September 16, 2025 • 27 mins
Persistent facial redness isn’t always just sensitive skin. In this episode, Dr. Linda Stein-Gold unpacks rosacea — how it differs from acne, its wide range of symptoms, common triggers, and why it’s more than a cosmetic issue. She also shares practical skincare tips and highlights emerging links between rosacea and broader health conditions.
Whether you’re a patient, provider, or just curious, you’ll walk away with a clearer understanding of this complex condition.
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Speaker 1 (00:00):
Also, if you have the thymitis changes, that
thickness that people can see ontheir nose where it gets thick
and you can see the glands muchmore easily.
That's also an independentdiagnostic criteria for rosacea
in rosacea patients, and some ofthem have burning, they have
stinging, they have dryness, sothese are all things and their
skin tends to be overlysensitive.
(00:21):
You know, people have a redface.
People are wondering well,what's wrong with you?
You have papules or pustulesand you're a 45-year-old woman.
Speaker 2 (00:30):
Is it something that if people don't treat, can it
have serious complications ifthey don't address it?
Speaker 3 (00:36):
Welcome to Dermot Trotter Don't swear about
skincare when host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and
skincare experts to separatefact from fiction and simplify
skincare.
Let's get started.
Speaker 2 (00:54):
Welcome to the Dermatrotter Don't Swear About
Skincare podcast.
We've got a great episode linedup here for you today with Dr
Linda Stein-Gold.
She's Director of DermatologyClinical Research for the Henry
Ford Health System in Detroit,michigan.
She is also Division Head ofDermatology for the Henry Ford
Health System in West Bloomfield, michigan.
Welcome to the podcast, drSteingold.
(01:16):
Thanks so much for having me.
Of course, this is, I know, atopic that's near and dear to
your heart.
Unfortunately, I suffer with itas well.
If I had a glass of red winesitting next to me here on the
podcast, you would see my flareoccur.
But we're going to talk moreabout rosacea tonight, and so
one of the things I wanted tojust talk about is kind of just
(01:37):
really, what is it?
Because I have patients come inand they're like my face has
always looked this way.
I'm just always a little pinkand red.
So I wanted to kind of give anidea of kind of what exactly is
it and are there different types?
Speaker 1 (01:48):
That's a really good question because a lot of people
think that rosacea is justanother form of acne and the
truth is it's not.
It's actually its own distinctdisease and we know at its core
it's an abnormality of theinnate immune system.
Basically, things are revved uptoo much and our body's immune
system overreacts and causesthat redness and inflammation
(02:12):
and bumps.
Speaker 2 (02:13):
And so when we talk about the acne standpoint,
that's actually an excellentpoint, because people do come in
and say, oh, I'm breaking out,I must have adult acne.
And I don't think they evenappreciate, maybe, how that's a
little different.
If somebody was trying tofigure out, do I have adult acne
or is this maybe more likealong the lines of rosacea?
How do you help them?
Or what do you look at in theskin to kind of help make that
(02:34):
distinction?
Speaker 1 (02:35):
It can be challenging , even for us, but there are a
few keys to think about.
First of all, when making thediagnosis of rosacea.
If you have background redness,that's always there.
That's an independentdiagnostic criteria for rosacea.
Also, if you have the thymitischanges, that thickness that
(02:55):
people can see on their nosewhere it gets thick and you can
see the glands much more easily,that's also an independent
diagnostic criteria for rosacea.
But not everybody has that.
Sometimes people have somebackground erythema, but you can
also have that flushing andblushing.
You can have the papules andpustules, little blood vessels
or telangiectasias, and you canalso have eye involvement.
(03:18):
So there are a lot of differentcharacteristics of rosacea and
we actually look at theindividual patient and say, okay
, you have rosacea and you havethese individual features as
well.
Because it's important toidentify what aspects of rosacea
any patient has, because thetreatment can be multifactorial
and we actually look at theindividual parts of the
(03:40):
diagnosis and parts of what thatpatient has in order to make
our game plan for treatment.
Speaker 2 (03:48):
Yes, I think that's where it gets confusing, right,
because to a patient it might benormal, but then, when you
think about they're coming inwith the redness or the acne
lesions, they're wondering okay,is this a part of the rosacea
spectrum or acne spectrum?
And then I think, also, too,people are wondering, you know,
does everyone get rosacea?
Is it something anyone couldpotentially get?
Are there people that are moresusceptible to it as well?
(04:08):
You?
Speaker 1 (04:09):
know we think about especially women in their
fifties who have Europeanancestry, and that's true.
But you have to realize anybodycan get it.
I live in Detroit and Ipractice in Michigan and we have
a lot of patients that havevery diverse backgrounds.
I see rosacea in patients withskin of color and it can look
(04:29):
very different, but they stillhave fairly classic features,
including the redness and thepapules and the pustules.
One key, though, in order todifferentiate rosacea from acne
is with rosacea you don't getcomedones, so you don't see the
blackheads and the whiteheads.
So that's kind of interesting.
And also, what's kind ofdifferent about the papules and
(04:52):
pustules of rosacea, especiallyin a patient with skin of color?
When those lesions heal, youdon't see the post-inflammatory
hyperpigmentation the same wayyou do in an acne patient.
So it's kind of interesting,you can see it.
But you know, if somebody hasskin of color and they've got
some papules and they go away,they're definitely going to have
(05:12):
really pronouncedhyperpigmentation and we just
don't see it the same way in arosacea patient.
Speaker 2 (05:21):
With these presentations and understanding
just kind of why it happens.
You mentioned the immune systemkind of rubbed up and off
balance.
You know I had somebody come inand I read that I've got mites
right.
These mites are causing me toget rosacea or the bacteria on
my skin.
Can you talk a little bit moreabout sort of the theory behind?
You know all the normalmicroorganisms that live on the
(05:42):
skin that potentially might becontributing to rosacea?
Speaker 1 (05:45):
It is interesting.
Years ago when people wouldbring up the idea of demodex and
rosacea, a lot of people wouldsay, oh, that's just not true,
we don't really see that, it'snot a major factor.
But we're starting tounderstand and over the past
many years we've come tounderstand.
Yes, demodex are important inrosacea, everybody has some
demodex that live on their skin.
(06:05):
We know some rosacea patientshave an increase in the demodex
and these are little organismsthat live kind of head down in
their hair follicles and atnight they kind of come out and
migrate.
They're normal.
There's different types ofdemodex, though.
They're different species andwe know one of the species tends
to be more inflammatory thanthe other one and we know in
(06:26):
rosacea patients they tend tohave more of that particular
species.
But it's something that is acontributing factor.
It's not the cause, but it issomething that contributes.
Speaker 2 (06:40):
And do you think the bacteria as well might play a
role, or are they really?
