Rosacea

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Overview

Rosacea is a very common disease in the population that is mainly characterized by the appearance of erythematous areas (flush) located on the face, with some general clinical signs that include: telangiectasia, inflammatory papulopustular eruptions (like juvenile acne vulgaris). Reddish spots tend to appear especially on the cheeks, nose, forehead and less on the neck, chest, ears and scalp. Left untreated, rosacea tends to develop and worsen over time.
The disease is cyclical: it is acute for a few weeks, then the symptoms disappear (however, without completely disappearing), then the process resumes. It is estimated that over 40 million people suffer from this disease worldwide. Women appear to be affected much more frequently than men (the ratio is 3:1), and the peak incidence is between 30-60 years.

What is the cause?
Specialists have not yet established the exact cause of rosacea. It affects mainly the Caucasian population (light pigmentation of the skin), but not only, and it seems to have a genetic component. Unlike what was thought in the past, rosacea is not due to excessive consumption of alcohol (but alcohol may exacerbate the disease’s symptoms and its intensity). Rosacea can worsen during emotional moments or whenever vasodilation is triggered especially in the face. The most common triggers are thought to be: strenuous exercise, sun exposure, stress, spicy foods, alcohol, hot baths, sudden temperature changes (switch from hot to cold and from cold to hot).
Frequent complaints
Most often, patients with rosacea complain about:
- Flushed face with the occurrence of pustules on the skin of the cheeks, nose, around the lips and on the forehead, which persist for several days
- Visualization on the surface of the skin of very thin blood vessels (giving the aspect of a spider web)
- Tingling and even burning sensation in the face, especially if various cosmetic creams and lotions inadequate to the needs of the skin are applied; the patient may feel his face overly dry, cracked and very sensitive to touch.
- Dry, irritated and reddened eyes; the eyelids may appear swollen (inflamed) and the eyesight may be blurred. If left untreated, rosacea can cause serious eyesight problems. In the absence of treatment, rosacea progresses, causing the appearance of some raised formations, called papules, which remain especially on the nose and cheek and tend to multipy, until the common appearance of the region is changed. In severe cases, rosacea may progress to Rhinophyma (but this situation rarely occurs).
Therapeutic principles
Doctors can prescribe medications to patients in order to keep symptoms under control, along with hygienic-dietary measures that improve the patient’s quality of life. Rosacea itself does not have a treatment which ensures healing (the disease is considered incurable), but it can be successfully controlled.
The most common treatments include:
- Creams or antibiotic tablets in order to control the erythema and pustules that may appear on the face, and also the eye problems. Such treatments are not indicated for pregnant women because antibiotics are not considered safe substances during pregnancy. If the patient started an antibiotic treatment, he should be patient – it may take even two months until the appearance of the results. – If the treatment with antibiotics is unsuccessful, you can try something stronger, such as creams based on vitamin A or its derivatives, such as isotretinoin or tretinoin (Retin-A). Neither these substances are safe so as to be administered during pregnancy (regardless of its stage).
- Surgery is indicated only if the patient has a very advanced rosacea (in this case, cosmetic surgery can successfully correct skin imperfections). Commonly used procedures are dermabrasion, cryosurgery and laser surgery.

Preventing the aggravation of the condition
There are some practical tips that experts give to patients with rosacea in order to prevent the reactivation and exacerbation of the disease:
- The discovery of triggers and their avoidance – the triggers are actually situations, environmental factors, or food, that have the ability to trigger a vasodilator crisis. Patients are advised to determine exactly which these factors are and try to avoid them whenever possible. An useful method is noting in a notebook the food and the beverage that were consumed and the activities conducted on the days when the crises occurred. This notebook may be shown to the doctor on the next visit so that he can establish what should be avoided in the future.
- Daily use of a moisturizer with sun protection factor. We recommend a sunscreen with a minimum of 15 SPF, which can block both ultraviolet A and B and the infrared ones. On winter days, patients should use moisturizers to prevent drying and cracking (these inconveniences may occur due to the action of the cold wind and low temperatures)
- Avoid abrasive or exfoliating products. The dermatocosmetic products which are especially designed for sensitive skin are recommended.
- Careful eye care- it is recommended to use special lotions and artificial tears if the patient feels the need for them.


