Q: I recently began having flushing on my face. What is causing this and what can I do about it?

A: Flushing is defined as a sensation of warmth accompanied by visible reddening of the skin. Flushing results from an increase in facial blood flow, which in turn is caused by dilation of the blood vessels in the face.

There is a long list of medical causes of flushing, but the most common causes are an emotional reaction, certain foods and beverages, alcohol, and rosacea. Emotional flushing is an easy diagnosis to make; it is characterized by flushing which occurs when an individual is emotionally upset or has a feeling of embarrassment. If certain foods, beverages, or alcohol cause flushing, their avoidance will usually cure the flushing.

Rosacea is another very common cause of flushing. Rosacea is characterized by symptoms of facial flushing and a collection of other clinical signs such as facial redness, broken capillaries (medically called telangiectasias), coarseness of the skin, and an inflammatory eruption that may be similar to acne. The most likely areas to be affected by rosacea are the nose and cheeks, but in more severe cases the entire face and neck can be affected. Eventually, the redness of the face becomes permanent.

Rosacea is most likely to start in fair skinned people in their thirties and forties. Although there are many theories, the cause of rosacea is still unknown. Genetic and environmental factors such as sun exposure probably play roles in the development of rosacea.

The treatment of rosacea begins with sun protection. Patients who have rosacea should carefully monitor their exposure to the sun and routinely use sunscreen. Antibiotics, taken either orally or applied topically to the affected areas, are also regularly used to treat rosacea. Topical azaleic acid may also be used, especially if antibiotics do not give sufficient improvement. The redness and broken capillaries associated with rosacea are best treated with either laser therapy or intense pulsed light. These treatments have no downtime and lead to amazing improvement in the skin of rosacea patients. The good news is that by combining several skin care modalities, an experienced skin care professional will be able to control nearly every case of rosacea.

We are very pleased to announce that we are now using our new Q-switched alexandrite laser for skin rejuvenation in our office. This laser is used to remove a wide variety of pigmented skin lesions. Sun spots, brown spots, freckles, and patchy areas on the face and body can all be removed with the "Q-switched Alex." The laser is extremely safe and highly effective. It is so easy to tolerate that the procedure does not require any numbing cream. Generally, only one or two sessions are needed to remove these skin lesions.

Because this is a non-ablative laser, no special skin care is needed after the treatment. Patients only need to take reasonable sun precautions, apply an ointment to the treated spots, and use sunscreen. There is absolutely no recovery downtime with the Q-switched alexandrite laser.

Any of our patients who have pigmented spots on their face or body that they would like to remove are invited to call our office and make an appointment with either Dr. Amerian or Dr. Anterasian.

Read more about this new service  |  Make Appointment

Many people have scars that they find unattractive. In addition, the presence of the scar may continue to remind the person of an experience from the past that was upsetting such as a cancer treatment, a traumatic injury, or a medically required surgery. Scars like these can occur on any part of the body. Other times, the scars are simply the result of an earlier childhood or teenage ailment such as acne or chicken pox.

Thanks to modern medicine, there are now many ways that scars can be cosmetically improved. In this month's newsletter, we will review the different types of scars and the methods available to improve the appearance of unfavorable or unsightly scars.

Scars come in several different types.

• Hypertrophic scars: Hypertrophic scars are raised, firm, thick, and red.
• Atrophic scars: Atrophic scars are depressions in the skin that result from the loss of collagen.
• Keloid scars: Keloid scars are raised reddish nodular scars that are quite firm and relatively large. With a keloid scar, the size of the keloid is actually larger than the size of the original surgery.
• Acne scars: Acne scars are very common. Although they may occasionally be hypertrophic or keloidal, they are usually atrophic. The most common type of atrophic acne scar is referred to as an "ice-pick" scar. Ice-pick scars are narrow with sharply demarcated tracts that can reach deep into the skin.

Options for improving the appearance of scars include the following:

• Steroid Injection – Steroid injections are often used to treat hypertrophic scars and keloid scars. With a series of steroid injections, the inflamed raised scar should flatten out and become less inflamed and less irritated. Although steroid injections may be used alone, combining steroid injection with laser treatment enhances scar treatment.
• Vbeam Laser – The Vbeam laser is an excellent choice for hypertrophic scars and keloids. In research studies, there has been significant improvement in scar redness and in reduction of bulk following Vbeam laser treatment. Generally, after three or four treatments, the scars are flatter and less red. The Vbeam laser procedure is very well tolerated, with patients only feeling a mild snapping sensation. There is no downtime after a Vbeam laser treatment.
• Fraxel Lasers – The two Fraxel lasers will improve all types of scars and they are the most commonly used lasers to improve the appearance of scars. The most common scars treated with the Fraxel lasers are atrophic acne scars and surgical scars. However, even traumatic scars resulting from injury to the skin can be improved with the Fraxel lasers. Often, Fraxel laser treatment is combined with steroid injection to provide optimum improvement of the scar.
  
  Patients undergoing Fraxel laser treatment of scars may choose between traditional Fraxel laser treatment and Fraxel Repair laser treatment. With traditional Fraxel laser treatment, patients undergo a series of 4 or 5 Fraxel laser procedures at monthly intervals, with no downtime, to improve the scar. The improvement in the scar results from the new collagen that is formed as a result of the laser treatment. This procedure is FDA approved for the treatment of acne scars and surgical scars, and it will also improve all other types of scars as well.
  
  With Fraxel Repair laser treatment, patients generally need only one or two treatments; however, depending on the size of the treated area, there may be a few days of downtime with Fraxel Repair laser treatment. The improvement in the scars following treatment with the Fraxel Repair laser results from immediate shrinkage of the scar tissue followed by new collagen growth. Like the traditional Fraxel laser, the Fraxel Repair will improve all types of scars, including acne scars, surgical scars, keloid scars, and atrophic scars.
• Surgical Scar Revision – Occasionally, a scar that healed poorly needs to be surgically removed and stitched using very precise and careful surgical technique. In properly selected patients, this will result in a much-improved scar. However, surgical scar revision is only rarely necessary, and nearly all patients can have their scars improved without surgery, using lasers and steroid injections.

Any of our patients who have a scar that they do not like are invited to call our office (1-866-811-7986) and make an appointment with either Dr. Amerian or Dr. Anterasian.