What is the theory?
Is it all types of organisms ormaybe more linked to the
demodex mite?
Is that the primary cause we'rethinking you?
Speaker 1 (06:51):
know.
It's interesting because withacne we know that cutibacterium
acnes is at the center of thepathogenesis In rosacea.
We don't have that organism.
That really is the central keyplayer.
There's some supporting roles,we would say, but it's not
really the center in thepathogenesis.
So when we think abouttreatment options, for instance
(07:12):
topical ivermectin, we know thatthis kills demodex and when we
look at the numbers of demodexin patients who have used
topical ivermectin, thosenumbers go down dramatically.
But we also know thativermectin has very potent
anti-inflammatory properties.
So it really works in both ways.
So the organisms are important.
The microbiome, you know,maintaining a healthy microbiome
(07:35):
is important, but again, theorganisms just aren't at the
central core of the pathogenesis.
Speaker 2 (07:42):
Yeah, I like that you kind of point that out because
that distinction, I think for alot of people they always think
you know things on the skin to adegree I think patients in
general they can always thinksomething's infectious or it's
contagious and you know, maybethis is more reactive, but you
know it sounds like it'sdefinitely more complex.
You know our understanding ofkind of that pathophysiology,
how that all kind of comestogether and we talk about the
physical, like we talked aboutyou know, the redness, the
(08:04):
background or erythema peopleget, the broken blood vessels or
telangiectasia, the thickeningof the nose, the inflammatory
papules or pustules that peopleget.
What about like physicalsymptoms?
Do you feel like you haverosacea patients that can report
changes beyond maybe just whatyou see in rosacea skin?
Speaker 1 (08:21):
That's such an important issue because a lot of
people say my skin is sosensitive and we have these
secondary criteria in rosaceapatients and some of them have
burning, they have stinging,they have dryness, so these are
all things, and their skin tendsto be overly sensitive.
For some rosacea patients, theyget irritated when they wash
(08:43):
their face, they get irritatedwhen they put moisturizer on.
So there is this heightenedsense of irritation on a lot of
these patients.
And it's interesting, when welook at the skin in a rosacea
patient, it's more similar to anatopic dermatitis patient than
to a normal patient.
(09:04):
So there's abnormalities in theskin barrier in the rosacea
patient as well.
Dr Justin Marchegiani.
Speaker 2 (09:10):
I know we don't like to use the word abnormality
sometimes a lot that kind ofraises some eyebrows nowadays
with just being sensitive toword choice.
But I really like that youbring that up, because often I
think rosacea is looked at ortreated as simply this cosmetic
condition.
Right, people see the bumps,they see the redness, and you
bringing up just the symptomaticnature how it can burn or it
(09:32):
can be very sensitive I think itmakes people feel like their
rosacea is real.
It's a true medical diagnosiscondition.
You know disease again andsometimes we don't like using
that term as much anymore, butit truly is something that
deserves to be treated.
Is that something you feel likepeople kind of, you know, push
back on a little bit and maybemore about not so much even the
patient, but just in generalthat people feel like it's not
(09:53):
like a real thing that needs tobe prioritized?
Speaker 1 (09:55):
For a lot of patients .
That's absolutely true, andsome people don't even know that
this is a condition.
You know if you think about it,if you look at your parents and
your siblings and they all havered faces and they tend to
react if they have a glass ofred wine or they're out in the
sun or they eat hot foods.
You just think that's how we'remade, this is just the way we
are.
It's normal.
(10:15):
But in fact, a lot of thesepatients have families that have
a lot of rosacea and when youtalk to patients who have
significant rosacea, moderate orsevere disease and you ask them
about the psychosocial impact,it's devastating.
You know, people have a red face.
People are wondering well,what's wrong with you?
You have papules or pustulesand you're a 45-year-old woman.
(10:38):
People look at you like well,what's wrong with you?
Why do you have acne?
Why didn't you take care ofthat stuff?
And these are the things that.
It is a skin disease.
It's an inflammatory skindisease and if you take the
whole picture of the mentalhealth impact, the sensitivity
of the skin, and put that alltogether, this is something that
(11:00):
really deserves treatment.
Speaker 2 (11:03):
Rosacea is a condition I feel like just it
deserves respect and sometimesit's not, given that you know, I
think, in general in medicine,sometimes even by some of our
colleagues, but then also on theside another discussion but you
know insurances and looking atthis, that it needs to be
treated and addressed for ourpatients.
When you were just talking to,you mentioned some of those
things that might bring on arosacea sort of flare.
(11:24):
That red wine that I mentionedearlier on too, that's been
craven at the end of the day.
So I'd like to kind of just goover what types of triggers do
you think are more common thatpeople think about, and are
there things that people don'treally appreciate that might
actually cause the rosacea toflare up?
Speaker 1 (11:38):
Triggers are different for every patient, but
there are some things that wehear about more commonly.
As you mentioned, alcohol iscertainly one of them.
Anything that can vasodilatethe skin the sun, heat, we say,
spicy foods, exercise these areall things that you know.
We notice the skin becomes morered, flushes, people might
(12:01):
notice a papular or pustularflare after exposure to these
triggers.
So there are things that youknow.
A lot of people don't want toavoid them completely, but when
you can identify what causes youpersonally to flare up, it's
easier to limit those triggersand kind of keep them in check.
Speaker 2 (12:19):
Yeah, and sometimes I know for mine that red wine
could do it.
But it can be worth it,sometimes worth it.
I just got to get ready for it.
So I think you know along thosetrigger lines we've talked
about skin just like thesymptoms and being a part of it.
I wanted to get down to kind ofhow rosacea affects the eye
because I do think for patients,listeners out there, people
don't really appreciate kind ofthis extension beyond.
(12:42):
You know just what we think oftraditionally with skin.
Can you just touch briefly uponlike eye or ocular rosacea?
Speaker 1 (12:48):
Yes, ocular rosacea is certainly a type of rosacea,
and sometimes patients haveclassic rosacea.
Sometimes they really just haveminimal cutaneous symptoms, but
have very obvious ocularsymptoms.
Now patients will sometimesfeel a gritty feel in their eye.
Sometimes their eyes will lookred, sometimes they tear a
(13:11):
little bit, and this issomething often patients will
see an ophthalmologist for.
What's interesting, though, iswe don't have any FDA-approved
treatments for ocular rosacea.
We know that when we put peopleon systemic medications like
systemic antibiotics ortetracycline-class antibiotics
for the rosacea of their skin,often this will help their eyes
(13:31):
as well.
Speaker 2 (13:34):
Is it something that if people don't treat, can it
have serious complications ifthey don't address it?
Speaker 1 (13:40):
If it's more moderate or severe, it could.