Causes

The exact cause of rosacea remains unknown. It is thought to have a genetic component, but the vascular, environmental, degenerative or chemical factors are equally important. It seems that the microbes that inhabit the skin are also involved, as well as some abnormalities of the pilosebaceous unit (it consists of hair follicles and the sebaceous glands attached to it). There are currently several theories aiming at explaining the appearance of the disease. The vascular theory is based on the existence of an increased sensitivity of the vessels located in the skin of the face, which have an exaggerated response to the dilator stimuli. Because the skin temperature changes, this leads to the increase of bacterial growth, which will cause the appearance of pustules or pimples (hence the similar clinical appearance between rosacea and acne vulgaris). A role in the appearance of specific skin lesions may also have some microorganisms, Demodex folliculorum, which are normally found on the skin. However, it seems that the number of patients with rosacea is very high, compared with people who do not have this disease. Rosacea worsens when the patient is exposed to triggers (which cause the excessive dilation of vessels). They are generally represented by the sun, intense physical activity, hot water, emotional stress, spicy foods, alcohol, caffeine-based products, especially coffee and tea, vasodilator drugs (including antihypertensive drugs) and corticosteroids. Some studies correlate with the existence of rosacea with the presence of Helicobacter Pylori, which is the etiologic agent of stomach ulcer, but the results and their relationship are still unclear. Also, researchers noticed that patients with rosacea have significantly increased levels of a peptide called cathelicidin.
Other theories include the hypothesis that rosacea is actually a neurological disease that occurs after the hypersensitivity of the sensory neurons by bradykinin (which is activated by the kinin-kallikrein system, as a consequence of the exposure to bacteria of enteric origin). An inflammation of a neurogenic cause is then produced due to any dermatological stimulation which will cause the vasodilation characteristic of the disease. Certain drugs or certain local chemical irritants are able to accelerate the evolution of the disease. Steroids induce the appearance of rosacea, even those with topical or nasal use.


Symptoms


There are four major types of rosacea, each with its symptoms. Some patients may experience several types and have, therefore, a much wider range of simptome. These 4 types have been established taking into account the clinical signs and the symptoms of the patient and are presented below.
The erythematotelangiectatic type – is characterized by central facial flushing, often accompanied by a burning sensation of the skin. The erythema spares most of the times the bilaterally periocular regions. The patients with this type of rosacea have a very thin complexion with tendency to dehydration. The chronically affected areas can become rough to the touch over time (due to dermatitis). The triggering factors are represented by emotional stress, hot drinks, alcohol, spicy foods. Another feature of this type is represented by the worsening of the burning sensation when various creams, ointments or local ointments are applied.
Papulopustular Rosacea – represents the classic form of the disease. The patients are often middle-aged women. The lesions have a central location and are in the form of erythematous plaques, reddish papules on which pustules appear. Telangiectasias are also present, but they are noticed with more difficulty due to the intense erythema that characterizes this disease. Because of its aspect, this form is often confused with acne.
Phymatous rosacea – is characterized by the accentuated and diffuse thickening of the skin of the face, with the appearance of irregularities or nodes on the surface of the nose (Rhinophyma), chin (gnathophyma), forehead (metophyma), ears (otophyma), and / or eyelids (blepharophyma). Phymatous rosacea has in its turn four histologic subtypes: glandular, fibrous, fibroadenomatous and actinic.
Ocular Rosacea – is the type of rosacea in which the ocular manifestations precede those of the skin with a few years (but there are many situations when the ophthalmic manifestations appear simultaneously with those of the skin). The ocular manifestations include blepharitis, conjunctivitis, swollen eyelids and glands, interpalpebral conjunctival hyperemia and conjunctival telangiectasia. The patients can also complain about the sensation of a foreign body in the eyes or about a burning and dryness sensation. Photophobia may also be present.
Other forms of rosacea have also been described, but they have not yet been accepted as individual subtypes. They are:
- Granulomatous rosacea;
- Rosacea fulminans (pyoderma faciale), a rare and severe form that affects only young women around the age of 20 years;
- Perioral (or periorificial) dermatitis;
- Rosacea conglobata;
Patients with rosacea often go through intense periods of depression, as a result of facial damage and pain. All symptoms significantly reduce the quality of their lives.
Keep in mind!
Whatever the particular type of rosacea a patient might have, there is a range of symptoms that are found in all of them. The main symptoms include:
- Facial flush (erythema) – it can look like a butterfly erythema (although this semiological description is more characteristic of the systemic lupus erythematosus) because it affects the nasal pyramid and the cheekbones (the zygomatic arches). In women, it typically occurs on the cheeks, nose, chin and forehead and in the case of men on the nose. In rare cases, it occurs also on the neck and chest.
- Pustules – occur mainly on the erythematous areas or on their margins. The reddish colour differentiates them from the acne pimples.
- Telangiectasias – are superficially visible vessels at the level of the skin, especially on the cheeks. They appear linear and sinuous, like cobwebs.
- Localized thickening of the skin or skin nodules (as it occurs in patients with rhinophyma, most men, who have such a prominent nose)
- Eye irritation: redness, sensation of sand in the eye, conjunctivitis, eyelid edema.
Patients do not tolerate contact lenses and the eyesight becomes blurry (only in really severe cases, the eyesight of the patient is seriously and irreversibly damaged). Approximately 50% of patients with rosacea suffer, in a more or less degree, from visual disorders. Some of the symptoms that occur in rosacea are found in other diseases as well, such as systemic lupus erythematosus (acute phases), perioral dermatitis, sarcoidosis, seborrheic dermatitis, carcinoid syndrome and mitral insufficiency, acne, pustular folliculitis.


