Ask the Doctors

Monday, October 27, 2008

Q Rosacea has made the pores on my face large. When I get my rosacea under control, will my pores return to their normal size?

Response by Dr. Michelle Pelle, assistant clinical professor of dermatology, University of California-San Diego School of Medicine:

Patulous follicles (the medical term for enlarged pores) are one of the characteristics of subtype 3 (phymatous) rosacea, which most commonly involves the nose but may also affect the cheeks, chin, forehead and ears. One possible explanation for the follicles' appearance is that protein excreted by the connective tissue beneath the skin builds up faster than the lymphatic drainage system can remove it. As the fluid builds up, the tissue becomes hard and thickened and may have the appearance of an orange peel, with sebaceous oil glands mimicking the pitted surface.

Fortunately, the enlarged pores often improve or return to normal following successful therapy.

Topical and oral antibiotic therapy may be prescribed for mild cases, but more severe cases may sometimes be treated with isotretinoin, which is an oral medication typically used for severe acne. Clinical studies have shown that patients' large sebaceous glands were diminished in size and number during isotretinoin therapy. There is also evidence that retinoids, topical medications with many of the same properties of isotretinoin, may decrease skin thickening and sebaceous gland enlargement. Spironolactone, a mild diuretic with anti-androgen properties, can also be used to decrease pore size.

When phymatous changes caused by rosacea become too severe, resulting in contour changes such as a bulbous nose, surgical therapy or laser therapy may be indicated. It is important to follow your doctor's instructions and prescribed medical therapy carefully, as well as to avoid your own personal environmental and lifestyle triggers, in an effort keep your rosacea from progressing to this stage.