So I would say, if you havethat gritty, uncomfortable feel
in your eyes, if they look red,just certainly have an
ophthalmologic evaluation justto really figure out what's
going on and see is it rosaceaor maybe it's something else,
and there are treatments thatcertainly help this.
There was an interesting studya small study but I thought
(14:01):
interesting anyway topicalivermectin used on the face and
then used on the eyelids forocular rosacea and those
patients actually did quite welland that was kind of easy to do
and got both skin and eyeimprovement.
Speaker 2 (14:15):
Wow, that's well, killed two birds with one stone
with that one.
So that's good, cause I do theeye rosacea, ocular rosacea part
.
I'm glad that we talked alittle bit about it, cause I do
think it's sort of misunderstood.
I've been sometimes impressedwith how in extensive the eye or
ocular involvement could be andthen how little the skin
appears to be and then viceversa sometimes too.
You know, just you think therosacea, the skin, is just
(14:37):
terribly fine.
You don't definitely don't seethat correlation often
clinically that they can kind ofbe a little mismatched, if you
will.
So I think that's alsofascinating when people come in
and you know, just kind ofgetting them to think you know
twice about.
Maybe maybe you do have eyeinvolvement or you could develop
it at some point down the line,and your skin doesn't
necessarily have to be thatimpressive with rosacea
involvement as well.
But I think the one thingpeople are going to want to know
(14:59):
is if you feel like you haverosacea you've been potentially
diagnosed by your dermatologist.
Are there particular skincareproducts or ingredients you
recommend that could be useful?
And then maybe potentially onceyou would say, hey, stay away
from these, they're definitelygoing to probably make your
rosacea worse.
Speaker 1 (15:14):
Yes, it's tough because if you have rosacea,
your skin is overly sensitive.
So when you walk into thedrugstore and you see all these
great products on the shelf,first of all, as we talked about
earlier, it's not acne.
So you can't just go pick upthose acne medications and put
them on your skin for yourpapules or your pustules and
expect that's going to do okay.
(15:35):
A lot of the acne medicationsare way too irritating for
rosacea patients.
I'll use benzoyl peroxide as anexample.
We have an encapsulated silica,encapsulated benzoyl peroxide.
That's a prescription thatactually calms the skin down in
addition to reducing the papulesand the pustules.
But if you go to Target and youbuy 5% benzoyl peroxide from
(15:58):
over the counter justconventional benzoyl peroxide
and put that on a patient withrosacea, you can probably hear
them screaming from here.
It's going to be just way tooirritating.
And then other things are just,you know, for especially women
who are looking for productsthat might help with photoaging
and the maintenance of healthyskin, some of those products are
(16:20):
not going to be good for arosacea patient.
Topical retinoids might be alittle bit too irritating.
Over-the-counter retinoids orretinol, even like alpha or the
glycolic acid products, might bea little bit irritating.
So this is something you haveto just really go gentle
cleanser, gentle moisturizer,good sunscreen.
Speaker 2 (16:44):
And now that we've kind of tackled skincare, how
would you describe kind of thetreatment options?
And again, that's a reallyobviously in-depth conversation,
but if you kind of give anoverview of how to approach
potentially some options totreat rosacea, do you mind just
kind of reviewing that with us alittle bit?
Sure?
Speaker 1 (17:00):
And the first thing I do when I have a patient
standing before me is say okay,what are the features of rosacea
that I see in this particularpatient?
If they have fixed backgrounderythema that redness that's
always kind of there we can usean alpha-adrenergic agonist like
bromonidine or oxymetazoline.
Those are applied in themorning and they usually last
(17:20):
all day.
Sometimes some of the deviceswill be helpful for that.
If patients havetelangiectasias they're the
little blood vessels on the skinyou can cream them all day and
it's not going to take thoseblood vessels away.
So they generally are going toneed to have some kind of a
device for that.
If they have papules andpustules, they need either a
(17:41):
topical and or an oralanti-inflammatory medication.
Talked about topical ivermectin,encapsulated benzoyl peroxide.
We have oral antibiotics,including submicrobial dose
doxycycline.
We have a low dose minocyclinethat was recently FDA approved.
That's highly effective.
The traditional drugs likeazelaic acid and metronidazole
(18:05):
maybe not quite as effective assome of the newer ones, but they
still are FDA approved.
And then if somebody has athymidus lesion the thickness it
depends on if it's stillinflammatory, maybe you'll use a
systemic antibiotic or oralisotretinoin.
If it's more scarred, you'rereally going to need a surgical
approach to that.
Speaker 2 (18:26):
You mentioned the oral antibiotics.
They had a patient come in,probably now a few weeks ago,
that had been on oraldoxycycline for well over a year
, higher dose, around 100milligrams twice a day.
I wanted to get your thoughtson, you know, with managing
chronic inflammatory diseaselike a rosacea patient.
What do you feel aboutlong-term antibiotic use?
(18:47):
Because I think that's some ofthe pushback I get often with
rosacea patients is they'rereserved or maybe cautious about
antibiotic use, which we shouldbe good users of that and not
just throw it around.
But what are your thoughtsabout sort of that long-term use
, or do we have options to kindof get around that where you
would feel comfortable havingsomebody take it in the long
term?
Speaker 1 (19:05):
And that's really a critical issue that we face in
dermatology every single day.
And that's really a criticalissue that we face in
dermatology every single day.
And I'll tell you, when I firststarted out in practice I might
write oral antibiotics and seethem in a year and maybe refill
them.
But we kind of know now thatthat's not the best approach in
terms of the patient's overallhealth and our community's
health because of the potentialfor resistant organisms to
(19:28):
develop.
So we now try to limitfull-strength oral antibiotics
to maybe three or four months.
But with rosacea, because we'renot using the antimicrobial
property, we're really usingmore of the anti-inflammatory
property, we use much lowerdoses and get great efficacy.
So we see that with thesubmicrobial dose, doxycycline,
(19:52):
that has anti-inflammatoryeffects but it doesn't go above
the killing line.
So you can use this for yearsat a time and we haven't seen
the development of bacterialresistance.
So that's great.
And then we have the newminocycline.
That's a low dose.
Extended release also wasstudied and we didn't see the
development of bacterialresistance and it didn't seem to
(20:14):
affect the microbiome.
We don't have as long data withthe newer minocycline drugs,
but preliminary data is goodnews that it looks like this is
going to be effective and alsosafe for longer periods of time.
Speaker 2 (20:29):
I think it's a great option that we have that and to
alleviate some of the concerns Iknow the patients have and you
know ourselves obviously, howare we changing, you know, the
gut, the microbiome, long-termwith the antibiotic use we've
done historically and now Ithink, the advent of these new
products to kind of help andsome that have been around a
little bit longer, obviouslywith the doxycycline.