Pathophysiological mechanism

Rosacea occurs in stages. The first sign may be the patient’s tendency to redden easily because of apparently insignificant stimuli. Typically, flushed cheeks and erythematous areas that remain, occur. The complexion becomes more sensitive and has an exaggerated reactivity to cosmetics, lotions and creams. There are some patients who initially experience irritation of the eyes, before any other signs or symptoms. The skin changes are the clinical expression of the pathophysiological processes that occur in the deep structures.
There are several confounding processes and mechanisms that have as a final result the appearance of rosacea.
The vasogenic mechanism: the increased blood flow through the vessels that are located in the superficial layers of the skin is the main factor incriminated in causing facial flush. Vasodilation (which is actually the normal vascular response to hyperthermia) is significantly more intense in patients with rosacea.
Climatic exposures – there is evidence supporting the theory that exposing the body to harsh environmental conditions affects the blood vessels of the skin and the dermal connective tissue. Such situations include exposure to ultraviolet radiation, extreme cold or excessive heat. On the contrary, other studies show that the symptoms of most patients are not aggravated by sun exposure, nor worsen if the person suddenly comes into contact with UV.
Dermal matrix degeneration – rosacea involves both vascular endothelial damage and the degeneration of the connective matrix. However, it has not yet been established if the initial damage is at the level of the matrix (thus causing a poor connective support of the vessels that alter the permeability with extravasation of serum, the mediators of inflammation and toxic metabolites) or at a vascular level (with the extravasation of the mentioned compounds, their presence leading to further degenerative changes of the matrix).
Irritant mechanisms – flush episodes may occur as a consequence of the ingestion of certain foods that are able to trigger this reaction, spicy foods, alcohol, hot drinks. Although these factors have a role in triggering the crisis, they are not involved in the pathophysiological mechanism after which rosacea appears. There are even drugs that cause the exacerbation of symptoms, such as amiodarone, steroids with local and nasal administration and high doses of vitamin B6 and B12.
Perifollicular inflammation vs. perivascular inflammation – they can be infiltrated in the perivascular and / or perifollicular space. It has not yet been determined exactly which is the favourite location of this inflammation.
Microbes – Demodex folliculorum (a microorganism that populates the hairs) can play an important role in the pathogenesis of rosacea. It has been demonstrated the fact that Demodex prefers the skin regions that are affected in rosacea (nose, cheeks). Also, it is known that the body defends itself against Demodex antigens by triggering an inflammatory response based on T helper cells. Because Demodex is found also on the skin of healthy patients, specialists still make tests and studies in order to be able to correlate the presence of the microorganisms with the disease.
If the stimulus that initiates the disease remains elusive, the evolution of the process was pretty much analyzed. As rosacea develops, facial erythema appears and disappears from the prone areas: cheeks, forehead, chin. Whenever the blood flow in the integumental vessels intensifies or factors that cause their dilation appear, the skin will redden. The chronic dilation is the cause of the occurrence of telangiectasias.
Little pustules can begin to appear at the level of the erythematous plaques or on their edges (pustules which resemble the acne pimples). If the disease is not treated, the erythema can become permanent. Besides the skin changes, ocular changes also occur (sometimes even before those of the skin). The main cause is conjunctivitis. If left untreated, the patient may suffer over time from significant impairment of the visual acuity, but the total loss of eyesight can never be reached. The treatment which is correctly performed can control the appearance of symptoms and prevent the progression and worsening of the disease. If left untreated, rosacea can cause the appearance of Rhinophyma – a condition caused by the chronic inflammation of the nose which causes skin changes – thick, red and large nodules. Rhinophyma is the expression of the inflammation of the sebaceous glands from the skin. It is more common in men. Because it is a very advanced stage in the evolution of rosacea, Rhinophyma occurs only rarely (most cases are treated correctly and on time).


