Rosacea Support Group » papules & pustules

How to cure a red swollen nose

David Pascoe — Thu, 13 Nov 2008 05:33:17 +0000

The red swollen nose of rosacea is a much hated symptom. I know that this was the symptom that I despised most and indeed drove me 10 years ago to start to look for good information about how to treat rosacea. Incidentally, this drive lead to the creation of the internet based Rosacea Support Group in 1998.

I hated that I looked like I had adult acne and a constant sun-burned nose. Especially as I have somewhat fair skin, a red nose stood out a mile away.

There has been quite a lot of interest in a article I wrote titled “how to cure a red face (facial erythema or redness)“. That article gave some tips on how to deal with general facial redness. What about a red and swollen nose ? What can you do to treat a red rosacea nose ? Read on for some suggestions.

A rosacea nose has the extra complication that one might end up suffering from rhinophyma. Although rare, rhinophyma is also a much hated symptom of rosacea. While we don’t know for sure how any particular rosacea sufferer’s symptoms will progress, reducing your inflammation and flushing is a good start to winning the battle.

Here are my top tips for dealing with the red nose of rosacea.

Rosacea-LTD III

Rosacea-LTD was one of my first discoveries after starting to look for treatments on the internet in 1998. They consist of compressed disks of sulfur and various salts. You wet your face and glide them over the skin, leaving a thin film. For me these `disks’ did a great job of reducing the papules and pustules on my nose. I could feel them shrinking all those acne looking lumps and bumps. As much of my redness was associated with my papules and pustules, this treatment was a good step in the right direction. I continued to use rosacea-ltd for several years.

Disclaimer: rosacea-ltd is a site sponsor of rosacea-support.org

Oral Antibiotics

If the nasal swelling is associated with the papules and pustules normally seen in rosacea, then systemic antibiotics along with topical metrogel or finacea may also be of benefit. Once the papules and pustules are under control, the associated swelling may be reduced enough to see an overall benefit in appearance. One of the newer antibiotics on the market is a low dose form of doxycycline called Oracea, which may be useful in helping to maintain a long term benefit from antibiotic usage.

Accutane

Accutane or roaccutane has been used for many years to treat cystic acne. There is a good body of evidence to say that you can successfully treat rosacea with accutane. Additionally there are some published papers that deal specifically with treating rhinophyma with accutane.

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

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Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change.

[See treating rhinophyma with accutane]

Accutane is not a drug to be taken lightly. If you would like to try this as an option, the above references might help you find a doctor that can support you using this as a treatment option. You may also want to discuss the option of low-dose accutane with your doctor.

Covering Up

As you start to reduce the inflammation, you will probably also benefit from covering over some of the redness. Some options include the easily available Clinique Redness Solutions, or Eucerin Redness Relief which may be able to offer some relief from the redness. Additionally the green tinted version of the Tone Perfecting Cream may cover some redness.

Perhaps you can find some foundation or tinted moisturizer that you can also include in your daily regime. It might not be easily obtainable worldwide, but The Cancer Council in Australia has a range of tinted moisturiser SPF 25 that looks interesting. Don’t discount a liquid foundation as a possibility, even if you are a guy.

IPL and Lasers

We now know that IPL is excellent for treating a red face and broken blood vessels. Will any of the benefits of IPL also help a red swollen nose ? In general IPL and pulsed dye lasers are useful in reducing the redness flushing, burning, itching, dryness and swelling of rosacea.

The AAD suggests that for thickening of the skin on the nose and cheeks as seen in rhinophyma, the CO2 laser and erbium:YAG laser can be used.

Surgical Options

When the growth of the nose tissue becomes impossible to manage with topicals or isotretinion, surgical intervention can be an option. Surgery can naturally have its own risks. With the removal of extra tissue also comes the risk of scarring.

CO2 Laser

A 2004 paper; The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2 Laser, details how the authors suggest that the combined YAG/CO2 laser is superior to other lasers, scalpel, radiotherapy and skin grafts in dealing with rhinophyma.

Also some related comments from the AAD page Is laser treatment right for your rosacea? ;

Some patients with longstanding rosacea develop thickening skin on the nose and cheeks, which is called rhinophyma. The CO₂ laser and erbium:YAG laser can be used to remove this thickening skin and improve the contour of the nose. Other surgical procedures used to treat this condition include dermabrasion and excision with a scalpel. Treatment options may be combined to obtain best results.

Dermatologists recommend early treatment of rhinophyma to help prevent the condition from progressing and becoming more difficult to treat. In the advanced stages, rhinophyma can cause difficulty breathing through the nose. It also is possible for the nostrils to collapse.

Other Surgical Methods

A 2003 paper; New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal details a novel technique using a standard microdebrider followed by a haemostatic sealant to eliminate bleeding.

