The fight against rosacea: the capabilities of a cosmetologist

2016-08-04

Couperosis, which until recently could not be treated with most classical methods, today can be neutralized once and for all thanks to laser medical technologies. Let's take a closer look.

Catherine de Goursac, MD, Secretary of the French Anti-Aging Association (AFAA), Member of the Association of French Aesthetic Medicine (AFME) (Paris, France)

Doctors encounter such a problem as rosacea quite often in their work. With the help of special medications, you can significantly improve the condition of skin affected by rosacea, strengthen the walls of blood vessels, improve microcirculation, and prevent the formation of telangiectasia. However, most of the recommended drugs that help increase vascular tone have only a temporary effect - they reduce skin manifestations, but do not eliminate them completely. An alternative may be physical methods, such as electrocoagulation, sclerotherapy and laser therapy.

Unsightly but harmless

On the face, dilated vessels are most often visualized on the cheeks, wings of the nose, and occasionally on the chin and forehead. Unaesthetic but harmless rosacea primarily affects clients with light, thin and sensitive skin, as well as those who spend a lot of time outdoors.

As for the cause of this disease, much depends on heredity. At the same time, research results indicate that climatic conditions, living in certain geographical areas, lifestyle and stress also play an important role. Thus, heat, sun and strong wind, as well as sudden changes in temperature, are factors that provoke or aggravate the manifestations of rosacea. Lifestyle, of course, also plays a role. Excessive consumption of alcohol and spicy foods puts constant stress on the capillaries - you need to warn your patients about this. Ultimately, stress also affects the development of rosacea, causing hot flashes that are accompanied by redness of the face.

It should not be assumed that rosacea appears only on mature skin - spider veins can be seen on the face of a child or a 30-year-old woman. Therefore, be attentive and careful with patients predisposed to this pathology: advise them proper home care, and during the procedures use cosmetics for hypersensitive skin.

Cuperosis under a microscope

Remember that rosacea does not appear suddenly, in the form of a network of small dilated vessels. It forms latently and is one of the stages of the disease, which in its development goes through several stages: erythrosis, rosacea and rosacea. You should be very attentive to the slightest signs of skin lesions and, if necessary, begin dermatological treatment immediately.

Skin redness

If the patient’s skin responds to harmful external influences with a burning sensation, tingling, itching, and sometimes redness or even inflammation, then you are dealing with the first stage - erythrosis, which indicates a predisposition to rosacea. This skin condition manifests itself as uniform redness without clear outlines, usually on the cheeks, nose, forehead, and chin. At the initial stage of the disease, the burning sensation and redness may be temporary.

Erythrosis can be observed at any age, especially in young girls, and does not always develop into rosacea. But in the case of frequent relapses, ordinary diffuse redness can transform into permanent redness over time. So this symptom is the first alarming sign, and you should ask the patient in more detail about in what cases redness appears, and based on the information received, give appropriate advice.

Telangiectasia

Over time, the vessels expand and lose elasticity: the redness becomes permanent and becomes more intense. This is the stage of rosacea at which dilated small vessels of the skin, so-called telangiectasia, are visible to the naked eye. In this case, it is appropriate to use the possibilities of dermatological treatment: oral or local tetracycline antibiotics, synthetic retinoids (isotrentinoin, roaccutane). However, due to the huge number of side effects, they should be used with extreme caution.

Rosacea

As a rule, rosacea occurs in women during the perimenopausal period, against the background of persistent rosacea, but this disease also occurs in men. Persistent redness affects the center of the face (forehead, nose, chin and cheeks), and may spread to the chest and back. First, small pink papules form, which eventually turn into pustules (blackheads). Feelings of itching, burning, and tightness of the skin are possible. At a late stage of the disease, infiltration and an increase in the size of individual areas of the skin, mainly on the nose (rhinophyma), can be observed. This condition occurs predominantly in men and develops slowly. In this case, systemic dermatological treatment is necessary, and in cosmetic procedures it is recommended to use hypoallergenic, non-comedogenic and fragrance-free products.

We fight rosacea

Modern medicine uses combined methods to combat rosacea, choosing certain remedies according to indications and depending on the form and stage of the disease. However, not all classical methods give good results, often leaving behind disappointment and traces in the form of pinpoint scars and age spots.

Fortunately, over the past decade, techniques for combating dilated blood vessels have been significantly improved, using new high-tech materials based on the latest scientific developments. Among them, three methods stand out - in our opinion, the most effective.

