Rosacea: pathogenesis and auxiliary therapy

Rosacea (acne rosacea, teleangiectasiasis faciei) is a fairly common infectious chronic disease of the facial skin, characterized by the presence of erythema, telangiectasia, papulopustular rashes, damage to the eyes and eyelids, and is also associated with angioneurosis in the area of innervation of the trigeminal nerve. The incidence of rosacea in the world ranges from 1 to 20%. In the United States, it affects about 20 million people. In the UK, the prevalence reaches 1.65 people per 1,000 population. The prevalence of rosacea in Russia is 5–7% of all dermatoses, but over the past 10 years the number has increased significantly. In 80% of cases, rosacea is diagnosed in people over 30 years of age. In this case, approximately 20% of patients also have eye damage. People with fair skin and sun-sensitive skin (phototypes I and II) tend to have the greatest risk of developing rosacea. The disease is significantly more prevalent in women.

Reasons for the development of rosacea

Rosacea is a complex, multifactorial, chronic, treatment-resistant and controversial disease, as scientists and researchers have differing opinions on many issues. Due to the disruption of the skin barrier permeability, various cytokines such as tumor necrosis factor alpha (TNF-a), IL-1 and IL-6 are released in the stratum corneum, leading to skin inflammation. Also, increased activity of epidermal serine protease causes the precipitation of cathelicidal peptides in the skin. As a result of the effect of these peptides on the vascular wall, a small amount of plasma is extravasated in the process of vasodilation, which induces an inflammatory response; Moreover, repeated vasodilation enhances it.

Erythema is a vascular reaction and represents an increase in the number of red blood cells in the inflamed vasculature. Chronic extravasal fluid accumulation in the papillary dermis causes damage to the lymphatic vessels and subsequent inflammatory edema. In addition, neutrophil elastase, released in the inflammatory zone, destroys the extracellular matrix and type IV collagen in the capillary walls, reducing the integrity of blood vessels. A decrease in the amount of connective tissue of the papillary dermis leads to a passive expansion of the vascular network, causing the development of telangiectasia.

Factors that provoke a rush of blood to the face are conventionally divided into two main groups: endogenous and exogenous. Endogenous factors in the development of rosacea include:

• diseases of the gastrointestinal tract due to infection;
• pathology of the immune system;
• the presence of microorganisms, including Demodex folliculorum (detection frequency ranges from 40 to 95%);
• disorders of the pilosebaceous apparatus;
• neuroendocrine disorders in perimenopause (however, a number of women note the presence of symptoms of rosacea during pregnancy, in the premenstrual period, while taking oral contraceptives);
• activation of the kallikrein-kinin system with increased production of bradykinin; imbalance of cellular and humoral immunity with a significant increase in CD3 and CD4 against the background of a decrease in CD8, the presence of antinuclear antibodies, the formation of autoimmune reactions.

Exogenous factors are:

• physical factors (for example, insolation, strong winds, temperature changes, ionizing radiation);
• active physical exercise;
• irritating cosmetic procedures;
• long-term local use of glucocorticosteroid drugs;
• consumption of irritating and hot foods, alcohol.

Rosacea is considered a skin disease, and there is evidence of an association of rosacea with systemic diseases. A study conducted by Motley RJ et al. showed that the majority of patients with rosacea had concomitant allergic, respiratory, gastrointestinal, metabolic, urogenital diseases, as well as hormonal imbalances. In addition, moderate to severe rosacea was associated with the presence of hypertension, hyperlipidemia, metabolic and cardiovascular diseases. In addition to medical comorbidities, rosacea has been associated with an increased risk of developing depression and anxiety disorders.

Daily skin care

Since, on the one hand, the skin of patients with rosacea is prone to redness, irritation, and rashes of various types, and on the other hand, many external influences lead to the progression of capillary dilation, the main goals of skin care are as follows:

• gentle, but at the same time thorough cleansing with the removal of irritating and toxic agents;
• reduction of existing irritation and inflammation, restoration of the epidermal barrier;
• adequate hydration and protection from external influences;
• strengthening the walls of blood vessels, reducing dilated capillaries.

Care products are selected individually, taking into account skin type. Specific ingredients for patients with vascular problems include vitamins C, K, B5, extracts of gingko biloba, green tea, parsley, essential oils of geranium, rosemary, chamomile, cypress.

Temperature compliance

Since the vasculature is sensitive to temperature fluctuations, it is primarily necessary to avoid pronounced fluctuations from extreme cold to heat and vice versa.

