Q MY GP DOESN’T WANT TO PRESCRIBE ANTIBIOTICS FOR MY ROSACEA. WHAT ELSE IS THERE I CAN TRY? Q WILL A TENS MACHINE HELP MY PAIN? AND IS IT SAFE TO USE?
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Avoid triggers (such as spicy foods, alcohol and hot saunas), detergents and any topical steroids, which can aggravate rosacea in the long-term. Use leave-on emollients, and high-factor sunblock (SPF 30+) all year round. Many foundation creams contain sunblock, and green-tinted creams can provide camouflage.
Prescription treatments depend on the predominant rosacea type. In Erythrotelangiectatic rosacea, antibiotics don’t often help anyway. Brimonidine gel, an alpha-adrenergic receptor agonist, may control background flushing, as may oral clonidine or beta blockers. Intense pulsed light (IPL) or pulsed dye laser (PDL) therapy are options, but are usually only available privately.
Papulopustular rosacea may be caused by demodex folliculorum mite and bacillus oleronius, so anti-mite treatments, such as topical permethrin or oral ivermectin, can help, as can azelaic acid gel or low-dose isotretinoin. More severe or resistant disease may still require antibiotics.
Ocular rosacea needs simple eyelid hygiene (regular hot saline washes, eye lubricants and warm eye compresses). In severe cases, oral antibiotics are needed – but an eye specialist’s opinion is necessary.
The British Association of Dermatologists has a useful leaflet. Go to bad.org.uk and search under Patient Information leaflets for ‘Rosacea’.
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Transcutaneous electrical nerve stimulation (TENS) machines are alternatives to painkilling medication. A small battery-operated device attached by wires to electrode pads stuck to the skin, transmits small electrical pulses, felt as tingling, affecting how pain signals reach the brain. This helps ease pain in some people with certain pain. It’s not suitable for everyone, so ask your doctor if it’s appropriate for you – it’s most commonly used for musculoskeletal pain, migraine and period pains. The effect varies between individuals, even with the same condition. There’s minimal proof that TENS works, but many find it helpful, and largely have no side effects. On a pulse rate of 90-130Hz, the impulses interfere with and block pain messages sent to the brain (the brain is busy dealing with these quick messages, rather than the slower pain signals the body is receiving. Set on a low pulse rate (2-5Hz), it stimulates the body to make its own pain-easing chemicals called endorphins, acting a bit like morphine to block pain signals.