Rosacea. Full Review and Treatment Options

What are rosacea and rosacea?

Rosacea and rosacea are types of vascular pathologies that are characterized by the appearance of dilated blood vessels. As a result, the skin acquires a reddish tint.

Rosacea is a chronic skin lesion that occurs with rashes and redness. That is why the pathology received a name that speaks for itself - pink acne.

Today, there is no exact explanation for why rosacea occurs. The disease can be triggered by diet, hormone imbalance, or predisposition. Alcohol consumption, stress, hypothermia, allergies - any factors that provoke vasodilation - contribute to the occurrence of rosacea.

Cuperosis is an expansion of small capillaries that causes redness of the skin. Due to expansion, the walls of blood vessels become thinner and lose their elasticity. The vessels fill with blood, giving the skin a reddish tint. If the disease progresses, stable networks of blood vessels form on the skin, covering large areas of the face.

Cuperosis can be attributed to a physiological feature that requires treatment. Prolonged manifestations of rosacea lead to a lack of oxygen and nutritional components in skin cells. The skin loses water, becomes dry, its color deteriorates, and aging processes begin prematurely.

What do rosacea and rosacea look like? Spider veins and spider veins appear on the skin. They often occur in the T-zone. Those with sensitive, fair skin are most susceptible to vascular pathologies.

Clinical picture

The erythematotelangiectatic subtype of rosacea begins with a mild form that is easy to treat. It progresses slowly, intensified by a rush of blood to the skin of the face in stressful conditions, after physical exertion, at very high temperatures or frost. The next stage is persistent erythema of the cheeks and wings of the nose. Gradually, the rashes spread to the neck and upper chest, giving a pink tint. Because of the discoloration of the tissues, English dermatologist Thomas Bateman named the disease rosaceus, which is Latin for made of roses. Arterioles are the smallest blood vessels that can instantly change the width of the duct. As the disease worsens, the color of the affected areas becomes more and more saturated red. Due to the ongoing inflammatory process, the flow of fluid increases, which pathologically increases swelling. Patients complain of constant itching, a desire to scratch, and pick off inflamed plaques.

The papulopustular subtype of rosacea is similar to the first. The main difference is a larger volume of pustular rashes covering the scalp and upper back. Swelling in men is more pronounced. The difference from other skin diseases is the absence of peeling and comedones - sebaceous plugs in the pores. Papules are unlike pustules because they are not filled with pus. This is a form of rash. The protrusions are soft or firm to the touch. They do not leave scars behind.

The phymatous or hypertrophic subtype involves significant thickening of the connective tissue, uneven distribution of pineal formations - fim. If the tissues of the nose become pathologically uneven, then the form is called rhinophyma, the forehead - metaphyma, the chin - gnathophyma, the ears (sometimes one-sided) - otophyma, the eyelids - blepharophyma. Types of tissue pathologies (fim): glandular, fibrous, fibroangiomatous, actinic. The skin looks like a reddish orange peel. The color does not fade. The appearance of conglobates - large spherical spots - also belongs to this subtype.

Ophthalmic rosacea has two distinctive features: simultaneous inflammation of the eyelids and membranes of the eye. Usually accompanied by the appearance of a red network of dilated vessels around the pupils. Patients complain of a scratching reflex, sensation of a foreign body under the eyelids. Sometimes the eyes are affected first, and then the surrounding skin. Complications may develop:

• Keratitis is an inflammation of the cornea of ​​the eye, accompanied by clouding.
• Scleritis is an inflammatory reaction that develops in the outer layer of the eye.
• Iritis is inflammation of the iris.

Sometimes patients complain of unpleasant crusts in the corners of the eyes, peeling of the folds of the eyelids, and lacrimation. In severe cases, there may be a sharp deterioration in vision up to its complete loss - blindness.

