Methods of influencing rosacea

Svetlana Tkachenko – dermatovenerologist, candidate of medical sciences, associate professor of the department of dermatology, venereology and medical cosmetology of the Kharkov National Medical University (Ukraine, Kharkov).

Risk factors

The condition of erythrocouperosis can develop against the background of any skin type, however, light, thin, dry and sensitive skin is more prone to the development of this pathology. Symptomatic telangiectasias can be a manifestation of certain dermatoses: rosacea, seborrhea, lupus erythematosus, acrodermatitis, solar geroderma. Congenital telangiectasia occurs due to increased vascular development (vascular spots, vascular nevi, stellate angiomas). The genetic factor plays an important role in the development of vascular problems: thin capillary walls, thin, dry, sensitive skin. In addition, erythrocouperosis can develop against the background of absolute or relative hyperestrogenemia (pregnancy, COC use, impaired estrogen metabolism of hepatic origin), in patients with diabetes mellitus (glycation). Internal factors contributing to the development of this pathology also include disorders of the cardiovascular system, liver pathology, gluten enteropathy, food intolerance, hypertension of various origins, and vegetative-vascular dystonia. Trigger factors for the development of erythrocouperosis are considered to be meteorological conditions (frost, sun, temperature changes indoors and outdoors), a certain lifestyle (abuse of saunas, steam baths, spicy hot foods, alcohol, smoking, use of very hot and cold water), psycho-emotional and physical stress , avitaminosis (vitamins C, rutin).

Occupational factors that contribute to the occurrence of dilated blood vessels include contact with lime, solvents, and aggressive cleaning agents. Environmental pollution with harmful industrial compounds and their subsequent contact with the skin can also affect the blood supply to the skin tissue. These substances include: sulfur dioxide (dioxide), released into the atmosphere during the combustion of liquid fuel (fuel oil), diesel fuel and coal; a suspension of fine particles formed when gasoline is burned in car engines; nitrogen oxides that enter the air as part of the exhaust gases of automobile engines.

The development of erythrocouperosis can also be caused by the irrational use of topical and systemic corticosteroids, hyperemic and vasodilating medications, irrational use of cosmetics, and abuse of hyperemic cosmetic and medical procedures. There is evidence that systemic use of cinnamon oil to reduce glucose levels in patients with type 2 diabetes mellitus can cause erythrocouperosis and even rosacea-like syndrome, since this oil has a vasodilating effect. However, these observations are isolated, and cinnamon oil is not considered today as a trigger factor for erythrocouperosis.

Thus, the main pathogenetic mechanisms for the development of erythrocouperosis are:

• vasodilation as a result of chronic inflammation and the influence of trigger factors,
• increased load on the vessels due to increased pressure in the vessels (impaired venous outflow, hypertension),
• disruption of the vascular wall as a result of age-related atrophy, oxidative stress, glycation, MMP activation,
• pathological neovascularization,
• atrophy of the epidermis and dermis.

Clinical stages of microcirculation disorders

Microcirculation problems are divided into five stages.

With improper skin care and lack of control over the microcirculation process, patients will not be able to avoid the sad consequences that begin with the development of rosacea, then progress to erythrosis, erythrocouperosis, rosacea and then rosacea acne. Moreover, each of these diseases begins with milder forms of manifestation and develops up to the most aggravated ones.

Cuperosis and telangiectasia

These diseases are characterized by the appearance of small linear areas of dilated capillaries as a result of atrophy of their endothelium and expansion of the diameter, as a result of which they lose their elasticity and are unable to return to normal size and shape after stimulation. On the skin, rosacea most often manifests itself in the form of telangiectasias, which originate from superficial capillaries and can be of different colors: red, blue, dark purple. Red and thin telangiectasias that do not protrude above the surface of the skin develop from capillaries and arterioles. Blue, wider, are formed from venules. All telangiectasias are divided into congenital and acquired. Based on their shape, they are divided into several types. Red linear telangiectasias are most often located on the nose and cheeks and are called rosacea. Blue and red linear and tree-like telangiectasias develop on the lower extremities. Spider-like red telangiectasias consist of a feeding arteriole, from which multiple dilated capillaries diverge radially.

Depending on the prevalence of the process, three stages are distinguished:

Stage I – single telangiectasias on the cheeks and wings of the nose;

Stage II – vascular pattern (blush) occupies 1/3 of the face;

Stage III – diffuse rosacea, occupying almost the entire surface of the facial skin.

Erythrosis and persistent erythema

They are characterized by extensive redness of the skin and hyperemia, which are accompanied by the development of rosacea. Inflammation, red areas on the skin become persistent, and the temperature of the inflamed areas of the skin increases.

Erythrocouperosis

As the name suggests, this condition includes symptoms of both the skin conditions mentioned above - both rosacea and erythrosis. Erythrocouperosis is characterized by a violation of the venous outflow from the capillary facial network, periodic increased intracranial pressure, which manifests itself at the first stage of the disease with paroxysmal erythema and a feeling of heat. As the process worsens, against the background of regular exposure to trigger factors, stages II–III develop. They are characterized by an expanded capillary network (telangiectasia or rosacea) and persistent erythema. The appearance of new venous collaterals (even after coagulation) occurs due to the activation of the vascular endothelial growth factor (VEGF). In the future, the disease is complicated by papulopustular rashes - rosacea or rosacea appear.