Risk Factors

There are no known risk factors for the appearance of the disease, but it is believed that rosacea has a genetic component. Patients with a higher risk are those with fair skin, aged between 30 and 60 years, especially women in menopause, with a history of flush or hot flushes. The triggers of the crisis are many and include sun exposure, stress, hot water, alcohol, caffeine, spicy foods, hot showers, cold weather, exercise. The triggers have the capacity to produce a sudden rise in the circulatory flow especially in the facial vessels, which causes their dilation (the process having as a clinical expression the flushing of the patient). The triggers have an individual variability (they are not the same in all patients and do not produce the same effects or with the same intensity).


Consulting a specialist

Patients are advised to consult a medical specialist if they have signs and symptoms suggestive of rosacea, such as:
- Red spots on the face that have a cyclical character (come and go regularly);
- Erythema, papules or very thin purple lines (telangiectasias) stationed in certain regions of the face;
- Eye irritation, frequent eye redness;
- The appearance of some changes in the nose (thickened, red teguments);
If the patient notices the presence of some symptoms similar to those presented above, they are advised to consult a doctor. If the disease is diagnosed correctly and in time, the prognosis of the patient is favourable and a treatment to keep symptoms under control and prevent them from worsening (or their growth rate) can be applied.
The patients can address to many specialists in order to be diagnosed, consulted and benefit from a treatment. They can be the family doctor, the dermatologist, the internist physician, the ophthalmologist (if there is also eye damage). If the patient needs surgery or mini-surgery, the dermatologist or the plastic surgeon can take care of him.
Preparation of the visit to the doctor
At the beginning, there is the possibility that patients be in the care of a family doctor (but if the condition is very serious and extensive, the patient can be immediately sent to a dermatologist). Despite the attention with which doctors treat each case, the time for each patient can sometimes be quite limited. Therefore, they are advised to prepare in advance a list of possible questions to ask their doctor in order to learn more about their disease.
These questions may refer to the signs and symptoms, the necessary tests in order to confirm the diagnosis, the main treatment modalities and their effectiveness and what are the most important measures that the patient can take in order to improve this condition (especially which dermatocosmetic products are recommended, which should be avoided and which should be the routine of taking care of the skin).
In turn, the doctor will address to the patient a number of questions so that they can make at the end of the anamnesis a diagnosis of suspicion. Some questions may be related to the onset of symptoms, the frequency of their occurrence, their character (if they were permanent or disappeared for a while), the conditions that determine the improvement or worsening of symptoms. Preparing the responses to this kind of questions, can save precious time of which the patient can take advantage and use it to his best, in this way getting the most out of the visit.


Prognostic

The prognosis is favourable in the case of patients who are receiving a correct treatment – they reach a stable state of the disease, and the symptoms have low intensity. The disease can become chronic and can progress in the case of some patients.