Now Over to You

What have you found to be useful in your battles with a red nose ? Please help your fellow rosacea sufferers by leaving a comment below.

rosacea not on your face, it is possible

David Pascoe — Tue, 08 Jan 2008 06:46:12 +0000

One often asked question by newly diagnosed sufferers is `can you get rosacea on areas other than your face’. The usual answer is no; you normally only see rosacea symptoms on the flushing zone areas in the central areas of your face. This paper slightly dispels this idea with a case report about one patient who had rosacea lesions on his arm, and upper chest area.

Rosacea with extensive extrafacial lesions, Int J Dermatol. 2008 Jan;47(1):52-5, Pereira TM, Vieira AP, Basto AS
Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

The patient had papules, red nodules, pustules and large granulomatous lesions involving the face, neck and upper chest, and extending from the left shoulder along the whole left arm. It was mostly missing from the central facial region. Demodex was not seen as a possibility.

The treatment regime was deflazacort (an oral steroid) 30mg for 3 weeks, azithromycin at 500mg, 3 days a week for 4 weeks and isotretinoin (accutane) 10mg a day for 1 year. The accutane was reduced in the later months. The patient was advised to avoid the sun and use a physical sunscreen (i.e. zinc oxide or titanium dioxide based).

After 1 year, the chest, left shoulder and arm were clear, with some facial redness remaining.

In order to diagnose these symptoms as being rosacea-like, the doctors had to rule out several other possibilities like infectious folliculitis and demodicosis.

Therefore, in this case, the presence clinically of inflammatory papules, pustules, and nodules on a congestive background, with spread from the typical midfacial involvement to other areas of the body, and the presence of poorly organized epithelial granulomas and follicular pustules in the biopsy allow the diagnosis of extrafacial rosacea.

A review of 53 cases of granulomatous rosacea found extrafacial lesions in 15% of the patients.

Interestingly the patient was treated with low-dose accutane and pulse dosing with azithromycin. A 3 week dose of oral steroids was also included.

The paper ends with the following conclusion.

Reports of extrafacial rosacea are rather scarce. However, it may be
more common than it is thought, because it is generally not considered and/or not researched. We presented an unusual setting of extrafacial rosacea that is remarkable for the exuberant and extensive involvement, when comparing with facial involvement, the initial diagnostic difficulty and the good therapeutic results obtained

What about you, have you ever suspected that you have `extrafacial rosacea’ ? How did you treat it ? Leave a comment below.

Senetek Trialling Pyratine 6 / PRK124

David Pascoe — Sun, 30 Dec 2007 11:13:40 +0000

A new trial has just been posted that will be looking at how Pyratine 6 (a variant of Kinetin) treats the papules & pustules, redness and visible blood vessels of rosacea.

From Clinical Trial NCT00580723: Effects of PRK 124 Lotion in Acne Rosacea

The purpose of this open-label study is to determine the tolerance and efficacy of twice-daily application of PRK 124 (Pyratine-6)(0.125%) moisturizing lotion for improving the signs and symptoms of mild to moderate facial rosacea.

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Cytokinins are plant growth factors that regulate plant growth and differentiation. PRK 124 (N-furfuryl-9-(2-tetrahydropyranyl) adenine)(Pyratine 6™) is a cytokinin that has been shown to have modulatory, anti-ROS (reactive oxygen species), and antisenescence effects on the growth of human skin cells.

Originally created as an anti-aging product, Pyratine 6 is now being targeted as a rosacea treatment. Back in April 2007 a flurry of press releases (covered by Rosacea News as Pyratine 6 (vs. Kinetin) reduces redness and acne lesions) Synetek signalled that they were readying to trial Pyratine 6 for rosacea. The recently posted trial will run for 48 weeks and is expected to be completed in January 2009.

Previous studies that have been highlighted by Rosacea News have shown that the related topical kinetin is a good anti-aging moisturizer for rosacea sufferers and may even show some benefit for rosacea symptoms.

ivermectin clears untreatable rosacea

David Pascoe — Tue, 23 Oct 2007 02:14:15 +0000

In this case report of one patient, the papules and pustules of rosacea were difficult to treat until oral ivermectin was included in the treatment regime.

This 2007 paper is similar to a 2002 paper, Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream. The 2002 paper is also a case report of a single patient with recalcitrant symptoms.

Note that topical permethrin may well be too harsh for many rosacea sufferers. Back in 2000, a a project that proposed using topical permethrin was suddenly canceled after reports surfaced of strong negative reactions to permethrin.

I would suggest that these results are the exception rather than the rule when approaching how to treat your rosacea.

Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin

Cutis. 2007 Aug;80(2):149-51., Allen KJ, Davis CL, Billings SD, Mousdicas N. Indiana University School of Medicine, Indianapolis 46202, USA.

