Rosacea: etiology, types and therapy

Lyubov Khorunzhaya , dermatologist, cosmetologist, trichologist

Rosacea is a chronic, recurrent, inflammatory skin disease caused by angioedema disorders, has a polyetiological nature and a staged course. This characteristic most clearly describes this pathology. As soon as you diagnose a patient, you need to teach him to live with it, because it is lifestyle, skin care, and working conditions that influence the course of the disease.

Rosacea is one of the most common skin diseases - from 5 to 50% of the population is affected by this disease. The difference in rates can be explained by the fact that people with fair skin and blond and red hair are more likely to develop rosacea.

Rosacea usually debuts at the age of 35-40 years, but in recent years there has been a tendency towards “rejuvenation” of this disease. According to statistics, it is detected less often in men than in women. Most often, patients have a positive family history.

Etiology of rosacea

• lifestyle (alcohol, hot drinks, spices, baths, saunas, high physical activity, low temperatures, strong wind, solar radiation, stress, smoking);
• immune disorders;
• thyroid dysfunction;
• pathology of the gastrointestinal tract.

Trigger factors that patients should be told about:

• nutritional (food, alcohol);
• exogenous (baths, saunas, weather conditions);
• influence of medications: vasodilators, glucocorticoids, antibiotics (rifampicin, vancomycin), prostaglandin E, interferons, halogens, methylxanthines, nitroglycerin.

Types of rosacea

There are four stages of the disease:

1. Erythematous, which is characterized by periodic redness of the face.
2. Papular, when papules appear on the skin of the face against a background of redness and spider veins.
3. Pustular, characterized by suppuration of papules.
4. Phymatous, or hypertrophic form, which is characterized by significant thickening of the tissue and uneven tuberosity of the skin surface.
5. Ophthalmic rosacea.

Today, the classification of rosacea into subtypes is widely used:

• erythematotelangiectatic;
• papulopustular;
• phymatous, or hypertrophic;
• ophthalmic rosacea.

Rosacea criteria:

• unstable erythema;
• persistent erythema, telangiectasia;
• papules, pustules.

Additional criteria:

• burning, tingling, swelling, dryness of facial skin;
• "eye symptoms";
• phymatous changes.

Differential diagnosis is an important point when making a diagnosis:

• seborrheic dermatitis;
• dermatomyositis;
• acne vulgaris;
• perioral dermatitis;
• carcinoid syndrome;
• Randu-Osler syndrome (hereditary hemorrhagic telangiectasia);
• lupus pernio;
• angiosarcoma;
• rubromycosis of the facial skin;
• erysipelas;
• acne vulgaris conglobata.

It is important for a dermatovenerologist to collaborate with related specialists, such as a therapist, gynecologist, endocrinologist, and surgeon.

Treatment for rosacea depends on the stage of the disease. It is important to teach the patient to live with this disease and avoid trigger factors. The patient should avoid mechanical aggressive cleansing, peeling, visiting baths, saunas, and solariums. When caring for your skin, you should give preference to creams for sensitive skin with sunscreens not only with chemical protection factors, but also with physical factors; they will prevent the skin from heating and vasodilation. Proper care is the key to successful treatment of rosacea and long-term remission.

Drug therapy includes:

• ivermectin, 1% cream. Apply to facial skin for at least 4 months;
• metronidazole, gel 0.75%, 3-4 months/2 times a day;
• azelaic acid, gel 15%, 2 times a day. Improvements will be noticeable by the fourth month of use.

Antibacterial drugs: coindamycin phosphate gel 1% (6 months).

Topical calcineurin inhibitors:

• tacrolimus, ointment 0.03% 2 times a day;
• pimecrolimus, cream 1%, 2 times a day;
• benzoyl peroxide, 2.5-10% gel, 2 times a day. The effect is noticeable after four weeks of use.

Maintenance therapy:

• ivermectin, cream 1%, 1 time per day at night;
• metronidazole, gel 0.75%, 2 times a week;
• photoprotection on an ongoing basis, 30 minutes before going outside.

Non-drug therapy:

• electrocoagulation (for single telangiectasias);
• laser treatment (destroys telangiectasias, has an anti-inflammatory effect);
• microcurrent therapy (improves drainage function, every 2 days, 6 procedures for 5-15 minutes);
• cryotherapy (anti-inflammatory, vasoconstrictor, antidemodex effect (3 times a week, course of 10 procedures).

Photodynamic therapy

Injection techniques:

• plasma therapy – 10 procedures, 1 time every 7-14 days;
• polynucleotides – 4 procedures, once every 3-4 weeks;
• redermalization – 6 procedures, once every 14 days;
• botulinum therapy "oflabile" - dilution 1:3 from the standard.

Important to remember! The treatment plan depends on the stage of the disease. Equally important is proper home care, lifestyle correction, and regular use of tacrolimus or pimecrolimus during remission.