Nose Disfiguration

One of the worst side effects of the disease is nose disfiguration, Rhinophyma, which, in addition to being unsightly, actually can interfere with breathing, Dellavalle said. The condition, most common in men, can require surgery, he said.

“We anesthetize the nose, cauterize and cut,” according to Dellavalle, who said a surgeon can reshape the nose to its normal size, and, “the outcome actually is very good.”

More moderate cases of rosacea can be well-controlled with current topical treatments, including gels made from substances such as azelaic acid and metronidazole, which work by killing bacteria that infect pores or decreasing inflammatory action.

Rosacea also can be treated with lasers that target blood vessels in the skin, which VA usually outsources to private practice, he noted.

“It’s hard to reverse rosacea compared to other skin diseases,” he said. “We have very little power to reverse it other than laser. That’s been the biggest step forward in recent years.”

Laser treatments are not a cure and have to be repeated, he pointed out, but, with appropriate sun screening, a patient could go for years without additional laser treatment.

An issue with laser treatment, however, is who pays for it.

It is not clear within the VA whether rosacea, particularly in milder cases, is a cosmetic or medical condition. If a physician deems it strictly cosmetic, it might not qualify for VA treatment.

“That’s been an ongoing, chronic issue,” said Gallo. He suggested that VA should continue to evaluate the question on a case-by-case basis, rather than through a blanket policy.

“That’s a gray issue,” added Dellavalle. “How cosmetic is it, how medically necessary?”

The same conflict has arisen in the private medical market as well, with some insurance companies refusing to cover rosacea treatment on the grounds that it is cosmetic not medical, a dilemma that experts say will likely linger until researchers find a cause and cure for the condition.

Back to 2012 Compendium

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Inhibits Proteolytic Activation of Tryptic Kallikrein-Related Peptidases and Activation of Cathelicidin. J Invest Dermatol. 2012 Feb 16. doi: 10.1038/jid.2012.14. [Epubahead of print] PubMed PMID: 22336948.

2. Sulk M, Seeliger S, Aubert J, Schwab VD, et al. Distribution and Expression of Non-Neuronal Transient Receptor Potential (TRPV) Ion Channels in Rosacea. J Invest Dermatol. 2012 Apr;132(4):1253-62. doi: 10.1038/jid.2011.424. Epub 2011 Dec 22. PubMed PMID: 22189789; PubMed Central PMCID: PMC3305847.

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