Rosacea – a chronic inflammatory skin disease that predominantly affects the cheeks, forehead, chin, and nose. Clinical manifestations of rosacea include persistent facial erythema, papules, pustules, telangiectasias, and recurrent skin flushing.
Characteristic sebaceous hypertrophy and fibrosis can lead to the development of rhinophyma – chronic lesions of the skin of the nose with its characteristic increase.
Rosacea can cause low self-esteem, depression and stigma, with a marked negative impact on patients' quality of life.
In this article on estet-portal.com we will look at what factors can contribute to the development of exacerbations of rosacea, as well as modern principles for diagnosing and treating the disease.
Classification of rosacea: main subtypes of the disease
Rosacea develops predominantly at the age of 30-50 years, characterized by episodes of exacerbations and periods of remission. Women get rosacea more often than men.
According to the classification of the National Rosacea Society Expert Committee, there are four subtypes of the disease:
1. erythematous-telangiectatic form;
2. papulo-pustular form;
3. phimosis form;
4. ophthalmic rosacea.
According to this classification, the presence of at least one of the following main features in a central location on the face is diagnostic of rosacea: hyperemia (transient erythema), persistent erythema, papules and pustules, telangiectasias.
Follow us on Facebook
What factors can provoke an exacerbation of rosacea
Rosacea can often occur in the form of not a specific subtype, but several of them at once.
The pathogenesis of rosacea is not fully understood today.
Genetic predisposition, dysregulation of innate and acquired immune response, vascular and neuronal dysfunction, infectious agents – all these factors can play a decisive role in the development of rosacea.
Triggers contributing to the exacerbation of the clinical manifestations of rosacea are psycho-emotional stress, ultraviolet radiation, the use of spicy foods, hot drinks, alcohol, and smoking.
Rosacea is associated with disruption of the skin barrier, leading to excessive transepidermal water loss, dryness, and flaking of the skin. This may be accompanied by characteristic tingling and burning sensations.
Facial Rosacea: 5 Things You Should Know
Rosacea: diagnosis and differential diagnosis of the disease
The diagnosis of rosacea is established clinically after taking anamnesis and objective examination of the patient. A biopsy is performed only if differential diagnosis with other diseases is necessary, since the histopathological signs of rosacea – non-specific.
The differential diagnosis of rosacea includes seborrheic dermatitis, acne, lupus erythematosus, and actinic keratosis.
It is important to inform the patient about potential trigger factors for rosacea – this may help prevent the development of relapses of the disease in the future.
Given the impairment of the skin barrier function in rosacea, the patient should avoid the use of irritating cosmetics. UV radiation is a powerful trigger for exacerbation of rosacea, so the patient should be advised to apply sunscreen daily.
Goutta rose: main approaches to the treatment of rosacea
Evidence-based treatment for rosacea: brimonidine and oxymetazoline
Two randomized clinical trials showed that the use of brimonidine tartrate 0.5% gel – highly selective α2-agonist with vasoconstrictor activity – helps to reduce the severity of persistent erythema.
In a Cochrane meta-analysis, a reduction in erythema was reported in 41% of patients treated with brimonidine.
After application of brimonidine gel to the face, clinical improvement is seen as early as 30 minutes, peaking at 3-6 hours, and then gradually regressing.
Side effects after using brimonidine include itching, burning and flushing. Some patients experience rebound erythema associated with brimonidine use.
Rosacea Treatment: Debunking Popular Myths
Recently, the FDA approved a cream containing 1% oxymetazoline hydrochloride for the treatment of persistent erythema in rosacea. α1-adrenergic agonist and partial α2-adrenomimetic action.
Modern aspects of the treatment of inflammatory skin lesions in rosacea
Treatment focused on the elimination of papular and pustular elements in rosacea depends on the severity of inflammatory changes in the skin. Topical azelaic acid, metronidazole, and ivermectin are first-line treatments.
If local treatment of rosacea is ineffective, international protocols recommend the use of systemic antibiotic therapy – doxycycline at a dose of 40 mg once a day.
Doxycycline is the only antibiotic approved by the FDA for rosacea. Doxycycline 40 mg mg is believed to have an anti-inflammatory effect rather than an antimicrobial effect.
In severe rosacea, as well as in the absence of the desired effect of the use of oral antibiotics, it is reasonable to prescribe low doses of isotretinoin (from 0.25 to 0.3 mg per kilogram of body weight per day).
Thank you for staying with estet-portal.com. Read other interesting articles in the "Cosmetology" section. You may also be interested in Macrolides: how safe is prescribing popular antibiotics
Translated from The New England Journal of Medicine
Share:
Add a comment