A 68-year-old healthy man presented with papulopustular rosacea (PPR) recalcitrant to multiple therapies, including permethrin cream 5%. Histologic examination detected the presence of chronic folliculitis and numerous Demodex organisms. A diagnosis of rosacealike demodicidosis was rendered, and the patient was treated with oral ivermectin and permethrin cream 5%, resulting in resolution of the folliculitis. Demodex infestation should be considered in any patient with rosacealike dermatitis resistant to conventional rosacea therapies. If infestation is demonstrated in these patients, oral ivermectin in combination with topical permethrin is a safe and effective therapeutic option.

Further Extracts

A 68-year-old healthy man presented with a 6-year history of PPR recalcitrant to multiple therapies, including topical and oral metronidazole, doxycycline, and erythromycin. The patient reported occasional pruritus but no flushing.

He had been treated unsuccessfully with permethrin cream 5%, and skin scrapings from prior examinations revealed Demodex infestation.

Physical examination demonstrated numerous erythematous papules and pustules with associated scale on his face, ears, and upper neck. Skin biopsy showed acute and chronic folliculitis with numerous Demodex organisms.

A diagnosis of rosacea like demodicidosis was rendered.

Because of the previously failed response to permethrin monotherapy, a combination of oral ivermectin 12 mg once weekly for 2 weeks and permethrin cream 5% applied 3 times weekly was prescribed. The permethrin cream was continued for 3 months for maintenance.

The patient misunderstood the dosage instructions and actually took 3 mg daily of oral ivermectin for a total dose of 24 mg. At 3-month follow-up, he showed marked improvement and sustained this response for at least 9 months

The pathogenic role of D folliculorum in rosacea is controversial and a clear separation between rosacealike demodicidosis and rosacea exacerbated by Demodex infestation often is difficult to establish. In our patient, however, the diagnosis of demodicidosis mimicking rosacea is more appropriate. The presence of pruritus and perifollicular scaling, lack of flushing, demonstration of Demodex organisms with associated folliculitis on histopathology, and the patient’s dramatic response to antimite therapy after several conventional rosacea therapies were unsuccessful all support the diagnosis of rosacealike demodicidosis.

Ivermectin is an acaricidal agent that has been successful in the treatment of scabies, lice, and helminthic infections, but is not US Food and Drug Administration approved for use in human mite infections.

Conclusion

Our patient was recalcitrant to multiple therapies, including permethrin cream 5%; however, the combination of oral ivermectin and topical permethrin resulted in substantial clinical improvement of his rosacealike demodicidosis.

When Demodex infestation is demonstrated in a patient with PPR and the patient is recalcitrant to standard rosacea therapy or permethrin monotherapy, oral ivermectin in combination with permethrin cream 5% should be considered as a safe and effective therapeutic option.

demodex mites ivermectin effective treatment ?

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demoodex mites continue to confuse

demodex mite bacteria causes the inflammation ?

ocular demodex, tea tree oil as a treatment

Pyratine 6 (vs. Kinetin) reduces redness and acne lesions

David Pascoe — Mon, 16 Apr 2007 14:05:00 +0000

The internet Press Release sites are full of an announcement from Senetek about a product called Pyratine 6 and its possible use in treating rosacea. The announcement is based on a comparison of Pyratine 6 with another of Senetek’s products – Kinetin.

According to their results, Pyratine 6 (or PRK 124) shows higher scores, compared to Kinetin in the areas of fine wrinkles, skin roughness and and overall skin aging. Additional tests of Pyratine 6 (although not stated, I assume against placebo, but this is not a given) showed increases in skin moisture, reductions in skin redness, and after 12 weeks, reductions in acne lesions.

Kinetin was originally created as an anti-aging product. Senetek say that Pyratine 6 is their `second-generation patented cytokinin’.

Senetek will now commercialise this new product as an anti-aging product and conduct more studies into its usability in rosacea. The press release mentions a `a major cosmetic company’ who licenses Kinetin, who will also commision their own `clinical trials of Pyratine 6 for Acne Rosacea and for skin whitening’.

I can imagine that to cosmetic companies the market for rosacea treatments and also to treat aging, look like 2 big piles of cash. We should keep an eye on these clinical trials to see how Pyratine 6 performs on rosacea sufferers.

Those who suffer from rosacea ought to consider a daily sunscreen and limit their sun exposure, both to remove a common rosacea trigger and also to reduce the aging affects of the sun. This is something we can all do today, without having to wait for products such as those featured in this press release.

Further Reading;

pulsed dye laser and papulopustular rosacea

David Pascoe — Sat, 24 Sep 2005 09:54:00 +0000

A small study suggesting that FPDL has limited value for rosacea papules and pustules.

Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea, Laster in Surgery and Medicine, Volume 34, Issue 3 , Pages 266 – 268, Published Online: 5 Mar 2004, Mats Berg, PhD MD, Desiree Wiegleb Edstrom, PhD MD

Keywords: erythematotelangiectatic, flashlamp pulsed dye laser, papulopustular rosacea treatment

Abstract: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions.

Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment.

Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions.

Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.

Abstract Online