But I think it's just a greatoption for patients to get them
(20:54):
that understanding of there'ssome safety with this use if we
have to do it on a morelong-term basis.
And I just think the concept iscool in explaining it to
patients about anti-inflammatorybenefits, because we all think
about antibiotics, especially inthe patient world oh, I got an
infection, right, that's whywe're using it but to capitalize
on kind of the benefit theyoffer to control inflammation.
I just think the concept itselfis very fascinating and
patients I think wouldappreciate that at the low dose.
And I know one of my patientscame in and asked about and I
(21:16):
don't this is one of the thingsI wanted to talk with you.
I know I sent this to you kindof earlier about this concept of
the small intestinal bacterialovergrowth, like screening
people and I was like well, thisis something that I haven't
thought about on a regular basis, and so I wanted to talk to you
about what your thoughts wereon it Like.
First, what is it to kind ofexplain to people, and what do
you think about this potentiallink to rosacea?
Speaker 1 (21:37):
And that's something the link between small
intestinal bacterial overgrowthand rosacea something that had
been looked at for quite a longtime.
And when we look at the dataand look at the clinical trials,
there are some studies thathave shown that patients with
(21:57):
rosacea are more likely to havethat intestinal bacterial
overgrowth.
And there are some studies thathave shown that if you can
treat that with oral antibiotics, in some cases you can get the
rosacea under control.
And the thought is that thebacteria produce these
inflammatory mediators and theypermeate through the intestinal
(22:19):
wall and get into the systemiccirculation and cause increased
inflammation, including in theskin, causing rosacea.
Now we, you Now.
It's interesting becauserecently we haven't talked about
that so much at all.
We don't talk about it in termsof our rosacea management and
our guidelines, but it has beensomething that's out there.
It's been out there for a longtime and there are some nice
(22:41):
studies that have actuallylooked at trying to treat this.
I don't normally recommendchecking for it today, but you
know it's certainly somethingthat people could think about
and we do know.
You know we learned withpsoriasis that inflammatory skin
diseases are more than justskin deep and with psoriasis we
(23:01):
learned that you're more likelyto have cardiovascular disease
and mental health issues andliver disease and kidney disease
, mental health issues and liverdisease and kidney disease.
And what's interesting isrosacea.
Maybe not to the same extent,but we do know that there are
some comorbidities with rosaceaas well.
We know neurologic disorders,parkinson's disease, alzheimer's
disease.
We see an increase in rosacea.
(23:23):
There have been a number ofstudies that are looking at a
cardiovascular disorderassociation with rosacea and
then GI disorders and anassociation with rosacea,
including Crohn's disease, anirritable bowel disease,
ulcerative colitis.
So you know, I think we havemore to really understand, but
(23:44):
you know, don't rule out thatsystemic inflammation and the
link to other areas ofinflammation.
Speaker 2 (23:52):
So, with all those conditions you just mentioned,
if somebody's newly diagnosedwith rosacea, does that
necessarily mean they need to gosee a cardiologist or talk to
their doctor?
Are there any, like you know,meaningful interventions that we
really recommend, based on someof those associations, or do
you feel like the jury's stillout on kind of how we make you
know, make sense of it all?
Speaker 1 (24:11):
I don't know that we're there yet.
I'll tell you.
If I have a patient with severepsoriasis, I will tell them
you're more likely to die of aheart attack than somebody who
has no psoriasis or mild disease.
So I make sure that patientswhether it's a psoriasis patient
or somebody with significantrosacea make sure you have a
primary care physician.
I don't take on that challengemyself, you know, but I
(24:34):
certainly tell my patients havea good physical done.
Make sure you're up to date onall the testing that is
appropriate for your age.
And you know, I don't know thatit's recommended to have all
these patients see acardiologist, but certainly a
primary care physician should bein all of these patients' lives
.
Speaker 2 (24:54):
And then, lastly, I like to end with this because I
feel like I'm getting morequestions.
You may have patients, too,that are asking about this.
You know we've talked to kindof the whole spectrum of rosacea
, from diagnosis and clinicalpresentation treatment.
One of the areas of treatment Ithink that's definitely more
popular now is looking for morenatural ways or potential
supplements that might actuallyassist in treating rosacea.
(25:14):
Are there any supplements thatyou recommend or think carry
their weight to be a part of arosacea regimen?
Speaker 1 (25:22):
I don't recommend any oral supplements, necessarily
for rosacea, and when we weredoing the acne guidelines in
2016, I was responsible for thatalternative medicine supplement
kind of category and wecouldn't make any real
recommendations for acne at thatpoint either.
I'll tell you something kind ofinteresting, though, when we
(25:43):
were talking about natural wehave a drug that was actually
developed from a sponge a spongeand it was ground down and made
into actually a mask.
It was applied once a week, andwe studied this for both acne
and rosacea and it was found tobe quite effective.
(26:04):
So it's kind of interesting.
It's certainly a differentmechanism of action.
It's not to beanti-inflammatory.
Can you imagine putting a maskon once a week that comes from a
sponge?
But you know, there are somealternative treatments that are
out there, and I think it'sstill exciting and our minds are
open to new mechanisms ofaction, new treatments, so
(26:27):
hopefully we'll get even moreand better treatments in the
near future.
Speaker 2 (26:32):
Yeah, I think that's where we're headed.
For Rosacea, like I saidearlier, it's finally getting
you know some respect.
You know, on the front of youknow patients understanding it I
think providers as well andtreating it and bringing it up
because, you're right, peoplelike you mentioned before like
that's just my skin, right, thisis my norm and may not even
recognize that it's truly a skincondition that warrants
treatment.
So I appreciate really bringingattention to that and I hope
(26:52):
this podcast will really, youknow, get people thinking twice
about it.
You know, on both fronts, andget patients seeking treatment,
getting clinicians to go afterit maybe a bit more aggressively
, to help those patients notunderestimate the toll it can
take on them, especially, as youmentioned, their emotional and
mental wellbeing.
There definitely is a rolethere to improve this as well.
Well, thank you so much, drSteingold, for coming on today.
(27:14):
This was fantastic.
I really appreciate your timeand expertise because you
definitely are going to helpsomebody out there that's been
listening to our podcast.
Well, thank you, and I reallyappreciate the very insightful
discussion.
Speaker 1 (27:24):
So thanks so much.
Speaker 2 (27:26):
Of course, happy to have you on again sometime in
the future.
And, of course, happy to haveyou on again sometime in the
future and for those of youlistening, if you like the
podcast, please click like anddon't forget to subscribe and
thank you so much for joining ustoday and stay tuned for the
next episode of Dermot Trotterdot com.