Rosacea

Against the background of the development of erythrocouperosis, signs of rosacea are found - a skin condition that is characterized by a severe form of hyperemia (stagnation, blockage of small vessels and capillaries) and inflammation of the skin, leading to the expansion of venules at the level of the venous plexuses, the appearance of a papular rash, the formation of conditions for skin dysbiosis, and demodicosis.

Acne rosacea

When determining this skin condition, it is fair to refer to its extreme condition due to microcirculation problems. This condition combines all the previously mentioned symptoms and also includes the formation of papules, papular infiltration, and pustules. It is also worth mentioning the manifestation of rosacea in the neck area, associated with the expansion of capillaries in the V-cut area, which is accompanied by atrophy of the dermis and epidermis.

Treatment methods

Today, the most radical methods of treating erythrocouperosis in the early stages are, of course, dermatosurgical: electrocoagulation, selective angiophotothermolysis. However, a one-time removal of dilated vessels does not solve the problem pathogenetically and does not stop the pathological process. It is the constant and regular use of special anti-rosacea cosmetics both in home and professional cosmetic care that allows not only to stop the development of new telangiectasia and erythrosis, but also to reduce the severity of existing pathology and prevent the development of severe consequences of skin microcirculation disorders.

Effect on skin

Considering the high reactivity of the skin with erythrocuperosis, it is advisable to choose delicate forms, devoid of alcohol, aggressive surfactants, the formulations of which are based on the principles of cosmetics for sensitive skin.

Preference should be given to emulsions (cleansing milk, cream, serum); you can use mousses and cream gels. For intensive cleansing, enzyme peels are preferred. The use of protective agents (photoprotectors, cryoprotectors, barrier creams) is mandatory. To restore skin tolerance and reduce its reactivity, products are introduced into cosmetics that restructure the epidermal barrier, film-forming rehydrants that block the production of inflammatory cytokines in response to skin moisture loss and reduce its permeability to various irritants. In the first case, these are ceramides, lecithin, essential fatty acids, especially linoleic, gamma-linolenic, cholesterol. The second contains hyaluronic acid, amino acids, proteins, chitin, chitosan and others. In cryoprotectors, it is advisable to use occlusive hydrophobic rehydrants: paraffin, petroleum jelly, lanolin, saturated fats, waxes. Also, the formulation of anti-rosacea agents necessarily includes antioxidants (vitamins A, E, C, carotenoids, lycopene, pycnogenol, selenium, chromium, manganese, zinc, methionine, cysteine, carnosine, superoxide dismutase, ubiquinone, plant extracts of green tea, blueberries, grape seeds, thyme, maritime pine bark, fir, oregano, cloves, chamomile, calendula, soybean, cornflower, etc.). Antioxidants block the destructive effect of free radicals on membrane cellular structures, ceramides of the epidermal barrier, and indirectly reduce the intensity of glycation processes, inflammation, and UV damage in the dermis and epidermis. To reduce skin reactivity, anti-inflammatory ingredients are used: bisabolol, allantoin, omega-3 fatty acids, beta-glucans, dehydroavenanthramide and avenanthramides, thermal waters, extracts of calendula, chamomile, aloe vera, etc.

Effect on blood vessels

The main biologically active substances of anti-rosacea cosmetics are substances that affect blood vessels: venotonics, capillary protectors, vasoconstrictors. This group includes horse chestnut extract, gamma hazel (venotonics), hesperidin methyl chalcone, pycnogenol, green tea extract, grape seed extract, medicinal leech, bioflavonoids rutin and quercetin (capillary protectors). Barley and cypress have a vasoconstrictor effect, and dextran sulfate has an anti-edematous effect.

The effectiveness of anti-rosacea cosmetics is also determined by the elastic stimulants and elastoprotectors included in its composition. They stimulate the formation of new collagen and elastin fibers of the dermis and vascular wall, and also protect them from destruction.

Despite the variety of ingredients in these groups, it is most advisable to introduce retinoids into anti-rosacea cosmetics. The group of retinoids in medicinal cosmetics is represented by retinol, retinaldehyde and retinol esters. They have not only an elastic-stimulating and elastoprotective effect, but also an anti-agiogenesis effect, blocking the production of vascular endothelial growth factor. With long-term regular use of medicinal cosmetics with retinoids, even in the absence of vascular components, you can count on an anti-rosacea effect due to the suppression of abnormal vascularization and thickening of the dermis and epidermis.

Necessary camouflage

A feature of therapeutic anti-rosacea cosmetics is the use of special green and reflective pigments, which make it possible to camouflage the red color of dilated blood vessels. As an aroma component, the formulations of anti-rosacea agents may include essential oils of kanuka, lemon, cypress, rose, rosewood, lavender, chamomile, and birch.

Thus, in the treatment of vascular problems, a comprehensive, regular and, most importantly, professional approach is extremely important.

First published: KOSMETIK international journal, No. 1 (35), 2009, pp. 26-29