Vascular lasers

Over the past ten years, laser techniques for eliminating vascular formations have become widespread and have proven themselves in practice. At the same time, YAG and KTP lasers have proven to be the safest and most effective. A laser beam with a high degree of selectivity, acting on blood vessels, absorbs only oxygenated hemoglobin located in the blood vessels, without affecting the surrounding tissue. In other words, lasers for the treatment of rosacea and vascular diseases are highly selective. Small vessels disappear instantly, larger ones turn pale and become smaller. Large working area, high power, built-in cooling system (cryospray) make the procedure comfortable, effective, painless and fast. The number of sessions depends on the prevalence of rosacea. With an average degree, you need to conduct 24 sessions with an interval of 1 month. This treatment provides a guaranteed result and leaves no traces.

YAG belongs to the group of solid-state lasers; the active medium in it is yttrium aluminum garnet doped with neodymium ions. The wavelength is 1,064 nm. The power of this type of laser can be extremely high - up to several hundred watts; radiation is absorbed by tissues to a small extent, and therefore has a high penetrating ability.

The laser can be coupled with a potassium titanyl phosphate (KTP) crystal, which doubles the frequency to produce a wavelength of 532 nm, located in the green part of the spectrum. This modified YAG laser acquires the properties of a KTP laser.

A frequency doubled YAG laser, or KTP laser, emits light in 150 ns pulses at a frequency of 5 Hz, operating almost continuously. The wavelength approaches the optical region of oxyhemoglobin (490–590 nm) and deoxyhemoglobin (490–700 nm). In terms of its ability to selectively affect blood vessels, it is closer to a continuous dye laser with a wavelength of 585 nm than to an argon laser. KTP laser radiation (532 nm) is selectively absorbed by hemoglobin, and to a small extent by the dense material of cell nuclei (DNA) in the brown part of the spectrum, located at a sufficient distance from the melanin absorption sites. Lack of competition with melanin reduces the risk of skin dyschromia.

Electrocoagulation

Perhaps everyone is familiar with the diathermocoagulation procedure. The operating principle of this method is as follows: a tiny needle-electrode is installed on each vessel, through which a short high-frequency current passes, which promotes the adhesion of its walls and resorption. In this way, manipulation is carried out along each vessel.

What has changed is the device itself and the needles. Previously, the current was very powerful and was often used incorrectly; sessions lasted too long, which led to scarring. The latest generation of devices, which contain an electronic unit for generating and controlling electrical impulses, makes it possible to supply a much lower current, so the procedure has become less painful. To this we must add the use of ultra-thin needles with a diameter of 0.15 mm instead of the millimeter needles used previously, and therefore, the procedure turns out to be much less traumatic for the epidermis and does not leave marks. The duration of sessions has decreased, but requires a longer treatment period. So, for rosacea of moderate severity, it is necessary to carry out 2-3 sessions with a 10-day interval. Attention! It is necessary to avoid sun exposure and tanning beds during the entire treatment period.

Sclerotherapy

This method is undoubtedly the most appropriate when it comes to treating venous insufficiency of the lower extremities. However, it can also be used to treat rosacea. The principle is the same: a very mild agent is injected into the capillary with an ultra-thin needle, which causes sclerosis of the vessel. The administered dose is extremely small, but is sufficient to remove the capillary vessel and its branches.

This method is completely painless (which will calm nervous patients) and provides instant and long-lasting results. It is mainly recommended for dilated or large vessels that are not accessible to laser and electrocoagulation. The only drawback is the possible appearance of swelling (since this procedure is always accompanied by an inflammatory process) - like after an insect bite, which, depending on individual sensitivity, lasts for 2-6 days. But this swelling is easy to hide with makeup.

For mild forms of rosacea, it is necessary to carry out 2 sessions with an interval of 10 days. In more severe cases, as a rule, electrocoagulation and microsclerotherapy are combined during one session.

This technique requires very precise and careful execution, as well as great skill of a specialist.

Rules to follow

For prevention and/or after treatment, regardless of the method used, the following recommendations must be followed:

refrain from exposure to the sun, refuse to visit solariums and apply sunscreen to the skin even in cloudy weather;
avoid anything that activates blood circulation - changes and high ambient temperatures, strong winds, etc.;
do not visit the hammam and sauna - the heat dilates the blood vessels;

If possible, exclude from the diet foods that can cause exacerbation of rosacea;
take care of your skin daily using gentle hypoallergenic cosmetics (preparations must be applied to the skin of the face with your fingertips, without the use of special devices such as cosmetic gloves, massage brushes, etc.);
men are advised to use electric razors rather than razors with blades;
Vaporization procedures, mechanical and chemical peeling are contraindicated due to excessive irritation, any electrical procedures and classic cosmetic massage;
Mechanical cleansing of the skin is contraindicated, since trauma to the skin aggravates the manifestations of rosacea;
if you have rosacea, regular use of vitamin complexes will help strengthen capillaries and prevent new rashes;
To disguise spots and redness of the skin, it is recommended to use decorative cosmetics.

First published: Les Nouvelles Esthetiques Ukraine, No. 2 (78), 2013, pp. 90-92