Speaker 3 (27:46):
Don't forget to subscribe, leave a review and
share this podcast with anyonewho needs a little skin care
sanity.
Until next time, stay skinsmart.
Also, if you have the thymitis changes, that
thickness that people can see ontheir nose where it gets thick
and you can see the glands muchmore easily.
That's also an independentdiagnostic criteria for rosacea
in rosacea patients, and some ofthem have burning, they have
stinging, they have dryness, sothese are all things and their
skin tends to be overlysensitive.
(00:21):
You know, people have a redface.
People are wondering well,what's wrong with you?
You have papules or pustulesand you're a 45-year-old woman.
Speaker 2 (00:30):
Is it something that if people don't treat, can it
have serious complications ifthey don't address it?
Speaker 3 (00:36):
Welcome to Dermot Trotter Don't swear about
skincare when host Dr Shannon CTrotter, a board-certified
dermatologist, sits down withfellow dermatologists and
skincare experts to separatefact from fiction and simplify
skincare.
Let's get started.
Speaker 2 (00:54):
Welcome to the Dermatrotter Don't Swear About
Skincare podcast.
We've got a great episode linedup here for you today with Dr
Linda Stein-Gold.
She's Director of DermatologyClinical Research for the Henry
Ford Health System in Detroit,michigan.
She is also Division Head ofDermatology for the Henry Ford
Health System in West Bloomfield, michigan.
Welcome to the podcast, drSteingold.
(01:16):
Thanks so much for having me.
Of course, this is, I know, atopic that's near and dear to
your heart.
Unfortunately, I suffer with itas well.
If I had a glass of red winesitting next to me here on the
podcast, you would see my flareoccur.
But we're going to talk moreabout rosacea tonight, and so
one of the things I wanted tojust talk about is kind of just
(01:37):
really, what is it?
Because I have patients come inand they're like my face has
always looked this way.
I'm just always a little pinkand red.
So I wanted to kind of give anidea of kind of what exactly is
it and are there different types?
Speaker 1 (01:48):
That's a really good question because a lot of people
think that rosacea is justanother form of acne and the
truth is it's not.
It's actually its own distinctdisease and we know at its core
it's an abnormality of theinnate immune system.
Basically, things are revved uptoo much and our body's immune
system overreacts and causesthat redness and inflammation
(02:12):
and bumps.
Speaker 2 (02:13):
And so when we talk about the acne standpoint,
that's actually an excellentpoint, because people do come in
and say, oh, I'm breaking out,I must have adult acne.
And I don't think they evenappreciate, maybe, how that's a
little different.
If somebody was trying tofigure out, do I have adult acne
or is this maybe more likealong the lines of rosacea?
How do you help them?
Or what do you look at in theskin to kind of help make that
(02:34):
distinction?
Speaker 1 (02:35):
It can be challenging , even for us, but there are a
few keys to think about.
First of all, when making thediagnosis of rosacea.
If you have background redness,that's always there.
That's an independentdiagnostic criteria for rosacea.
Also, if you have the thymitischanges, that thickness that
(02:55):
people can see on their nosewhere it gets thick and you can
see the glands much more easily,that's also an independent
diagnostic criteria for rosacea.
But not everybody has that.
Sometimes people have somebackground erythema, but you can
also have that flushing andblushing.
You can have the papules andpustules, little blood vessels
or telangiectasias, and you canalso have eye involvement.
(03:18):
So there are a lot of differentcharacteristics of rosacea and
we actually look at theindividual patient and say, okay
, you have rosacea and you havethese individual features as
well.
Because it's important toidentify what aspects of rosacea
any patient has, because thetreatment can be multifactorial
and we actually look at theindividual parts of the
(03:40):
diagnosis and parts of what thatpatient has in order to make
our game plan for treatment.
Speaker 2 (03:48):
Yes, I think that's where it gets confusing, right,
because to a patient it might benormal, but then, when you
think about they're coming inwith the redness or the acne
lesions, they're wondering okay,is this a part of the rosacea
spectrum or acne spectrum?
And then I think, also, too,people are wondering, you know,
does everyone get rosacea?
Is it something anyone couldpotentially get?
Are there people that are moresusceptible to it as well?
(04:08):
You?
Speaker 1 (04:09):
know we think about especially women in their
fifties who have Europeanancestry, and that's true.
But you have to realize anybodycan get it.
I live in Detroit and Ipractice in Michigan and we have
a lot of patients that havevery diverse backgrounds.
I see rosacea in patients withskin of color and it can look
(04:29):
very different, but they stillhave fairly classic features,
including the redness and thepapules and the pustules.
One key, though, in order todifferentiate rosacea from acne
is with rosacea you don't getcomedones, so you don't see the
blackheads and the whiteheads.
So that's kind of interesting.
And also, what's kind ofdifferent about the papules and
(04:52):
pustules of rosacea, especiallyin a patient with skin of color?
When those lesions heal, youdon't see the post-inflammatory
hyperpigmentation the same wayyou do in an acne patient.
So it's kind of interesting,you can see it.
But you know, if somebody hasskin of color and they've got
some papules and they go away,they're definitely going to have
(05:12):
really pronouncedhyperpigmentation and we just
don't see it the same way in arosacea patient.
Speaker 2 (05:21):
With these presentations and understanding
just kind of why it happens.
You mentioned the immune systemkind of rubbed up and off
balance.
You know I had somebody come inand I read that I've got mites
right.
These mites are causing me toget rosacea or the bacteria on
my skin.
Can you talk a little bit moreabout sort of the theory behind?
You know all the normalmicroorganisms that live on the
(05:42):
skin that potentially might becontributing to rosacea?
Speaker 1 (05:45):
It is interesting.
Years ago when people wouldbring up the idea of demodex and
rosacea, a lot of people wouldsay, oh, that's just not true,
we don't really see that, it'snot a major factor.
But we're starting tounderstand and over the past
many years we've come tounderstand.
Yes, demodex are important inrosacea, everybody has some
demodex that live on their skin.
(06:05):
We know some rosacea patientshave an increase in the demodex
and these are little organismsthat live kind of head down in
their hair follicles and atnight they kind of come out and
migrate.
They're normal.
There's different types ofdemodex, though.
They're different species andwe know one of the species tends
to be more inflammatory thanthe other one and we know in
(06:26):
rosacea patients they tend tohave more of that particular
species.
But it's something that is acontributing factor.
It's not the cause, but it issomething that contributes.
Speaker 2 (06:40):
And do you think the bacteria as well might play a
role, or are they really?
What is the theory?
Is it all types of organisms ormaybe more linked to the
demodex mite?
Is that the primary cause we'rethinking you?
Speaker 1 (06:51):
know.