Granulomatous rosacea is accompanied by the formation of dense, yellow, brown or red nodules, which may leave scars - post-acne. The rashes concentrate on the cheeks and areas around the body's natural orifices. For accurate diagnosis, histological examination is necessary.

Among the symptoms, clinicians distinguish between intermittent (non-constant) and persistent. The former appear only during periods of exacerbation, the latter do not disappear without treatment.

Table. Characteristics of the severity of the disease

Rosacea is difficult to distinguish from other dermatitis:

• Photosensitive after long-term use of hormonal drugs.
• Spring-summer pathological sensitivity to solar radiation.
• Discoid lupus erythematosus is a malfunction of the immune system.
• Tuberculous lupus, which triggers the process of tissue necrosis.
• Hormonal activity of tumors from cells of the APUD system (diffuse neuroendocrine system).
• Rendu-Osler-Weber disease is a hereditary disease.
• Granuloma with ring-shaped neoplasms.
• Acne is an acne disease.
• Dermatomyositis, which also penetrates muscle tissue.

The history of the course of the disease helps to distinguish rosacea from other pathologies. Stages of development: initial (episodic hot flashes), appearance of nodules or pustules, enlargement and thickening of the affected areas. The more complex the form, the more important it is to use a wide range of means of influencing the body during treatment. Don't forget about allergy medications and sedatives. Sometimes clinical recommendations for rosacea also include consultation with a psychologist, because Due to the unattractive appearance, the patient’s psycho-emotional state worsens and depression develops. If you do not contact a dermatologist, the disease risks causing the following complications:

• Development of abscesses.
• A secondary infection means that serious medical intervention will be required.
• Thickening of the skin that cannot be removed with conventional cosmetic products.
• Deterioration of vision.
• Psychological problems against the background of a changed appearance. In difficult cases it comes to depression.

What are the differences between rosacea and rosacea?

What rosacea and rosacea are is easy to understand. But the diseases are difficult to distinguish from each other without qualified help. Couperosis or rosacea can be determined by symptoms. The main difference is that rosacea is never accompanied by purulent inflammation, the skin is smooth, without compactions.

Couperosis and rosacea on the face have differences in symptoms. With rosacea, small and large blood vessels are affected, causing the skin to acquire a reddish tint. In rare cases, rosacea is accompanied by a fiery skin color - there is a feeling that the skin is burning, but in fact there are no painful symptoms.

Unlike rosacea, rosacea is accompanied by painful sensations. In addition to redness, purulent inflammation and uneven relief are formed. The difference between rosacea and rosacea on the face is itching.

The difference between rosacea and rosacea is the course of the disease. Rosacea occurs in several stages:

• Erythematous. Temporary redness of the skin occurs. Subsequently, the redness becomes persistent.
• Papulopustular. In the area of ​​redness, rashes filled with reddish liquid appear. They arise due to metabolic disorders in the skin and vasodilation. Blood seeps into the surrounding tissues, coloring them in a characteristic color.
• Phimosis. Densified nodules and plaques form on the skin.
• Rhinoform. Accompanied by an increase in the size of the nose. This stage is typical only for men.

Clinical guidelines for the treatment of rosacea

Rosacea is a chronic disease accompanied by inflammation of the skin. The capillary network stands out sharply, and purulent rashes appear. Blood rushes to the site of inflammation, the walls of blood vessels stretch, and excess fluid gradually accumulates in adjacent tissues.

There are four subtypes of the disease and one variant, granulomatous rosacea. Subtypes of rosacea are: erythematotelangiectatic (predominant), papulopustular, phymatous (hypertrophic), ocular (ophthalmic rosacea).

How is rosacea diagnosed?

Regardless of the nature of the disease (rosacea, demodicosis, rosacea), treatment is preceded by diagnosis. A cosmetologist will determine whether the patient has rosacea or rosacea. An examination, blood test, and in some cases, scrapings of the affected skin areas will be required. If necessary, the doctor will prescribe an ultrasound of the internal organs to rule out diseases that can provoke skin reactions.

