Treat the Vessel, Prevent the Pigment: Rosacea and Dermal PIH Across All Fitzpatrick Types

Everything visible in rosacea traces back to the same place: the vessel. In lighter skin types, that shows up as erythema and telangiectasia. In Fitzpatrick IV–VI it shows up as pigment, because sustained inflammation pushes melanin past the dermal-epidermal junction, where melanophages trap it beyond the reach of topicals. The redness and the pigment are the same disease at different depths. Treat the vessel and you're upstream of both.

Dara Spearman, MD, presents a treatment logic that inverts the standard sequence: address the vascular driver first and the pigment resolves downstream, rather than chasing pigment that keeps regenerating.

Key Takeaways:

• Why rosacea's inflammatory pathway produces different clinical endpoints across the Fitzpatrick scale
• The vessel-to-melanophage pathway that turns chronic erythema into dermal PIH, and why depth determines what will and won't work
• Why melanin-targeting devices carry real PIH risk in Fitzpatrick IV–VI, and how 1064nm Nd:YAG addresses vascular and pigmentary endpoints with a single wavelength
• Protocol sequencing, clinical endpoints, treatment intervals, and how to counsel patients when success is measured in what doesn't happen

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Register to watch this webinar live on September 24, 2026 at 8:00pm ET!

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Presented by Dara Spearman, MD

Dara Spearman, MD, is a board-certified dermatologist based in Fort Wayne, Indiana. She earned her medical degree from the University of Michigan, where she also completed her dermatology residency and was inducted into the Alpha Omega Alpha Honor Society.

Dr. Spearman founded Parkview Health’s dermatology department in 2016 and established a multidisciplinary skin cancer tumor board to improve care for high-risk patients. She is actively involved in organized medicine and currently serves as President of the Indiana Academy of Dermatology, with additional leadership experience through the American Academy of Dermatology and Indiana State Medical Society. She also serves as a peer reviewer for the Journal of the American Academy of Dermatology and frequently contributes to patient education through print and broadcast media.