Laboratory investigation

The investigation of patients with rosacea is complex and must be done as thoroughly as possible, without deviating from the classical scheme which includes anamnesis, physical examination, laboratory investigations. The anamnesis is centered on the onset of symptoms, their association with possible triggers, their character (progressive, permanent or not, discontinuous), but also on the personal antecedents and the family history (these are important because rosacea has a genetic component in its appearance).
The general physical examination provides information with respect to the general state of health of the patient and the obtained information is useful for the differential diagnosis and the physical examination provides data about the specific disease of that person. Because rosacea has a wide range of signs and symptoms, the examination must be made in detail, looking for:
- Erythematous areas, telangiectasia (they usually occur on the cheeks and forehead)
- Inflammatory papules and pustules (especially on the nose, forehead, cheeks)
- Ocular or periorbital lymphedema (it is quite rare, but it is significant when it appears)
- Conjunctival irritation, episcleritis (in the eye touch forms)
- Signs of seborrheic dermatitis and blepharitis (they are commonly associated with rosacea, but the reasons are not yet known with certainty)
- In more rare cases, patients may experience dermal abscesses, nodules (in facial pyoderma, for example), intense reddish papules and inflammatory erythema with symmetrical distribution on the upper area of the face, especially around the eyes and nose (in the case of granulomatous rosacea ).
Because at present there is no specific test for rosacea, the doctor heavily relies on the data obtained from anamnesis and the physical examination. The investigations are important in order to determine whether the disease has a systemic rebound or not. These are common laboratory investigations: complete blood count, glycemia, urinalysis. However, in order to rule out other diseases, such as sarcoidosis or systemic lupus erythematosus , a skin biopsy is practised. The results obtained from the histological analysis heavily depends on the stage of the disease, so that: the nonpustular lesions show the existence of some perifollicular and perivascular lymphoplasmacytic infiltrates, as well as numerous multinucleated, neutrophils, eosinophils cells. The papulopustular lesions are characterized by much more pronounced granulomatous infiltrates and sometimes also perifollicular abscesses (near the follicles numerous Demodex folliculorum can be highlighted).
Keep in mind!
Rosacea is a disease whose diagnosis is clinical, this is the reason why patients are advised not to omit any detail of their medical history that could be important for the case.


Medication

Antibiotics can be used in creams or tablets because they are able to improve symptoms, reduce redness and the intensity of ocular manifestations, they are useful in treating papules and preventing their infection. Moderate cases respond positively to the treatment with creams containing antibiotics, but the improvement is faster when antibiotics are administered orally. The long term treatment has numerous side effects, mainly dyspeptic syndromes and genital infections (especially vaginal infections in women). Therefore, it is recommend to start a treatment with antibiotics in the form of oral preparations, then the doses are reduced gradually and the cream inserted. Rhinophyma has no indication of antibiotic treatment. The aims of the pharmacological treatment are to reduce morbidity and prevent complications.
Besides antibiotics, a wide range of drugs is used:
Antiacne drugs – can be useful in patients with papules, pustules or glandular and phymatous rosacea. Among these drugs, those which are commonly used to treat rosacea are azelaic acid, benzoyl peroxide and sodium sulfacetamide. Azelaic acid is available in two forms: gel 15% and 20% cream. It is effective for medium papulopustular rosacea. At the beginning, it may be applied 2 times per day, then according to the doctor’s advice. Some patients have complained about transient irritations, especially at the beginning of the treatment.
Sodium sulfacetamide is a product that contains 5% sulfur and 10% sodium and it is used locally in acne rosacea because it has antibacterial properties. It is applied only to affected areas, but not if they are irritated.
Benzoyl peroxide can be released both on prescription and over-the-counter. There are several types of preparations (gels, creams, lotions) in different concentrations: 2.5%, 5% and 10%.
Immunosuppressants – are able to inhibit the reactions of the immune systems which occur in various exogenous stimuli. Tacrolim is generally used, but its mechanism of action is not yet completely understood. It has the ability to reduce itching and the local inflammation by suppressing and inhibiting the cytokines from the T lymphocytes.
It is recommended to apply very little of it and delicately massage, until the ointment is absorbed into the skin. The treatment should be continued for another week after signs and symptoms have disappeared.
Retinoids – are substances that reduce the aggregation of the abnormal keratinocytes and can greatly decrease the risk of malignant degeneration. It influence the differentiation of keratinocyte.
The main substances are:
Tretinoin: it is structurally related to vitamin A. It is a substance suitable for certain categories of patients as a long-term treatment, but it can cause local irritation. Some studies associate its use with the promotion of angiogenesis, but it has not yet been demonstrated whether it influences the occurrence of telangiectasias or not.
Patients must avoid applying tretinoin creams if they have eczema, irritations, local itching, or if they stay very long in the sun. The contact with the mucous membranes, mouth and nose must be avoided.
Isotretinoin: it is a pharmacological agent indicated in severe cases. It is contraindicated during pregnancy because it can cause miscarriage or severe congenital malformations in the fetus. Isotretinoin may decrease visual acuity, cause the appearance of the irritable bowel syndrome, hepatitis, large variations in blood sugar. The treatment should be interrupted if rectorrhagia, abdominal pain or diarrhea occur.
Antibiotics – alone or in combination with other classes of drugs, the antibiotics are among the most effective drugs in treating rosacea, the most frequently used being:
Azithromycin: inhibits bacterial growth, 500 mg are administered in the first day, then 250 mg / day for 4 days. It is not indicated for patients with hypersensitivity to this product or to those with liver damage. Side effects occur if the product is injected intravenously. There is the risk of increase of bacterial or fungal proliferation after a prolonged treatment.
Metronidazole – taken orally, it has shown its effectiveness in treating papules and pustules. 200 mg are administered 2 times a day. If it is locally applied, a proper cleaning and washing of the area is recommended, then apply a very thin layer of ointment over the red rea. During the treatment, patients should be monitored in order to avoid seizures or peripheral neuropathy.
Erythromycin- inhibits bacterial growth. It is effective in a dose of 500 mg 2 times / day, with an oral administration and the application of creams must be done for 2 weeks. If local irritation occurs, it is recommended to stop the treatment.
Clindamycin – it is recommended in the form of solutions and creams for external use. When it is applied to the skin, the product is metabolized and converted to the active compound that causes the inhibition of microorganisms. Solutions, lotions and gels are also available. It is very effective in treating papulopustular rosacea.
Other antibiotics are clarithromycin, tetracycline, minocycline, doxycycline.
Keep in mind!
The treatment of rosacea is an exclusively symptomatic one. If the patient has severe symptoms for a prolonged period of time, the treatment should be continued until their complete remission.