The task of a cosmetologist is not only to eliminate the external manifestations of rosacea on the skin, but also to establish the cause of the disease. To do this, it is necessary to examine the state of the gastrointestinal tract and endocrine system - to exclude gastritis, colitis, hormone imbalance, etc.

Seborrheic dermatitis

Seborrheic dermatitis is a chronic inflammatory disease associated with a violation of the amount and composition of sebum and a disturbance of the skin microbiota.

Clinical manifestations : hyperkeratosis, peeling, seborrhea, inflammation and itching.

Localization : areas with the largest number of sebaceous glands, including the T-zone of the face, as well as the scalp, upper third of the back and chest area, ears.

The common feature is centrofascial erythema, the distinctive features are: with rosacea – papules and telangiectasia, with seborrheic dermatitis – the formation of scales and peeling, which are not characteristic of rosacea.

What should you not eat if you have rosacea?

Rosacea and rosacea on the face are diseases that require a comprehensive approach to treatment. First of all, this concerns nutrition. To get rid of rosacea, you need to exclude dangerous and harmful foods from your diet:

• Sweet and floury. They contain sugars that cause inflammation
• Dairy products. Progesterone, which dairy products are rich in, enhances the functions of the sebaceous glands - there are more purulent inflammations on the skin.
• Alcohol. It has been scientifically proven that alcoholic drinks themselves do not cause rosacea, but aggravate the course of the disease. Alcohol dilates blood vessels and causes an additional blush on the face.
• Products containing caffeine (tea and coffee). They stimulate the production of the hormone cortisol, which triggers stress. Stressful situations often lead to inflammation on the skin.
• Canned, pickled, salted, fried and spicy foods. They lead to acne on the skin, dilate blood vessels, and weaken the immune system.
• Citrus and sweet fruits. Causes skin inflammation.

Can rosacea be cured permanently?

Regardless of whether it is telangiectasia, rosacea or rosacea, treatment should be comprehensive. The peculiarity of rosacea is that despite external signs, the causes are hidden deep in the body. And to get rid of rosacea forever, you need to identify and eliminate the cause of the disease.

Treatment of rosacea and rosacea is carried out in several directions. As a rule, an endocrinologist and cosmetologist develop a comprehensive treatment plan that is aimed at quickly eliminating the external manifestations of the disease and deeply treating the causes of rosacea.

Treatment of rosacea and rosacea consists of the following steps:

• Proper skin care. Careful hygiene, selection of cosmetics, daily use of cream with SPF protection. Acid peels, products containing alcohol, and rough scrubs are contraindicated for rosacea.
• Therapeutic treatment. Based on the use of antibacterial and antiseptic agents that eliminate the causes and consequences of acne.
• Drug treatment. Depending on the indications, the patient may be prescribed medications, hormonal drugs, etc.
• Hardware treatment. Elimination of spider veins using hardware methods.

Prevention

Along with treatment, preventative measures are also important. To prevent the development of rosacea, you need to avoid exposure to:

• sun and wind;
• unhealthy diet;
• harmful drinks;
• medicines;
• aggressive cosmetic procedures (peelings, surgical skin smoothing, rubbing, warming masks, etc.).

For prevention, specialists regularly prescribe short courses of antibiotics. It is recommended to constantly care for the skin with cosmetic products for gentle cleansing, moisturizing and protection from ultraviolet radiation (for sensitive skin). It is necessary to remember about the treatment of concomitant pathologies, especially diseases of the digestive tract. Getting rid of the consequences does not diminish the cause of the illness.

What cosmetic procedures can be done for rosacea?

When treating rosacea and rosacea on the face, you cannot do without cosmetic procedures. But not all of them are allowed for vascular pathologies.

