Rosacea is a persistent lesion of the vessels of the facial skin. It is manifested by redness of the skin of the cheeks, nose, forehead and chin, rashes of bright pink color, vascular asterisks, pustules. In the later stages, it is possible to develop irreversible thickening and infiltration of the skin of the nose, forehead, earlobes, eyelids, chin. It leads to deterioration of the appearance of the skin, sometimes pronounced cosmetic defects, changes in appearance, psycho-emotional problems. When the eyes are affected, keratitis and corneal ulceration develop.
ICD 10
L71 Rosacea
General information
Rosacea is a chronic skin disease characterized by redness of the skin, the presence of pustular rashes, thickening of the dermis and violation of epithelial detachment. Previously, the development was prescribed for the presence of demodecosis, but these two diseases are different in their etiology, although each of them complicates the course of the other. The pathogenesis development is caused by hypersensitivity of skin vessels. If there is a genetic predisposition or the vessels are fragile and brittle, then in response to such stimuli as sudden temperature changes, dry and hot air, the vessels expand, which is not observed in the majority of people.
The incidence of rosacea in people with a history of gastritis is much higher than in those with Helicobacter pylori, the bacterium that causes gastritis, has not been detected. Disease of medicinal nature is observed with prolonged use of corticosteroid ointments, the skin arteries become thinner, become more brittle and sensitive to minor temperature changes.
Risk factors
The incidence of rosacea is approximately the same in both sexes, but women during menopause are more susceptible to rosacea, as the hormonal background and vascular properties change. Blondes and redheads with thin sensitive skin prone to redness are at risk for rosacea. Allergic and contact dermatitis can provoke rosacea, since the vessels are often dilated and in the future their return to the previous state is no longer possible.
Genetically, the inhabitants of the northern peoples are more predisposed, living in a sharply continental climate and in northern countries also increases the risk.
Diseases and disorders of the endocrine system, diseases of the gastrointestinal tract and disorders of the immune system, especially combined with each other, lead to rosacea. The pathogenesis is not fully understood, but most dermatologists agree that being in hot or cold rooms, wind, eating excessively burning food, alcohol and spices provoke disease.
Rosacea does not belong to pyoderma, since repeated studies of the contents of pustules and pustules of a specific pathogen could not be identified; the gram-negative microflora found indicates prolonged irrational antibiotic therapy. The risk group also includes patients with vegetative-vascular dystonia, which proceeds according to the type of angioedema with damage to the vascular network of the face.
Symptoms
The debut should be assumed if, after contact with cold or hot water, after drinking hot drinks and alcohol, or with a sharp change in ambient temperature, the face is instantly covered with red spots that do not disappear for a long time.
Redness is localized in the T-zone of the face (forehead, nose, chin and cheeks). The first stages of rosacea, in which the main clinical manifestation is redness of the skin, often go unnoticed, since they do not cause any discomfort and are easily masked by cosmetics.
Rashes on the face with rosacea begin to appear with persistent expansion of capillaries, blood flow causes a local increase in temperature, which makes it possible for saprophytic microflora to actively multiply. The next stage of rosacea is manifested by the presence of bumps and irregularities on the skin, which after a while turn into small pustules.
The skin becomes dense, rough to the touch, seals with rosacea are most intense in the T-zone. At this stage of rosacea, a persistent expansion of the vascular network (telangiectasia) appears and therefore redness and swelling of the skin is already observed without connection with provoking factors.
The lupoid form of rosacea is characterized by the presence of periorbital and perioral eruptions in the form of brownish-red papules and nodules, the elements tend to merge and form an uneven bumpy surface. The skin of the face on unaffected areas, as a rule, is not changed and has a healthy appearance.
Rosacea can take a lightning course during pregnancy, after childbirth, with appropriate therapy, rosacea passes without a trace, but each subsequent pregnancy is associated with a relapse of rosacea.
If rosacea is diagnosed in men, then there is persistent redness and tightness of the skin on the nose. Rosacea in men is very often complicated by rhinophyma. With the progression, the area around the eyes and eyelids are affected. There is discomfort during blinking, a feeling of pain, dryness and sand in the eyes. With rosacea in the later stages, there is abundant lacrimation. In this case, ocular form is diagnosed, but it should be borne in mind that clinical manifestations may be several years ahead of skin lesions. In some cases, ocular form is complicated by rosaceaceratitis, which leads to vision loss. Itching, burning, a feeling of tightening of the skin and “goosebumps” are observed in almost all patients with rosacea.
Diagnostics
Diagnosis of rosacea is not difficult, usually a visual examination by a dermatologist is more than enough to make a diagnosis. But since demodex is activated and relapses of demodecosis are most likely, then often, having discovered demodex, they begin to treat not rosacea, but complications of the disease. Such treatment only aggravates the condition of the patient with rosacea, and the disease progresses further.
If rosacea is complicated by the presence of pustules and vesicles with purulent contents, then bacteriological sowing is carried out to study the microflora of the skin.
Rosacea treatment
The initial stages, which are characterized by redness of the skin, quickly respond to therapy. And rosacea, complicated by rhinophyma and telangiectasia, requires long-term treatment. Since patients seek medical help in the phase when purulent rashes are present, ointments and gels with an antibiotic are prescribed first of all. If local antibiotic therapy does not have the proper effect, then with such forms of rosacea, general medical treatment of rosacea with antibiotics is advisable.
There are no exact schemes and methods of treatment of rosacea, and therefore, in some cases, lotions with metronidazole and an infusion of medicinal herbs have a good therapeutic effect. Laser treatment of rosacea gives a good result. Treatment at home with iodine-containing drugs leads to the development of a conglobate form, which is characterized by abscessing globular nodes and the presence of purulent fistulas. In the event of such complications, surgical excision of tissues with the installation of drainage for the outflow of purulent contents is indicated.
Uncomplicated forms of rosacea respond to therapy relatively quickly, but sometimes treatment is delayed up to several months or more. After the inflammatory manifestations of rosacea are eliminated, it is necessary to eliminate the very cause of the disease – the expanded vascular network. Photocoagulation and local cryotherapy are the only reliable method for eliminating dilated vessels on the face in rosacea. The effect of the procedures becomes noticeable after a few days, after the closure of part of the vessels. Patients note that redness becomes less, the complexion improves, itching disappears and the skin looks clinically healthy. After a full course of procedures, it is recommended to use creams with a high protective filter from ultraviolet light.
Prevention
Since rosacea is a chronic disease, after eliminating the excessive capillary mesh, it will reappear after a while. Therefore, prevention consists in periodic visits to the cosmetologist’s office to eliminate newly appeared hypertrophied vessels. But, if between procedures to avoid overheating and hypothermia of the skin, as rarely as possible to be in the open sun, adjust the diet and use cosmetics that contain horse chestnut extract and other substances that strengthen the vascular wall, then you will need to repeat the procedures no more than once every 2-3 years.