It's interesting because withacne we know that cutibacterium
acnes is at the center of thepathogenesis In rosacea.
We don't have that organism.
That really is the central keyplayer.
There's some supporting roles,we would say, but it's not
really the center in thepathogenesis.
So when we think abouttreatment options, for instance
(07:12):
topical ivermectin, we know thatthis kills demodex and when we
look at the numbers of demodexin patients who have used
topical ivermectin, thosenumbers go down dramatically.
But we also know thativermectin has very potent
anti-inflammatory properties.
So it really works in both ways.
So the organisms are important.
The microbiome, you know,maintaining a healthy microbiome
(07:35):
is important, but again, theorganisms just aren't at the
central core of the pathogenesis.
Speaker 2 (07:42):
Yeah, I like that you kind of point that out because
that distinction, I think for alot of people they always think
you know things on the skin to adegree I think patients in
general they can always thinksomething's infectious or it's
contagious and you know, maybethis is more reactive, but you
know it sounds like it'sdefinitely more complex.
You know our understanding ofkind of that pathophysiology,
how that all kind of comestogether and we talk about the
physical, like we talked aboutyou know, the redness, the
(08:04):
background or erythema peopleget, the broken blood vessels or
telangiectasia, the thickeningof the nose, the inflammatory
papules or pustules that peopleget.
What about like physicalsymptoms?
Do you feel like you haverosacea patients that can report
changes beyond maybe just whatyou see in rosacea skin?
Speaker 1 (08:21):
That's such an important issue because a lot of
people say my skin is sosensitive and we have these
secondary criteria in rosaceapatients and some of them have
burning, they have stinging,they have dryness, so these are
all things, and their skin tendsto be overly sensitive.
For some rosacea patients, theyget irritated when they wash
(08:43):
their face, they get irritatedwhen they put moisturizer on.
So there is this heightenedsense of irritation on a lot of
these patients.
And it's interesting, when welook at the skin in a rosacea
patient, it's more similar to anatopic dermatitis patient than
to a normal patient.
(09:04):
So there's abnormalities in theskin barrier in the rosacea
patient as well.
Dr Justin Marchegiani.
Speaker 2 (09:10):
I know we don't like to use the word abnormality
sometimes a lot that kind ofraises some eyebrows nowadays
with just being sensitive toword choice.
But I really like that youbring that up, because often I
think rosacea is looked at ortreated as simply this cosmetic
condition.
Right, people see the bumps,they see the redness, and you
bringing up just the symptomaticnature how it can burn or it
(09:32):
can be very sensitive I think itmakes people feel like their
rosacea is real.
It's a true medical diagnosiscondition.
You know disease again andsometimes we don't like using
that term as much anymore, butit truly is something that
deserves to be treated.
Is that something you feel likepeople kind of, you know, push
back on a little bit and maybemore about not so much even the
patient, but just in generalthat people feel like it's not
(09:53):
like a real thing that needs tobe prioritized?
Speaker 1 (09:55):
For a lot of patients .
That's absolutely true, andsome people don't even know that
this is a condition.
You know if you think about it,if you look at your parents and
your siblings and they all havered faces and they tend to
react if they have a glass ofred wine or they're out in the
sun or they eat hot foods.
You just think that's how we'remade, this is just the way we
are.
It's normal.
(10:15):
But in fact, a lot of thesepatients have families that have
a lot of rosacea and when youtalk to patients who have
significant rosacea, moderate orsevere disease and you ask them
about the psychosocial impact,it's devastating.
You know, people have a red face.
People are wondering well,what's wrong with you?
You have papules or pustulesand you're a 45-year-old woman.
(10:38):
People look at you like well,what's wrong with you?
Why do you have acne?
Why didn't you take care ofthat stuff?
And these are the things that.
It is a skin disease.
It's an inflammatory skindisease and if you take the
whole picture of the mentalhealth impact, the sensitivity
of the skin, and put that alltogether, this is something that
(11:00):
really deserves treatment.
Speaker 2 (11:03):
Rosacea is a condition I feel like just it
deserves respect and sometimesit's not, given that you know, I
think, in general in medicine,sometimes even by some of our
colleagues, but then also on theside another discussion but you
know insurances and looking atthis, that it needs to be
treated and addressed for ourpatients.
When you were just talking to,you mentioned some of those
things that might bring on arosacea sort of flare.
(11:24):
That red wine that I mentionedearlier on too, that's been
craven at the end of the day.
So I'd like to kind of just goover what types of triggers do
you think are more common thatpeople think about, and are
there things that people don'treally appreciate that might
actually cause the rosacea toflare up?
Speaker 1 (11:38):
Triggers are different for every patient, but
there are some things that wehear about more commonly.
As you mentioned, alcohol iscertainly one of them.
Anything that can vasodilatethe skin the sun, heat, we say,
spicy foods, exercise these areall things that you know.
We notice the skin becomes morered, flushes, people might
(12:01):
notice a papular or pustularflare after exposure to these
triggers.
So there are things that youknow.
A lot of people don't want toavoid them completely, but when
you can identify what causes youpersonally to flare up, it's
easier to limit those triggersand kind of keep them in check.
Speaker 2 (12:19):
Yeah, and sometimes I know for mine that red wine
could do it.
But it can be worth it,sometimes worth it.
I just got to get ready for it.
So I think you know along thosetrigger lines we've talked
about skin just like thesymptoms and being a part of it.
I wanted to get down to kind ofhow rosacea affects the eye
because I do think for patients,listeners out there, people
don't really appreciate kind ofthis extension beyond.
(12:42):
You know just what we think oftraditionally with skin.
Can you just touch briefly uponlike eye or ocular rosacea?
Speaker 1 (12:48):
Yes, ocular rosacea is certainly a type of rosacea,
and sometimes patients haveclassic rosacea.
Sometimes they really just haveminimal cutaneous symptoms, but
have very obvious ocularsymptoms.
Now patients will sometimesfeel a gritty feel in their eye.
Sometimes their eyes will lookred, sometimes they tear a
(13:11):
little bit, and this issomething often patients will
see an ophthalmologist for.
What's interesting, though, iswe don't have any FDA-approved
treatments for ocular rosacea.
We know that when we put peopleon systemic medications like
systemic antibiotics ortetracycline-class antibiotics
for the rosacea of their skin,often this will help their eyes
(13:31):
as well.
Speaker 2 (13:34):
Is it something that if people don't treat, can it
have serious complications ifthey don't address it?
Speaker 1 (13:40):
If it's more moderate or severe, it could.
So I would say, if you havethat gritty, uncomfortable feel
in your eyes, if they look red,just certainly have an
ophthalmologic evaluation justto really figure out what's
going on and see is it rosaceaor maybe it's something else,
and there are treatments thatcertainly help this.
