What Is It?
Is the skin on your face always red – or sometimes red?
Does it get more red when you work out, go out in the wind, get emotional or stressed out, sit in a hot room, drink red wine or get nervous?
Are you always trying to cover the redness with make-up, but it never quite works?
Diffuse facial redness appears for several reasons: acne scarring, rosacea, sun damage, other types of scars and genetics. The redness can be present all the time, or may become more noticeable with certain trigger factors such as heat, wind, exercise or wine consumption. An increased number of very superficial blood vessels, combined with sensitive skin or skin that easily flushes, leads to increased red appearance of the skin. Chronic active or low-grade inflammation in the skin also makes the skin more red and sensitive.
The persistent redness that can occur on the vee of the chest and the lateral neck, especially in women, is called Poikiloderma of Civatte. This is a most troublesome cosmetic problem for many women.
If you are troubled by facial redness, redness on the neck and/or chest or any other form of redness, we will first meet with you and discuss medical treatment of any underlying skin diseases, including acne and rosacea. We will recommend skincare products to reduce the appearance of redness and to treat sensitive skin. Unfortunately, there are very few topical treatments that make a considerable impact, so we usually recommend topical anti-redness agents in conjunction with laser and light treatments to optimise redness reduction. We offer Candela VBeam Perfecta, Cutera Excel V, Genesis V, Gemini KTP and BBL, which are the most advanced treatments to improve the appearance of skin redness and allow us to customise treatments for the most effective and convenient experience for our patients. Some of the lasers can be combined at the same treatment session.
Rosacea is a chronic rash that typically begins with flushing and blushing of the cheeks and nose and progresses to persistent facial redness, broken facial blood vessels and inflamed pimple-like bumps. More advanced cases can progress into rhinophyma, in which the oil glands of the skin become enlarged, making the nose larger and the cheeks puffy.
About 50% of patients have eye involvement (also called ocular rosacea) which causes dryness, burning and grittiness of the eyes.
Four types of rosacea have been identified:
Type I: Flushing and persistent redness with visibly enlarged capillaries (telangiectasia). This type of rosacea is usually the least severe and may be accompanied by enlarged sweat glands, oiliness and/or dry and flaky skin. The skin may become sensitive with a burning and stinging effect when it comes into contact with make-up, sunscreens and other facial creams, or with sun exposure and/or consumption of hot and spicy food or drink.
Type 2: Persistent redness with transient bumps and pimples – papular rosacea. Papular rosacea is usually seen on a background of flushing and persistent redness and is characterised by the formation of lumps, pimples and pustules.
Type 3: Eye irritation (ocular rosacea). Ocular rosacea is the term used to describe rosacea when it involves the eyes, typically causing redness and grittiness in the eyes. The eyelids may show redness and scaling.
Type 4: Skin thickening, often resulting in enlargement of the nose (rhinophyma). This sub-type of rosacea presents as overgrowth of the oil glands, usually on the nose and sometimes is associated with significant disfigurement.
What is the Treatment of Rosacea?
There are a range of treatments available, and treatment regimes are customised to each individual to stop the progression of the disease. Education on avoidance of triggers is also important.
Things that trigger flushing are known to worsen rosacea and triggers can vary from individual to individual. Common triggers of rosacea include spicy foods, hot drinks, caffeine and alcoholic beverages and certain foods such as bananas, cheese, yoghurts, figs and nuts.
Rosacea is provoked by excessive sun exposure, which must be avoided with the use of a broad-spectrum sunscreen (SPF 50) and by wearing a wide-brimmed hat or generally remaining sheltered and avoiding extreme temperatures. (Exercise in a cool environment. Do not overheat and protect your skin from the cold and the wind).
Avoid abrasive scrubs. Because of skin sensitivity, topical skincare treatments should include soap-free cleansers, gentle emollients and light foundations. Mineral based make-up can be used and products to avoid are cosmetics and skincare products with toners, alcohol or irritating ingredients. Heavy foundations and cosmetics that are hard to remove, such as oil-based facial creams, are also not recommended. Under no circumstances should topical steroids be used to treat rosacea.
What Other Treatments Can We Provide for Rosacea?
Flushing and persistent facial redness – the mainstay of treatment for this type of rosacea is skin care and laser or intense light based treatment. At the Skin Specialist Centre we have several different laser and light systems, each with its own specific benefits. Treatment is based on the individual requirements and our equipment includes Candela VBeam Perfecta pulse dye laser, Cutera Excel V, Gemini long-pulsed KTP and Yag laser and Sciton BBL light device.
Papular rosacea – the firstline treatment for this is systemic antibiotics, which are usually prescribed daily, often in conjunction with creams and gels.
Rhinophyma – distortion of the nasal shape is treated very successfully with the carbon dioxide laser (Smart Xide Dot laser). Often systemic antibiotics are usually necessary to maintain improvement.
Ocular rosacea – oral antibiotics can be useful and where they are not successful, referral to an ophthalmologist (eye specialist) is required.
Port Wine Stain Treatment
Port wine stain birthmarks (flat patches of purple or dark, red skin) are vascular birth marks which often appear in infancy or early childhood and can be disfiguring. The most effective laser treatment for port wine stain removal is a pulse dye laser, and we use the state-of-the art model Candela VBeam Perfecta and, if required, the Cutera Excel V.