The following help to effectively get rid of rosacea and rosacea:

• Phototherapy. Pulsed light affects pathological tissues. The targets of the rays are microorganisms and altered capillaries. Under the influence of photo flashes, old collagen fibers are destroyed and the production of new ones is started. The main feature of phototherapy is the ability to glue blood vessels. The rays heat the vessel to 60 degrees, which provokes blood clotting and the vessels become empty.
• Plasma therapy. The procedure is based on the use of autogenous plasma. Plasma therapy triggers skin cell restoration processes, normalizes metabolism, and saturates the skin with useful substances. In the dermis, collagen synthesis is enhanced and inflammation processes are reduced.

Can rosacea be treated with laser?

Couperosis and rosacea can be eliminated with laser. Vascular networks are cauterized with laser beams. The method is effective at different stages of the disease - both at the initial and in advanced cases.

Laser beams quickly and permanently eliminate redness and spider veins from the skin surface. The number of sessions depends on the stage of rosacea and rosacea.

Laser removal of rosacea and rosacea is an effective method for spider veins. The procedure allows you to get a pronounced result and does not require a long recovery period. The effect of the procedure lasts for several years.

Is it possible to do a chemical peel for rosacea?

Couperosis or rosacea on the face are diseases that require careful skin care. Aggressive chemical peels can only worsen the disease. Unprofessional acid peeling provokes persistent redness - the skin takes a long time to heal after the procedure. An unskilled approach to therapy and an illiterate selection of home remedies will aggravate the course of the disease. A cosmetologist knows how to treat rosacea and rosacea on the face.

For rosacea and rosacea, only delicate peels are indicated (for example, using mandelic or lactic acid). Antioxidant monopilings are prescribed for the erythematous form of rosacea. Superficial almond peeling does not cause peeling or burning.

For the pustular form, combinations of azelaic and lactic acid can be used. They inhibit the production of reactive oxygen species and regulate the formation of secretion from the skin glands. The doctor selects the acid composition for peeling individually depending on the nature and course of the disease.

Solantra®

Suction

The absorption of ivermectin contained in Solantra was assessed in a clinical study involving adult patients with severe papulopustular rosacea using the maximum tolerated dose of the drug. At steady state (after 2 weeks of treatment), the highest mean (± standard deviation) ivermectin plasma concentrations were observed within 10 ± 8 hours after dosing (Cmax: 2.1 ± 1.0 ng/ml, range: 0. 7-4.0 ng/ml), and the highest mean (± standard deviation) AUC0-24 h was 36 ± 16 ng h/ml, range: 14-75 ng h/ml). Systemic exposure to ivermectin reached a plateau by the end of the second week of treatment at steady state. With longer treatment durations in phase 3 studies, systemic exposure to ivermectin remained the same as after two weeks of treatment. At steady state, systemic exposure levels of ivermectin (AUC0-24 h: 36 ± 16 ng h/ml) were lower than after a single oral dose of 6 mg ivermectin in healthy volunteers (AUC0-24 h: 134 ± 66 ng h/ml) .

Distribution

In vitro study

showed that the binding of ivermectin to plasma proteins (mainly albumin) is more than 99%. No significant binding of ivermectin to erythrocytes was observed.

Metabolism

in vitro studies

Using human liver microsomes and recombinant CYP450 enzymes, it was noted that ivermectin is metabolized mainly by CYP3 A4 inhibitors.

In vitro studies

showed that ivermectin does not inhibit CYP450 isoenzymes 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 3A4, 4A11 or 2E1. Ivermectin does not induce the expression of CYP450 enzymes (1A2, 2B6, 2C9 or 3A4) in cultured human hepatocytes. 2 main metabolites of ivermectin (3”-O-demethyl ivermectin and 4a-hydroxy ivermectin) were identified during a clinical pharmacokinetic study using the maximum permissible dose of the drug and were studied during phase 2 clinical trials. Like the parent compound, the metabolites reached equilibrium by the end of the second week of treatment, with no signs of accumulation observed up to 12 weeks. In addition, systemic exposures of metabolites (assessed using Cmax and AUC) obtained at steady state were much lower than those after oral administration of ivermectin.