There was an interesting studya small study but I thought
(14:01):
interesting anyway topicalivermectin used on the face and
then used on the eyelids forocular rosacea and those
patients actually did quite welland that was kind of easy to do
and got both skin and eyeimprovement.
Speaker 2 (14:15):
Wow, that's well, killed two birds with one stone
with that one.
So that's good, cause I do theeye rosacea, ocular rosacea part
.
I'm glad that we talked alittle bit about it, cause I do
think it's sort of misunderstood.
I've been sometimes impressedwith how in extensive the eye or
ocular involvement could be andthen how little the skin
appears to be and then viceversa sometimes too.
You know, just you think therosacea, the skin, is just
(14:37):
terribly fine.
You don't definitely don't seethat correlation often
clinically that they can kind ofbe a little mismatched, if you
will.
So I think that's alsofascinating when people come in
and you know, just kind ofgetting them to think you know
twice about.
Maybe maybe you do have eyeinvolvement or you could develop
it at some point down the line,and your skin doesn't
necessarily have to be thatimpressive with rosacea
involvement as well.
But I think the one thingpeople are going to want to know
(14:59):
is if you feel like you haverosacea you've been potentially
diagnosed by your dermatologist.
Are there particular skincareproducts or ingredients you
recommend that could be useful?
And then maybe potentially onceyou would say, hey, stay away
from these, they're definitelygoing to probably make your
rosacea worse.
Speaker 1 (15:14):
Yes, it's tough because if you have rosacea,
your skin is overly sensitive.
So when you walk into thedrugstore and you see all these
great products on the shelf,first of all, as we talked about
earlier, it's not acne.
So you can't just go pick upthose acne medications and put
them on your skin for yourpapules or your pustules and
expect that's going to do okay.
(15:35):
A lot of the acne medicationsare way too irritating for
rosacea patients.
I'll use benzoyl peroxide as anexample.
We have an encapsulated silica,encapsulated benzoyl peroxide.
That's a prescription thatactually calms the skin down in
addition to reducing the papulesand the pustules.
But if you go to Target and youbuy 5% benzoyl peroxide from
(15:58):
over the counter justconventional benzoyl peroxide
and put that on a patient withrosacea, you can probably hear
them screaming from here.
It's going to be just way tooirritating.
And then other things are just,you know, for especially women
who are looking for productsthat might help with photoaging
and the maintenance of healthyskin, some of those products are
(16:20):
not going to be good for arosacea patient.
Topical retinoids might be alittle bit too irritating.
Over-the-counter retinoids orretinol, even like alpha or the
glycolic acid products, might bea little bit irritating.
So this is something you haveto just really go gentle
cleanser, gentle moisturizer,good sunscreen.
Speaker 2 (16:44):
And now that we've kind of tackled skincare, how
would you describe kind of thetreatment options?
And again, that's a reallyobviously in-depth conversation,
but if you kind of give anoverview of how to approach
potentially some options totreat rosacea, do you mind just
kind of reviewing that with us alittle bit?
Sure?
Speaker 1 (17:00):
And the first thing I do when I have a patient
standing before me is say okay,what are the features of rosacea
that I see in this particularpatient?
If they have fixed backgrounderythema that redness that's
always kind of there we can usean alpha-adrenergic agonist like
bromonidine or oxymetazoline.
Those are applied in themorning and they usually last
(17:20):
all day.
Sometimes some of the deviceswill be helpful for that.
If patients havetelangiectasias they're the
little blood vessels on the skinyou can cream them all day and
it's not going to take thoseblood vessels away.
So they generally are going toneed to have some kind of a
device for that.
If they have papules andpustules, they need either a
(17:41):
topical and or an oralanti-inflammatory medication.
Talked about topical ivermectin,encapsulated benzoyl peroxide.
We have oral antibiotics,including submicrobial dose
doxycycline.
We have a low dose minocyclinethat was recently FDA approved.
That's highly effective.
The traditional drugs likeazelaic acid and metronidazole
(18:05):
maybe not quite as effective assome of the newer ones, but they
still are FDA approved.
And then if somebody has athymidus lesion the thickness it
depends on if it's stillinflammatory, maybe you'll use a
systemic antibiotic or oralisotretinoin.
If it's more scarred, you'rereally going to need a surgical
approach to that.
Speaker 2 (18:26):
You mentioned the oral antibiotics.
They had a patient come in,probably now a few weeks ago,
that had been on oraldoxycycline for well over a year
, higher dose, around 100milligrams twice a day.
I wanted to get your thoughtson, you know, with managing
chronic inflammatory diseaselike a rosacea patient.
What do you feel aboutlong-term antibiotic use?
(18:47):
Because I think that's some ofthe pushback I get often with
rosacea patients is they'rereserved or maybe cautious about
antibiotic use, which we shouldbe good users of that and not
just throw it around.
But what are your thoughtsabout sort of that long-term use
, or do we have options to kindof get around that where you
would feel comfortable havingsomebody take it in the long
term?
Speaker 1 (19:05):
And that's really a critical issue that we face in
dermatology every single day.
And that's really a criticalissue that we face in
dermatology every single day.
And I'll tell you, when I firststarted out in practice I might
write oral antibiotics and seethem in a year and maybe refill
them.
But we kind of know now thatthat's not the best approach in
terms of the patient's overallhealth and our community's
health because of the potentialfor resistant organisms to
(19:28):
develop.
So we now try to limitfull-strength oral antibiotics
to maybe three or four months.
But with rosacea, because we'renot using the antimicrobial
property, we're really usingmore of the anti-inflammatory
property, we use much lowerdoses and get great efficacy.
So we see that with thesubmicrobial dose, doxycycline,
(19:52):
that has anti-inflammatoryeffects but it doesn't go above
the killing line.
So you can use this for yearsat a time and we haven't seen
the development of bacterialresistance.
So that's great.
And then we have the newminocycline.
That's a low dose.
Extended release also wasstudied and we didn't see the
development of bacterialresistance and it didn't seem to
(20:14):
affect the microbiome.
We don't have as long data withthe newer minocycline drugs,
but preliminary data is goodnews that it looks like this is
going to be effective and alsosafe for longer periods of time.
Speaker 2 (20:29):
I think it's a great option that we have that and to
alleviate some of the concerns Iknow the patients have and you
know ourselves obviously, howare we changing, you know, the
gut, the microbiome, long-termwith the antibiotic use we've
done historically and now Ithink, the advent of these new
products to kind of help andsome that have been around a
little bit longer, obviouslywith the doxycycline.
But I think it's just a greatoption for patients to get them
(20:54):
that understanding of there'ssome safety with this use if we
have to do it on a morelong-term basis.