This aspect affects several areas of life at once. For example, food and drinks should be at a comfortable temperature. The use of baths and saunas is also contraindicated. In addition, you need to be quite reasonable about cryotherapy. At first, cold exposure sessions can improve the condition of patients with rosacea, but over time, with excessive enthusiasm for this technique, capillary dilation appears even in people who are not inclined to this. It must be taken into account that residents of central Russia, Siberia and the Far East are already constantly exposed to temperature contrasts, strong winds and changes in humidity, therefore additional cryotherapy in these regions should be used strictly according to indications. As a milder effect, for a kind of vascular training, it is recommended to periodically wipe the skin with ice cubes with extracts of medicinal plants that have anti-inflammatory and vascular-strengthening effects, a contrast shower, dousing and wiping with cool water.

On frosty and windy days, before skiing, snowboarding, skating, when the effects of the cold are aggravated by the wind, a protective cream must be applied to the face. Recommendations to use fatty creams are somewhat outdated. It is known that saturated fatty acids inhibit skin restoration, which, if used regularly, leads to skin damage and aggravates the effects of weather factors. Modern protective creams do not create a greasy film on the skin.

Diet

Eating hot and spicy foods leads to dilation of blood vessels, so it is better to eat exotic dishes with a lot of seasonings only on holidays, and the rest of the time to give preference to traditional cuisine without any frills. Excessive consumption of table salt leads to increased blood pressure and, as a result, increased pressure on the walls of blood vessels with subsequent dilation. Patients with rosacea are not recommended to drink coffee, cola, and it is advisable to replace black tea with green tea.

Particular importance should be attached to the choice of alcoholic beverages. Of course, it is better to keep your alcohol consumption to a minimum. Cognac, whiskey, and red wine most contribute to the progression of rosacea. At the same time, many people do not attach much importance to the daily intake of whiskey or cognac in small quantities, but such regular negative effects cannot pass without leaving a mark on the blood vessels, especially if they are predisposed to impaired function.

The list of foods that it is advisable to exclude from the menu of patients with rosacea is quite long. We present only the most frequently found ones in various sources. These include shellfish (attention lovers of French and Japanese cuisine!), crabs and pork.

Smoking

Smoking causes many vascular changes, including the formation of persistent capillary “mesh” and telangiectasia on the skin of the face and torso, impaired microcirculation, thinning and fragility of capillaries. These changes are associated not only with the direct effect of nicotine during absorption, but also with the influence of other smoke components. In addition, when smoking, vascular spasm occurs, as a result of which the nutrition of the skin is disrupted, it becomes dry and sensitive to any other external influences. That is why the treatment of smoking patients with rosacea is fraught with great difficulties, rarely leads to completely satisfactory results, and after the end of treatment a relapse occurs quite quickly. The situation is even sadder for patients who smoke marijuana. In such cases, a decrease in general and local immunity is added to the listed negative factors.

Patients with rosacea are recommended to completely quit smoking, otherwise all preventive and therapeutic measures will be ineffective.

Ultraviolet irradiation

Sunlight affects the skin through both ultraviolet and infrared radiation. Ultraviolet rays cause photodamage to the skin, while infrared rays heat it. Both of these effects contribute to the expansion and damage of capillaries. Therefore, patients with rosacea are recommended to use sunscreen, not only in the summer or when traveling to warm regions, but also on sunny winter days and while skiing in the mountains.

Since people with fair skin who are sensitive to ultraviolet radiation are most prone to rosacea, it is necessary to use sunscreens with a complex filter that also contains mechanical protection factors. After sunbathing, it is recommended to use restorative creams and body lotions containing ascorbic acid, panthenol, ubiquinol, green tea extract, kukui and macadamia oils.

Effective minimum

Thus, the basic principles of preventing rosacea and other vascular problems boil down to the following:

• limiting alcohol intake and completely quitting smoking;
• refusal of hot, spicy, salty foods, coffee, etc.;
• limiting temperature contrast and ultraviolet radiation;
• compliance with the rules of proper skin care.

If we consider the list of basic preventive measures, it becomes obvious that a patient with rosacea must significantly limit himself in a number of usual pleasures. Therefore, it is clear that the motivation to carry out these activities can only appear in a person who has already experienced one or more exacerbations of rosacea. In addition, sensitivity to various provoking factors is very individual. Therefore, the doctor and the patient must select the most significant factors leading to the deterioration of the condition in this particular case and narrow the range of restrictions. Then it will be possible to achieve a certain minimum of requirements and ensure effective prevention of exacerbations.

Literature:

• Elena Snarskaya, Doctor of Medical Sciences, Professor, First Moscow State Medical University named after. I. M. Sechenov Ministry of Health of the Russian Federation (Russia)
• Tatyana Rusina, graduate student of the department of skin and venereal diseases of the Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after I.M. Sechenov” (Russia)
• Les Nouvelles Esthetiques Ukraine No. 3 (115)
• Natalia Polonskaya – Candidate of Medical Sciences, Associate Professor of the Department of Skin and Venereal Diseases of the Federal Institute of Internal Medicine of the Russian State Medical University, Chief Physician of the Optimed Aesthetic Medicine Corporation (Russia, Moscow)
• KOSMETIK international journal, №1 (35)