Treatment at home

There is a series of measures that patients can take in order to improve their condition, prevent exacerbation and improve their quality of life in general. In addition to the medical treatment especially prescribed by the doctor, patients can improve their health if they are actively involved in what a complete treatment presupposes.
Experts recommend that patients should always have in mind:
- The use of skin care products – only soaps, lotions and dermatocosmetic products especially made for sensitive, problematic skin, are recommended. They must not contain alcohol, must not be abrasive and must not close the pores (it must be specified on the packaging that they are noncomedogenic). Patients must avoid rubbing the skin or wiping it brutally, with energetic movements. If the skin is not very sensitive and intolerant, the application of various coloured makeup bases and foundation cream can be tried in order to conceal the increased redness in some areas. Your doctor may recommend to the patients special products for rosacea.
- Permenantly use a sunscreen cream. Experts insist on the importance of such creams. It must be used daily and it is recommended to use one which protects the patient against UVA and UVB rays and has a minimum 15 SPF. Although finding a cream that is perfect for the needs of the skin is a long process, because many of them can cause adverse reactions, it is important for the patient to buy in the end such a cream. Other benefits of sunscreen creams are the fact that they contain protector silicone such as dimethicone, cyclometicon and some which are coloured (green or yellow) are able to cover the redness. Some patients also tolerate the physical blockers of ultraviolet radiation such as titanium dioxide or zinc oxide.
- The use of eye care products – the application of artificial tears is recommended if patients feel their eyes dry or the application of wet and warm compresses to the eyelids and the delicate wash of the eyelids with a special product (they are available in pharmacies).
- The identification of triggers – the patients can make a list of the emotional, food or environment factors that causes the appearance of episodes of rosacea. Experts have drawn even a kind of form for patients to be much easier to keep track of these factors. The patients must tick or note on the form the following: the weather conditions to which they were exposed, the drinks and foods that they consumed (spices, alcohol, hot drinks, fruits, milk, vegetables), the medicines they took, the activities they performed and the emotions they went through (physical work, stressful situations, hot baths, sauna, work at high temperatures), substances that came in contact with them (cosmetics, soap, perfume, aftershave, shampoo, dermatocosmetics, home care products), how the symptoms were and if the treatment was taken or not. Such a questionnaire should be completed at the end of each day in order to identify all the triggers of the crises.
- Avoid the triggers – after their identification, advise patients to try as much as possible to avoid them:
- To limit sun exposure, wear wide-brimmed hats in the summer and apply sunscreens with sun protection factor before going outside, in all seasons
- Reduce the daily stresses, have a balanced diet and moderately do sports
- Maintain a proper temperature in humid and warm places (using a fan, an electric fan, or ventilating the room or turning the air conditioning on)
- Avoid spicy foods, alcohol and hot drinks
- Do exercises only of moderate intensity and only for a short time (in the summer, do them only in cool mornings)
- Use a moisturizer during the winter in order to prevent skin dehydration. Patients are advised to wear a scarf or a muffler to cover their face and nose and avoid coming in contact with the cold wind
- Avoid hot water and sauna.
- Exclusive use of special products for sensitive skin and the avoidance of abrasive or irritant products. The products which are labeled as noncomedogenic are recommended ( they are able not to close the pores and not to block the drainage of the sweat and sebaceous glands). The affected areas must be washed only with lotions indicated and recommended by the doctor. There are several natural treatments that can be used, but they have not proved effective. Patients are advised not to resort to these alternative methods without first consulting the doctor.