And I just think the concept iscool in explaining it to
patients about anti-inflammatorybenefits, because we all think
about antibiotics, especially inthe patient world oh, I got an
infection, right, that's whywe're using it but to capitalize
on kind of the benefit theyoffer to control inflammation.
I just think the concept itselfis very fascinating and
patients I think wouldappreciate that at the low dose.
And I know one of my patientscame in and asked about and I
(21:16):
don't this is one of the thingsI wanted to talk with you.
I know I sent this to you kindof earlier about this concept of
the small intestinal bacterialovergrowth, like screening
people and I was like well, thisis something that I haven't
thought about on a regular basis, and so I wanted to talk to you
about what your thoughts wereon it Like.
First, what is it to kind ofexplain to people, and what do
you think about this potentiallink to rosacea?
Speaker 1 (21:37):
And that's something the link between small
intestinal bacterial overgrowthand rosacea something that had
been looked at for quite a longtime.
And when we look at the dataand look at the clinical trials,
there are some studies thathave shown that patients with
(21:57):
rosacea are more likely to havethat intestinal bacterial
overgrowth.
And there are some studies thathave shown that if you can
treat that with oral antibiotics, in some cases you can get the
rosacea under control.
And the thought is that thebacteria produce these
inflammatory mediators and theypermeate through the intestinal
(22:19):
wall and get into the systemiccirculation and cause increased
inflammation, including in theskin, causing rosacea.
Now we, you Now.
It's interesting becauserecently we haven't talked about
that so much at all.
We don't talk about it in termsof our rosacea management and
our guidelines, but it has beensomething that's out there.
It's been out there for a longtime and there are some nice
(22:41):
studies that have actuallylooked at trying to treat this.
I don't normally recommendchecking for it today, but you
know it's certainly somethingthat people could think about
and we do know.
You know we learned withpsoriasis that inflammatory skin
diseases are more than justskin deep and with psoriasis we
(23:01):
learned that you're more likelyto have cardiovascular disease
and mental health issues andliver disease and kidney disease
, mental health issues and liverdisease and kidney disease.
And what's interesting isrosacea.
Maybe not to the same extent,but we do know that there are
some comorbidities with rosaceaas well.
We know neurologic disorders,parkinson's disease, alzheimer's
disease.
We see an increase in rosacea.
(23:23):
There have been a number ofstudies that are looking at a
cardiovascular disorderassociation with rosacea and
then GI disorders and anassociation with rosacea,
including Crohn's disease, anirritable bowel disease,
ulcerative colitis.
So you know, I think we havemore to really understand, but
(23:44):
you know, don't rule out thatsystemic inflammation and the
link to other areas ofinflammation.
Speaker 2 (23:52):
So, with all those conditions you just mentioned,
if somebody's newly diagnosedwith rosacea, does that
necessarily mean they need to gosee a cardiologist or talk to
their doctor?
Are there any, like you know,meaningful interventions that we
really recommend, based on someof those associations, or do
you feel like the jury's stillout on kind of how we make you
know, make sense of it all?
Speaker 1 (24:11):
I don't know that we're there yet.
I'll tell you.
If I have a patient with severepsoriasis, I will tell them
you're more likely to die of aheart attack than somebody who
has no psoriasis or mild disease.
So I make sure that patientswhether it's a psoriasis patient
or somebody with significantrosacea make sure you have a
primary care physician.
I don't take on that challengemyself, you know, but I
(24:34):
certainly tell my patients havea good physical done.
Make sure you're up to date onall the testing that is
appropriate for your age.
And you know, I don't know thatit's recommended to have all
these patients see acardiologist, but certainly a
primary care physician should bein all of these patients' lives
.
Speaker 2 (24:54):
And then, lastly, I like to end with this because I
feel like I'm getting morequestions.
You may have patients, too,that are asking about this.
You know we've talked to kindof the whole spectrum of rosacea
, from diagnosis and clinicalpresentation treatment.
One of the areas of treatment Ithink that's definitely more
popular now is looking for morenatural ways or potential
supplements that might actuallyassist in treating rosacea.
(25:14):
Are there any supplements thatyou recommend or think carry
their weight to be a part of arosacea regimen?
Speaker 1 (25:22):
I don't recommend any oral supplements, necessarily
for rosacea, and when we weredoing the acne guidelines in
2016, I was responsible for thatalternative medicine supplement
kind of category and wecouldn't make any real
recommendations for acne at thatpoint either.
I'll tell you something kind ofinteresting, though, when we
(25:43):
were talking about natural wehave a drug that was actually
developed from a sponge a spongeand it was ground down and made
into actually a mask.
It was applied once a week, andwe studied this for both acne
and rosacea and it was found tobe quite effective.
(26:04):
So it's kind of interesting.
It's certainly a differentmechanism of action.
It's not to beanti-inflammatory.
Can you imagine putting a maskon once a week that comes from a
sponge?
But you know, there are somealternative treatments that are
out there, and I think it'sstill exciting and our minds are
open to new mechanisms ofaction, new treatments, so
(26:27):
hopefully we'll get even moreand better treatments in the
near future.
Speaker 2 (26:32):
Yeah, I think that's where we're headed.
For Rosacea, like I saidearlier, it's finally getting
you know some respect.
You know, on the front of youknow patients understanding it I
think providers as well andtreating it and bringing it up
because, you're right, peoplelike you mentioned before like
that's just my skin, right, thisis my norm and may not even
recognize that it's truly a skincondition that warrants
treatment.
So I appreciate really bringingattention to that and I hope
(26:52):
this podcast will really, youknow, get people thinking twice
about it.
You know, on both fronts, andget patients seeking treatment,
getting clinicians to go afterit maybe a bit more aggressively
, to help those patients notunderestimate the toll it can
take on them, especially, as youmentioned, their emotional and
mental wellbeing.
There definitely is a rolethere to improve this as well.
Well, thank you so much, drSteingold, for coming on today.
(27:14):
This was fantastic.
I really appreciate your timeand expertise because you
definitely are going to helpsomebody out there that's been
listening to our podcast.
Well, thank you, and I reallyappreciate the very insightful
discussion.
Speaker 1 (27:24):
So thanks so much.
Speaker 2 (27:26):
Of course, happy to have you on again sometime in
the future.
And, of course, happy to haveyou on again sometime in the
future and for those of youlistening, if you like the
podcast, please click like anddon't forget to subscribe and
thank you so much for joining ustoday and stay tuned for the
next episode of Dermot Trotterdot com.
Speaker 3 (27:46):
Don't forget to subscribe, leave a review and
share this podcast with anyonewho needs a little skin care
sanity.
Until next time, stay skinsmart.
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