Elimination
The terminal half-life averaged 6 days (approximately 145 hours, range: 92-238 hours) in patients who applied the drug to the skin once daily for 28 days in a clinical pharmacokinetic study at the maximum tolerated dose of the drug. . Removal from the body depends on the degree of absorption after external application of Solantra cream. The pharmacokinetics of ivermectin have not been studied in patients with hepatic or renal impairment.

What is rosacea and how to get rid of it?

Cuperosis can be either an independent manifestation of changes in the skin or a sign of serious diseases. Cuperosis occurs in several stages:

• Rapid redness for no obvious reason. After a while, the redness disappears without consequences - the vessels are still elastic to restore their original state.
• A characteristic pattern of blood vessels appears on the skin. This is a sign that the blood vessels cannot return to normal.
• Chronic blood circulation disorders and lack of nutrition of skin cells.

A cosmetologist knows how to treat rosacea and rosacea. You can get rid of skin pathologies in a comprehensive manner by identifying the cause of the disease. If rosacea is caused by a disease of the internal organs, they need to be treated first. The use of only external agents will eliminate the manifestations of rosacea, but will not protect against the appearance of new spider veins. A combination of therapy methods that complement each other will achieve lasting results.

Diagnostics

The diagnosis, as recommended in medical textbooks and articles, is made based on the results of a physical examination of the visible manifestations of the disease and clarification of the medical history. The patient is asked in detail about the time of onset of primary symptoms. The doctor may ask about factors that, in the patient's opinion, reduce or increase symptoms. An additional research method, biopsy, is rarely used. This is the removal of a small piece of skin with a swab or scraping to identify parasites. In rare cases, monthly blood chemistry tests are performed for total bilirubin, serum alanine aminotransferase, aspartate aminotransferase, triglycerides, total cholesterol, glucose, serum creatinine, or alkaline phosphatase. Sometimes testing is done for antinuclear antibodies, which appear in the bloodstream as indicators of destruction of connective tissue cells. According to indications, seek advice from one of the specialists: an ophthalmologist, gastroenterologist, endocrinologist or psychotherapist.

An ophthalmologist is necessary if there is a risk of developing ocular rosacea. This specialist can prescribe supportive measures to alleviate the patient’s suffering: relieve the feeling of pain and dryness in the eyes, reduce sensitivity to bright light.

The gastroenterologist will prescribe additional diagnostic procedures to assess the condition of the digestive system. He can develop recommendations for proper nutrition or therapeutic fasting. It has been confirmed that smoked foods, saltiness, spices, citrus fruits, coffee-containing drinks, as well as alcohol increase the redness of the facial skin and provoke the appearance of new rashes.

An endocrinologist uses an examination to identify hormonal imbalances. Pathologies of the endocrine system often cause hot flashes. If unpleasant skin rashes appear, pre-prescribed hormonal therapy requires adjustment.

The psychotherapist will conduct a conversation to determine the general psycho-emotional state. He will advise what psychological techniques, relaxation techniques or sedatives can be used to get rid of depression. Patients suffering from rosacea, especially the severe form, often become more shy and withdrawn. Women usually hide imperfections with camouflage cosmetics, hide them behind long hair, and do not like to be seen. Females aged 30 to 40 years are at risk.

What should you not do if you have rosacea?

Rosacea and rosacea, although not the same thing, have similar limitations. If you have rosacea, you should avoid the following:

• baths and saunas
• artificial tanning in a solarium
• traumatic facial cleansing
• laser resurfacing
• cosmetics with acids and alcohol
• scrubs and peelings with hard particles
• thermal masks
• contrasting washes

Acne, rosacea and rosacea should be treated by eliminating harmful foods from the diet:

• alcohol and carbonated drinks
• baked goods, sweets and cakes
• all types of red meat
• canned, spicy and salty foods