Fifty shades of red: Nelli Konnikov on the treatment of rosacea

Пятьдесят оттенков красного: Нелли Конниковa о лечении розацеа

The term "red face" used among specialists in aesthetic medicine to refer mainly to inflammatory or autoimmune skin lesions, or diseases associated with a change in the state of skin vessels. Rosacea – This is a chronic relapsing disease, the main manifestation of which is persistent reddening of the skin. This pathology is a fairly common phenomenon, and therefore requires early diagnosis, as well as proper treatment. Professor of Dermatology at the Boston University School of Medicine, USA, Chief Dermatologist and Head of Teledermatology at the Boston Veterans Hospital, Member of the American Society of Dermatologists (AAD) and the Society of Dermatological Surgery (ASDS) told estet-portal.com about the features of working with skin affected by rosacea ,

What diseases are classified as "red face"?

When a patient visits a dermatologist or aesthetic medicine specialist with a problem of the so-called "red face"; – it is not an easy task to help him in this matter. Differential diagnosis of skin diseases that are accompanied by its redness includes seborrheic dermatitis, psoriasis, acne, rosacea, as well as many stress disorders that increase the blood supply to the face.

Regarding systemic diseases, does it happen that the patient comes to you first?

Patients with systemic diseases, most often, turn to a dermatologist much earlier than to any other specialist. They see manifestations of this or that disease on their face, on their skin, and, of course, they turn to those who treat it. Therefore, it is so important for us to collect a detailed history and consult the patient, and only then – prescribe treatment, or refer to another specialist to confirm or refute the diagnosis of a systemic disease.

Tell me, what are the basic principles of rosacea treatment?

This is a good question, because rosacea is a fairly complex disease, which is characterized by stages of development. Rosacea is a chronic pathology that patients can apply for, both at the initial stage of the process, and already with an advanced disease.

We do not treat a diagnosis, not a picture from the pages of a book on dermatology - we treat a patient, taking into account his age, social status, financial capabilities, tolerance of certain drugs.

The most important step in working with a patient who has a "red face" problem is the correct diagnosis. It is necessary to figure out what you, as a dermatologist, can do for this particular person.

When should a patient with rosacea be treated with medication?

First of all, the doctor must consult the patient and make the correct diagnosis. In the early stages of rosacea, it may be enough to eliminate the triggers that cause redness, such as sun exposure, spicy foods, and excessive exercise. But in most cases, we prescribe a combination treatment, usually starting with topical therapy. Depending on how the patient responds to the treatment, whether they can afford the drugs prescribed by us, we can combine different means, trying to achieve the best result. & nbsp; Standard preparations for combating rosacea – these are metronidazole, sulfur preparations, topical antibiotics. Also, the patient may be recommended special lotions and cleansing masks. All this in combination can reduce the manifestations of rosacea, and also helps to make the remission of the disease longer.

How do you feel about cosmetic skin care products as an adjunct to the main treatment of rosacea?

Patients with rosacea need cosmetic products because they help to improve the condition of the skin. However, it is very important to recommend those cosmetics that, firstly, the patient can afford, and are absolutely safe and ideal for a particular person. Most often, patients with rosacea have very sensitive skin. Therefore, it is important to prescribe gentle and moisturizing products that do not contain soaps and fragrances, a good example is Galderma Cetaphil lotion. Of course, you do not know in advance how this or that cream will affect the skin of a particular person.

The patient should first try the cosmetic product on a limited area of the skin, and apply it only after making sure that there is no irritation.

The use of cosmetics can help achieve a stable remission of rosacea, but unfortunately, it happens that even with all the precautions, the disease progresses. Then the doctor needs to make a decision to move to the next stage of treatment, add systemic therapy to suppress the pathological microflora, and normalize the condition of the gastrointestinal tract, or even refer the patient for a consultation with a gastroenterologist.

You mentioned the "curse of the Celts" in your report. What is it?

The disease that is now called rosacea was known about two thousand years ago. Most often, middle-aged people, owners of I and II skin phototypes – now we usually call such skin northern or Celtic. In the ancient world, it was noticed that rosacea affects women and men who, to put it mildly, do not lead a very correct lifestyle. This is how the term "curse of the Celts" arose, which was associated with the punishment of the gods for objectionable behavior and neglect of religious dogma.