Modern methods for assessing vascular damage in rosacea

Rosacea belongs to the category of the most common dermatoses, since its population frequency reaches 1.5-10%, and in the structure of dermatological pathology - 2-8%. Rosacea is characterized by uncertainty of etiology, multifactorial pathogenesis, polymorphism of clinical manifestations, chronic relapsing course, and frequent resistance to standardized therapies. In addition, the disease causes a significant negative impact on the quality of life of patients.

Find out at estet-portal.com what modern methods exist for assessing vascular damage in rosacea.

causes of skin and eye damage due to rosacea
functionality of blood flow in rosacea
assessment of microvasculature in patients with rosacea

Causes of skin and eye damage due to rosacea

A special place in the pathogenesis of rosacea is occupied by disturbances in the vascularization of the facial skin: the redistribution of blood flow slows down and venous stasis is formed in the area of the facial vein, which corresponds to the favorite localization of the lesions.

This explains the frequent involvement of the conjunctiva in the pathological process, which is also located in the indicated vascularization zone . However, at the same time, secondary involvement of blood and lymphatic vessels of the skin in the inflammatory process is also allowed.

It is believed that the mechanisms of vascular disorders in these patients are caused by various neuroendocrine factors , which are variable, but not well understood. Available studies mainly concern the study of the morphological state of the microcirculatory skin beds with rosacea.

Functionality of blood flow in rosacea

The functional capabilities of the blood flow remain without attention, in particular, the amplitude-frequency spectrum of oscillations in the blood circulation of the dermis . And therefore, assessing the state of the microvasculature of the skin using laser Doppler flowmetry (LDF) seems very promising.

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In favor of its use are indicated:

- high information content;

- wide availability;

- non-invasiveness;

- financial accessibility.

As is known, LDF is a modern technology in the field of assessing the functional state of blood circulation, allowing monitoring of vascularization features in real time . This method is objective due to the possibility of long exposure and high sensitivity regarding the slightest changes in hemodynamics.

LDF is based on recording the amplitude-frequency response (AFC) of a laser beam, which is reflected from blood components, mainly red blood cells, which move in its direction.

Due to the penetration of the beam into the skin to a depth of 1.5 mm, information about blood circulation in superficial microvessels is obtained. The particular attractiveness of this research method is that it makes it possible to dynamically monitor the patient during the course of the pathological process and evaluate the effectiveness of therapy.

Tissue blood flow using LDF is determined, as a rule, in the ranges E, H, M, D and C :

- ultra-slow oscillations in the E range are caused by the rhythmic activity of the capillary endothelium;

- fluctuations in the H range (vasomotions themselves - rhythmic changes in the diameter of precapillary vessels) reflect the active contraction of precapillary sphincters and are under neurogenic control ;

- fluctuations in the M range associated with the functioning of the pathways of the juxtacapillary “shunt” circulation. Their source is the activity of smooth muscle cells of the vascular wall and precapillary sphincters ; these structural elements constantly respond to changes in intravascular pressure, that is, they ensure the implementation of the so-called myogenic reaction;

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- oscillations in the D range are synchronized with the act of breathing; they are caused by an increase in blood flow to the heart at the height of inspiration and a decrease at the peak of exhalation;

- fluctuations in the C range are synchronized with the heart rhythm and reflect changes in the diameter of arterial vessels that are induced by pulsation blood flow.

Assessment of the microvasculature in patients with rosacea

In a clinical study of the skin microvasculature in patients with rosacea, 57 patients (39 women and 18 men) aged 18 to 45 years were observed.

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The duration of the disease ranged from several months to 16 years. Was diagnosed:

- erythematous form of dermatosis - in 22 patients;

- erythematous-papular - in 19;

- papulopustular - in 16 patients.

The control group consisted of 15 healthy individuals. A study was carried out in the lesions in the cheek area using a laser Doppler flowmetry device. Blood flow was recorded for 20-30 minutes. LDF-grams were analyzed using the wavelet transform.

Determined in the range E, H, M, D and C:

- Amax (maximum amplitude of oscillations)

- Fmax (maximum oscillation frequency).

It has been established that in patients with rosacea, regardless of the clinical course of the pathological process, there is a probable increase in the Amax E indicator . This proves that the increase in the amplitude of oscillations of the capillary endothelium is combined with the inhibition of the neurogenic effect on the microvasculature of the skin in the form of a decrease in the amplitude of contractions of the precapillary sphincters.

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This data illustrates:

- increased activity of the juxtacapillary circulation

- suppression of the amplitude of the propagation of transmission pulsation to the venular link of the microcirculatory bed of the skin associated with the act of breathing;

- increased tone of arterioles, stagnation of blood in the venular sections and stasis of blood circulation in the capillaries.

Somewhat different changes occurred in the frequency spectrum of oscillations of the dermal blood circulation . Thus, Fmax remained within physiological values regardless of the clinical course of the pathological process. Consequently, the absence of possible changes indicates the discoordinated nature of the increased activity of the juxtacapillary circulation, which is caused only by an increase in the amplitude of its oscillations.

Thus, disorders of the microcirculatory bed of the skin in patients with rosacea are branched in nature, therefore, for patients with rosacea, it is advisable to prescribe LDF studies of the microvasculature of the skin in order to assess the depth and direction of the disorders that arise , and also the amplitude-frequency characteristic of the state of the dermal circulation should be taken into account when choosing remedies therapeutic correction and can serve as one of the criteria for the effectiveness of treatment of patients with rosacea.

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