Red spots on the face and body
Red spots on the face and body are known as angiomas. They commonly occur on the body and are benign growths. They are harmless medically but do bother some people cosmetically. They are effectively removed with either the Candela VBeam Perfecta, the Cutera Excel V, the Genesis V, the Gemini KTP/Yag laser, or the Sciton BBL light device.
Rhinophyma is a form of severe rosacea, relatively common in the New Zealand male population. In most cases it develops in the late forties and worsens with time. Mild cases present as uneven lumps and bumps of tissue on the nose and in more severe cases, the nose and adjacent areas of the face show a thickened over-growth of tissue.
Depending on the severity of the rhinophyma, we use a variety of methods to correct the deformity. Moderate deformity is treated with the Smart Xide Dot laser. This laser, aided by the skill of the specialist dermatologic surgeon, also re-shapes the nose, removing excess tissue with each pass.
Rhinophyma removal treatments are very successful and in all cases will significantly correct the underlying deformity. The majority of cases require only one treatment. Touch-up treatments are occasionally performed for optimal results with the Candela VBeam laser.
Rhinophyma is one of the most debilitating and deforming conditions for men, and is certainly a source of embarrassment, both physically and emotionally. Recovery varies but, on average, is 14 – 28 days, during which time patients must limit their work and social activities. For the majority of patients, this is fortunately covered under medical insurance.
Red neck and chest / poikiloderma of civatte
What is It?
Poikiloderma of Civatte (POC) refers to a “crepe-like” appearance of the skin and a characteristic red/brown discoloration that looks like a permanent sunburn or tan involving the neck and the vee of the chest (décolletage in women). The area under the chin is usually unaffected. The condition is more commonly seen in women and in places where there is high ultraviolet light exposure.
The cause of Poikiloderma of Civatte is unknown. Factors which are thought to play a part in the development of the condition include fair skin, ultraviolet light exposure, hormonal factors and some components of cosmetics and toiletries (photosensitising components).
How Does it Present?
Skin thinning (atrophy), redness from enlarged blood vessels (erythema) and colour (pigmentary) changes are seen in sun-exposed skin. It most commonly affects the sides of the neck. The area under the neck remains characteristically unaffected. Poikiloderma of Civatte may also affect other areas on the face.
How is Poikiloderma of Civatte Diagnosed?
The diagnosis is made by clinical assessment, and no tests are necessary.
How is it Treated?
Treatment of Poikiloderma of Civatte can be difficult and results will largely depend on the dermatology laser centre at which you present for treatment as to whether they have the appropriate laser specific to your needs. Dermatologists will frequently use a combination of treatments to achieve the best results. General measures include:
The use of perfumes and cosmetics should be limited.
Where practical, scarves or other clothing should be worn to cover the neck.
Broad-spectrum sunscreens (with SPF 50+ or greater) covering both the UVA and UVB spectrum should be applied twice daily and re-applied regularly.
Lightening creams may be used to treat the brown (pigmented) areas of the skin. Bleaching creams such as Hydroquinone and Vitamin-A based creams can be used. Alpha-hydroxy acids can also reduce brown pigmentation.
Combination Creams and Lasers:
Creams and lasers are often used in combination to treat this condition. The aim is initially to treat the redness first and then target the pigmented areas.
Laser and Light Therapies:
Laser and light therapies provide the most promising method of treating Poikiloderma of Civatte.
The Excel V laser includes the parameters for a patented procedure known as Laser Genesis. This microsecond 1064nm treatment is an excellent choice for Poikiloderma of Civatte. This unique procedure targets the microvascularity with microsecond, high peak power pulses, reducing redness whilst stimulating collagen production. This is our initial treatment of choice.
Candela VBeam pulse dye laser (595nm) – usually three to six treatments are required for the best results. Each treatment may produce temporary light bruising. Skin may initially turn pale and sometimes a “checkerboard” or spotty appearance may be seen. However, these symptoms resolve when treatment is completed.
Broadband light treatment (BBL) targets both blood vessels and melanin (pigment), treating both redness and brown discoloration. Treatments are spaced 4 – 6 weeks apart, but multiple sessions of treatment are required to improve the appearance.
Fractional non-ablative lasers (Fraxel Restore Dual 1927nm) – two to four treatments are required for the best possible outcome and are usually only used when the treatments mentioned above are ineffective.
Following treatment, the skin will need to be vigilantly protected from sun exposure to decrease the risk of Poikiloderma of Civatte recurring. Maintenance laser treatments may be used intermittently if the condition recurs.
Veins around the nose
PERINASAL TELANGIECTATIC VESSELS
These are very common. They can be due to genetics, rosacea or even frequent nose blowing. The key to treatment is the choice of laser. These vessels can be difficult to treat and they have a high rate of recurrence with many laser devices. We achieve excellent results with our latest Candela VBeam Perfecta and the Cutera Excel V lasers. The Gemini Nd:Yag laser can also be used, but can possibly cause pitted scars if used too aggressively, or hypopigmented steaks. We caution people that they may need periodic maintenance treatment for these vessels, as large deeper vessels tend to re-open eventually.
What’s the next step?
If you already have an appointment booked at The Skin Specialist Centre, you can easily add a redness and flushing treatment/consultation to your booking by calling our friendly team on (09) 524 5011. If you have never been to The Skin Specialist Centre, you can either give us a call on (09) 524 5011 or make an enquiry by clicking on the Enquire Now option below.