would love a video about treatments for structural skin changes from rosacea, that is, phytamous changes. I know that this is not what most people suffer from, but it is a frustrating condition, and can occur not just on the nose! Thank you for your academic-and approachable-style. It's refreshing.

[@DrJohnBarbieri]

Thank you for the positive feedback. Phymatous rosacea as well as other variants such as solid facial edema can be challenging to treat. I cover it briefly in this video (kzbin.info/www/bejne/i4DSXqNtfrWLhNEsi=CC-0MeIckPMPrrr9) and hope to cover it in more detail in a future video.

[@marybyrnes3951]

what do you think of Soolantra? It seems to help me but it’s expensive

[@DrJohnBarbieri]

In head-to-head studies, ivermectin (soolantra) is one of the most effective treatments for papules and pustules in rosacea. It can also be somewhat helpful for redness, but more in that it treats that papules and pustules (which can be inflamed and red) than for that kind of telangiectasia and background redness that some patients have. From the standpoint of cost, sometimes one can use a compounding pharmacy to make an ivermectin cream that can be less expensive than brand Soolantra.

[@Jasmine215100]

The only things that have come close to curing my Rosacea are oral tetracyclines (Achromycin V), V-beam Candela lasers, Rosadyn and 2% Salicylic acid washes. I use the SA about once a week and these treatments really work! No cures yet though.

[@DrJohnBarbieri]

Unfortunately, there is no cure for rosacea. As you mention, we do have treatments that can help to manage it.

[@Jasmine215100]

Too many different ways to profit off of these very common (although disfiguring) skin conditions)!@@DrJohnBarbieri

[@steve00alt70]

Why is demodex greater in all rosacea types than normal skin types? If we eliiminate the demodex mites for 12 weeks would the flushing (inate overreaction of demodex bacteria byproducts) reduces? I cant get oxymetazoline in uk

[@DrJohnBarbieri]

Great question and we don't really know why patients with rosacea tend to have more demodex or even if these demodex are causing rosacea vs a bystander. In general, for flushing, treatments aimed at demodex like ivermectin are not particularly helpful. Alpha-adrenergics (rebound has generally not been observed for oxymetazoline) and b-blockers are the only treatments included in the ROSCO recommendations (www.ncbi.nlm.nih.gov/pmc/articles/PMC7317217/). CGRP inhibitors might be a useful treatment option in the future, but more study is needed and they are currently only FDA approved for migraine.

[@squith99]

Hello doctor. Is it possible to make an appointment with you without a referral. I'm a Canadian and would like to meet with an expert. I would be happy to pay out of pocket.

[@DrJohnBarbieri]

Here is the information for our office if you'd like to ask for more information about our practice: www.brighamandwomens.org/dermatology

[@martinagallagher3354]

What can I take for my gut health, as in probioctics, as Roseaca can stem from the insides. What are the best probioctics to take.?

[@DrJohnBarbieri]

Gut health can definitely influence rosacea and other skin diseases. There are some studies finding that small intestinal bacterial overgrowth (SIBO) is more common in those with rosacea and that treating it can improve rosacea symptoms (pubmed.ncbi.nlm.nih.gov/18456568/). Unfortunately, probiotics are not well regulated, so there is a lack of evidence about whether probiotics can help rosacea and which ones might be best. In my experience, probiotics rarely are sufficient to help someone with rosacea on their own. However, it's also a relatively low risk treatment option for those who would like to try it.

[@jimmann4711]

seems to me its all heat related sun spicy food exersise all causes the body to heat up your thoughts?

[@DrJohnBarbieri]

Yes, heat and certain compounds in food can activate blood vessels and inflammatory pathways, causing rosacea to flare.

[@weeteelim3749]

Excellent 🙏🏻👍👍

[@DrJohnBarbieri]

Thank you!

[@bonnie_nelms]

Pimples are more problematic for me than redness. My redness is not severe but the pimples are annoying

[@DrJohnBarbieri]

Check out the other videos on the channel and make sure you are subscribed to stay up to date on rosacea content, including for pimples/papules: kzbin.info/www/bejne/i4DSXqNtfrWLhNEsi=r7MG-wjyn9NxPuki

[@marymurphyneecollins1788]

Heat gets it going what's best for me?

[@DrJohnBarbieri]

While I cannot provide direct medical advice without seeing you in clinic, heat is a common trigger for rosacea. As is discussed in the video (as well as our other videos on rosacea), avoiding triggers when possible, using medications that can help the blood vessels not over-react to these triggers (e.g. oxymetazoline, b-blockers) and using lasers to reduce the overactive blood vessels can all be helpful strategies in general for redness in rosacea.

[@ladislavstassel6405]

Rosacea = demodex

[@DrJohnBarbieri]

Skin microbes such as demodex are an important factor in rosacea, but other factors such as environment (UV, food, etc), gut microbiome, inflammation, and genetics also appear to be involved in causing rosacea.