What It's Really Like To Live With And Treat Rosacea
As long as she could remember, Linda had beautiful skin (you know, the glowy and youthful kind you receive compliments on). But everything changed during a particularly stressful time in her life two years ago. At age 57, small blood vessels began reddening her cheeks and nose, and her facial skin grew so sensitive and painful that she dreaded even washing it. “It was really hard to look at myself in the mirror and accept that I was having this extreme redness,” she shares.
Linda sought out doctor after doctor — some of whom even tried to prescribe antidepressants to treat her skin condition — until, after seven agonizing months, a dermatologist finally diagnosed her with rosacea. The skin disorder, which impacts an estimated 16 million Americans, has symptoms ranging from facial redness and extreme sensitivity to pimply bumps (a.k.a. papulopustular rosacea) and irritated eyes (i.e. ocular rosacea).
Why Treating Rosacea Is Difficult
The exact cause of rosacea is unknown, and flare-ups can be triggered by exposure to stress, heat, hormones, spicy foods, alcohol, and even caffeine. In Linda’s case, her constant worrying about her complexion definitely wasn't helping matters. “Because I was so stressed out about it,” she says, “I’m sure I was making it worse.”
Dermatologists usually treat rosacea symptoms with a combination of lifestyle modifications, light and laser therapies, specialized skincare routines, and antibiotics, but many patients find it difficult to obtain coverage for these treatment options because insurance companies categorize the skin condition as “cosmetic.”
Frustrated by the lack of results from doctor-prescribed meds, Linda sought out a naturopath, who helped balance her hormone levels with supplements and an anti-inflammatory diet. But she still wanted more. Extensive research led Linda — a Minnesota resident — to West Hollywood’s Jason Emer, MD, a board certified cosmetic dermatologist who specializes in laser technologies.
Since there is no cure for rosacea, Dr. Emer opts for a multi-modality approach to managing it. He likens its chronic nature to having diabetes or high blood pressure. "You’re always going to have it, so you have to maintain treatment for it,” he says. He employs a regimen of in-office lasers, facial treatments, and light therapy, as well as various at-home therapies, to help patients keep their condition under control.
The treatment program is intensive at first. Linda, for instance, made monthly trips to Southern California for the first six months before switching to quarterly visits. Now two years into her journey, Linda invited The AEDITION to experience firsthand what it’s like to undergo one of her laser treatments.
Using Lasers and Light Therapy To Treat Rosacea
When I met Linda in the reception area of Dr. Emer’s new Sunset Boulevard facility, the first thing I notice is her skin: It looks healthy and porcelain-hued, with no sign of the redness or inflammation I’d expected to see. Dr. Emer’s staff leads us into a treatment room, where a nurse applies a topical numbing cream to Linda’s face, before leaving the two of us to chat for about 40 minutes as the lotion takes effect.
Over the steady buzz of the laser machine warming up, Linda tells me that one of the hardest parts about having rosacea is the impact avoiding her triggers has had on her previously active lifestyle. “I like to ride my bike, kayak, walk,” she says. “But now I can’t just go out without thinking about it — I have to be careful.” Going out to eat can also be a challenge due to her dietary restrictions. “I can’t just have a glass of red wine with friends,” she shares, “because it’s not worth having to deal with the consequences.”
The nurse returns to remove Linda’s numbing cream in preparation for her treatment, and Dr. Emer arrives to calibrate the laser before getting started. In the past, he explains, the standard rosacea treatment was light therapy in the form of intense pulsed light (IPL), which just wasn’t that effective. Dermatologists were reluctant to combine technologies for fear that using lasers, light, and peels would overly irritate sensitive skin. “As it turns out,” he says, “non-ablative lasers — ones that don’t burn the skin but just heat the underlying surface — actually help.”
Depending on the patient’s skin tone, Dr. Emer uses different lasers with an array of wavelengths. In Linda’s case, he combines the Vbeam® vascular laser (which exclusively targets the skin’s blood vessels) with the Clear + Brilliant® laser (which works on the skin’s surface to help decrease inflammation). According to Dr. Emer, just two or three sessions with these tools (coupled with a program of facials, skincare, and at-home light therapy) can help many patients achieve up to a year of remission.
But are there any risks to doing all of this at once? Dr. Emer says that, when used incorrectly, the heat from the vascular lasers can damage the skin. He advises patients seek treatment with a board certified dermatologist for mild cases of rosacea and a cosmetic dermatologist (i.e. someone with extensive training in these advanced therapies) for more severe cases.
And what about the cost? On average, one session with a vascular laser ranges from $250 for a spot treatment to between $500 and $750 for larger areas like the face. Clear + Brilliant® runs about $500 per session, depending on the doctor and location.
As Dr. Emer prepares to apply the laser beam to Linda’s face, he places metal shields over her eyes and requires everyone else in the room to slip on purple-hued glasses to protect the blood vessels in our eyes (this laser can cause blindness). As the procedure begins, the handheld device imparts a dime-sized green light that glows on the skin in the moments before each high-pitched laser pulse. It sounds painful, but Linda seems unfazed. “They always say it feels like a rubber band snap,” she explains, “but I’ve never been super uncomfortable, no matter what he’s done.”
Partway through Linda’s treatment, Dr. Emer re-calibrates the Vbeam®, honing the focus to target her visibly dilated blood vessels. “This laser attracts the blood in the blood vessels. So, it heats it up and the vessel starts to spasm, which causes inflammation,” he says of the eight-minute procedure. “Then the body comes in and eats up the blood vessels.”
Next up: the Clear + Brilliant® treatment. The machine is considerably smaller than the Vbeam® — and much quieter, too. The nurse gives Linda a small, handheld fan to cool her face, as Dr. Emer carefully glides the device back and forth along every section of her skin. “By combining the deeper, vascular laser with the lighter, superficial laser, you actually get more improvement,” Dr. Emer says.
Minutes later, Linda's face is flushed but otherwise smooth and plump looking. She says her skin feels hot from the laser, and the nurse applies a crystal-fiber cooling mask to soothe it. After letting it sit for five minutes, the nurse follows it up with a 10-minute red LED light treatment to further soothe the inflammation. Post-treatment, things get worse before they get better — Linda says the redness usually persists for a few days and calms down over time.
Finished with her light therapy, Linda bids me farewell, still peppy and positive in spite of the afternoon’s scrutiny. She realizes how fortunate she is to have the means to make traveling for treatment a possibility. “For me, coming to Dr. Emer is more than worth it,” she says of her regular trips. “I have to take time off work to fly out here, but I see the results. I know I’m going to have rosacea for the rest of my life, but there is hope.”
She says her journey with rosacea has made her passionate about being her own health advocate. “Don’t take ‘no’ for an answer,” she shares. “There are things that can be done — you just have to find the right person to help you.”