Surgery

The patients who have surgical indication are generally those whose disease is very advanced and to whom Rhinophyma, telangiectasias and persistent erythema occurred. The response to surgical treatment varies depending on the patient: those with lighter skin, using care products with sun protection factor and who after the procedure limit their time spent in the sun, have more advantages after surgery than those with darker skin who stay longer in the sun.
The most frequently used types of interventions are:
Remodeling laser – the non-ablative laser is effective in rosacea because it reshapes the abnormal structure of the conjunctive dermis tissue and improves the quality of the skin. The main disadvantage of the procedure is the high cost. 1-3 sessions are necessary to be performed every 4-8 weeks, in order to get the best results. The laser is also used to remove telangiectasias: in this case the laser selectively absorbs the oxyhemoglobin, which causes the reduction of the vascular caliber with a minimal damage and scarring of the surrounding tissue. Pulsed light therapy is actually a multicromatic laser that has various targets, including the melanin and the hemoglobin. Therefore, it is used also for skin rejuvenation, vascular and pigmented lesions.
Dermabrasion – the procedure is able to improve the quality and texture of the skin and it is effective even in Rhinophyma.
Cosmetic surgery – permanent telangiectasias can be treated electrosurgically. Because the procedure does not improve also the facial redness, telangiectasias tend to recur over time. The maximum efficiency is nose reshaping in the severe cases of Rhinophyma.
Keep in mind!
Patients in a prolonged treatment with isotretinoin or those who have used it in the last 6-12 months, are not good candidates for surgery because they have an associated increased risk of ugly scars after the intervention. Other types of treatment should be discussed and analyzed only with the doctor, because he knows the complexity of each case.
The education and understanding of a patient with rosacea
Rosacea can be a very unpleasant disease which seriously affects the patient’s quality of life. Patients can often feel embarrassed by their symptoms and become withdrawn. In order to better handle the disease, experts recommend to patients the following things:
- To learn more about their illness and even participate in meetings and discussions with other persons affected by the disease
- To follow the doctor’s recommendations and modify their behavior according to the doctor’s advice
- To maintain relationships as good as possible with family and friends because they can provide a real support to the patient, when it is necessary.


Prevention

Because it is not know yet the exact cause of the appearance of rosacea, the disease can not be prevented. But there are certain measures that patients can take in order to diminish the risk of occurrence of the disease or the intensity of symptoms. They can try to avoid contact with various triggering agents (spicy foods, alcohol, hot baths, stress) and use special products for sensitive skin care. The reduction of symtoms is made only if the treatment is continued as it was recommended by the doctor and if the patient is careful with what cosmetic products he uses ( alcohol based products must be avoided because they irritate the skin).
 
Rosacea Pictures

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