JAN-FEB 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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34 JANUARY/FEBRUARY 2016 | Med Esthetics some of the same treatments for acne, such as topical antimicrobials or antibiotics. "My No. 1 prescription topical is Finacea Foam," says Dr. Lupo. "I participated in the clinical trials, so I saw fi rsthand very early on how benefi cial and well tolerated it was." "Azelaic acid may have some anti-infl ammatory and anti- microbial properties, and it might also decrease some of the infl ammatory mediators," says Dr. Berson. "Topical ivermectin has a dual mechanism of action—targeting Demodex mites and also having anti-infl ammatory properties." Mirvaso, on the other hand, is a vasoconstrictor that works on blood vessels that have muscular lining. Dr. Berson fi nds that effects can be seen half an hour after application, and though they last for about a day, the effects peak at around six hours. "It won't work on the superfi cial telangiectasia and capillaries, because they don't have a muscle lining," she says. "So those little vessels will still be there, but constricting the muscle lining of some of the bigger vessels will decrease redness by decreasing the blood fl ow." She also points out that Mirvaso is a cosmetic therapy. "It's for patients who want to look less red—it does not treat the underlying problem, and at the end of the day patients go back to their baseline redness," she says. In addition to topical treatment, low-dose doxycycline (Oracea, Galderma) is an effective oral medication that is antimicrobial and anti-infl ammatory. "Oracea is the optimal medicine orally, because it has a sub-antimicrobial Sun exposure is also one of the most common triggers for rosacea fl are-ups. Other triggers include extreme temperatures, alcohol, spicy foods and exercise. "It's unfortunate because exercise, otherwise benefi cial, can exacerbate redness, fl ushing and discomfort," says Dr. Berson. HEALING THE SKIN BARRIER Calming rosacea typically requires a combination approach, including topical and oral prescriptions, adjunctive aesthetic procedures and dietary changes. But providers must fi rst address the patient's compromised skin barrier. "You need to discuss the cosmeceutical protocols that a patient is on, because one of the main things that further infl ames a sensitive lipid barrier is the barrier disruption that occurs in rosacea as a result of the infl ammation. It's a 'chicken and the egg' situation—the disrupted barrier further exacerbates the rosacea, and so forth," says Dr. Lupo. "The single most important thing (non-prescription wise) is to make sure you repair the patient's barrier—make sure they are using anti-infl ammatory products that decrease transepidermal water loss (TEWL)." Because these patients have lost barrier function, providers should look for gentle cleansers and emollient moisturizers with hydrating or humectant ingredients— such as lipids, ceramides, heparan sulfate, glycerin and hyaluronic acid—to help restore it. Dr. Berson adds that anti-infl ammatory and antioxidant ingredients such as niacinamide (vitamin B), resveratrol, and vitamins C and E are benefi cial for compromised skin as well. "Simply restoring the barrier may help decrease fl ares as the patients are less sensitive to potential irritants," says Dr. Berson. "Recommending the appropriate skin care will make them not only respond better to their treatment but will also help maintain clear skin." Additionally, sun protection is mandatory for rosacea patients. "I like the physical sun blocking agents with inorganic ingredients such as zinc and titanium," says Dr. Berson. "We combine sun block agents with antioxidants in the morning, further protecting the skin by decreasing oxidative damage and free radical production. This can also help protect the skin from the effects of heat and infrared light, which contribute to infl ammation and photo damage." PRESCRIPTIVE CARE Popular prescription topical treatments for rosacea patients include Finacea Foam (azelaic acid, Bayer) and metronidazole for papules and pustules, Mirvaso (brimonidine, Galderma) for redness and Soolantra (ivermectin, Galderma), which targets Demodex mites. Papulopustular infl ammation may also be managed with © GETTY IMAGES CALMING THE STORM Sun protection with physical sun blocks helps to reduce the severity of rosacea symptoms.

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