Tackling rosacea flare-ups — as well as a time when redness may be helpful — were discussed at the recent American Academy of Dermatology annual meeting in Boston.
Dr. Hilary Baldwin, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School, presented on the phenomenon of “mask rosacea” during the pandemic. She noted that face masks may aggravate rosacea in several ways, including increasing temperature, humidity and sebum production; disrupting skin barrier function; and causing changes in the skin microbiome.
Additionally, many people may be allergic to ingredients in the masks, such as textile dyes, rubber and formaldehyde, leading to allergic contact dermatitis that may appear similar to rosacea.
“So the real question is, is this rosacea?” Dr. Baldwin said. “The bottom line is that it doesn’t matter, because regardless of the etiology, we’re going to endeavor to help the patient. So what could we recommend? In low-risk, non-medical situations, cloth masks are sometimes used, because they can be less problematic than surgical and N95 masks.
Cloth masks do reduce friction, but they also get very moist, so I usually recommend to my patients that they go to work with two or three of them stuffed in their pockets and change them regularly when they become moist.”
Dr. Emmy Graber, president and founder of The Dermatology Institute of Boston, reviewed laser and light therapies for rosacea, and offered advice to physicians on how to maximize results with pulsed dye laser (PDL) for persistent redness in rosacea. She explained that the redder a patient is during the procedure, the more precise the laser can be. If a patient is using an alpha agonist, such as oxymetazoline or brimonidine, to control their erythema, she asks them to stop using it a few days before the procedure to ensure the redness is prominent.
“If they come in and say, ‘well, I’m usually more red than this, but today I’m not very red’ — I hear that all the time — we keep a hairdryer in our PDL room,” Dr. Graber said. “I put the goggles on the patient and have them hold the hair dryer and make themselves red, and then perform the procedure.”