Rosacea: what it is, causes, symptoms, treatment at home, photos
Acne rosacea is a skin disease with a chronic course and frequent relapses, characterized by changes in the condition of the blood vessels and sebaceous glands. Favourite localization of pathology – cheeks, chin and nose. Likely to get lose the eyelids and eyes (oftalmologia).
Redness at the disease is associated with Hyper-reactivity of the capillaries, which instantly dilate at the slightest increase in temperature. As a result, gradually emerge telangiectasia persistent dilation of small vessels (arterioles, venules or capillaries), which outwardly manifested in the form of spider veins or veins.
Epidemiology of rosacea
- Often, the most predisposed to rosacea people with fair skin.
- Age patients – primarily for more than 30 years, the peak incidence occurs between 40 and 50.
- Women get sick more often. But with the development of pathology in men with a high probability of occurrence of rhinophyma, as they are more predisposed to hyperplasia an extreme degree.
Causes of rosacea
The etiology of the disease is not exactly known. But installed some of the factors contributing to the development of pathology. Endogenous causes:
- Mite Demodex folliculorum. Long time was considered the main cause of the disease. But recent studies have shown that patients recovered during therapy, in a scheme which was not part of acaricidal drugs. However, when disease conditions are favourable for the reproduction and development of mites. So indirectly it can affect the deterioration of the clinical picture of rosacea, in particular — to reinforce subjective feelings.
- The bacterium Helicobacter pylori. Affects the development of the disease in approximately 67% of patients. I believe that the tides on the skin associated with activation under the influence of bacteria vasoactive peptides and with the accumulation of toxic substances with vasodilating properties.
- Endocrine failure (endocrinopathy) in women during menstruation, pregnancy or menopause. Although not being one of the main causes of the disease, can cause frequent relapses of rosacea.
- Vascular-neurotic reactions (vegetative-vascular dystonia and asthenic-neurotic syndrome). In these cases, the rash of rosacea is localized over the inactive muscles of the face. Experts put forward the version that this is due to swelling of the skin due to poor drainage, lack of muscle activity in such areas. At the same time the capillaries are filled with blood, outwardly manifested in the form of hyperemia.
- Dermatological diseases of infectious nature.
- The decline in immune status.
- The effect of individual components of the coagulation or the kallikrein-kallikrein systems (groups of proteins involved in inflammatory reactions, controlling blood pressure, coagulation and are responsible for the emergence of pain).
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Exogenous (external) reasons:
- alimentary (alcohol, oral contraceptives, hot drinks and food, spices);
- physical (sun exposure, skin exposure to heat or cold, frequent re-treatments chemical peels);
- long-term external application of potent glucocorticoids.
The pathogenesis of rosacea
As well as the etiology, the pathogenesis is not fully understood. It is believed that the main mechanism of development of pathology – nonspecific inflammation, around which there is a gradual expansion of capillaries near the follicles. Over time, they become Hyper-reactivity, and their persistent expansion leads to the appearance of telangiectasias. Further, as the progression of the disease develops of diffuse hypertrophy of the connective tissue and sebaceous glands.
Classification of rosacea
Today, there are several classifications of the disease depending on the stages of development of lesions and clinical manifestations. Clinical-morphological classification of E. I. Ryzhikov divides disease into 4 stages:
- infiltrative-productive – rhinophyma.
Classification by J. Wilkin:
- prosacea – periodic occurrence of tides;
- vascular rosacea is the development of erythema and telangiectasia;
- inflammatory rosacea (characterized by rash in the form of papules and pustules);
- late rosacea is an extreme degree of severity is the development of rhinophyma.
As a result of long research G. Plewig and T. Jansen, A. Kligman proposed a new classification. Taking into account all stages of the disease and its atypical forms.
- I stage – erythematous-telangiectatica – is characterized by long, moderately severe erythema, and the appearance of single telangiectasia;
- Stage II – pustular papules – erythema staunchly preserved, increasing the number of telangiectasias, papules and pustules;
- Stage III – pustular-knotted – to the existing numerous lesions swelling join nodes, there is a hyperplasia of the sebaceous glands, there are thickened patches tend to merge.
Particular forms of rosacea
- steroid rosacea develops as a result of long-term treatment of highly active drugs-corticosteroids;
- supoena or granulomatous rosacea is characterized by rash in the form of red-brown papules with clear boundaries size up to 4 mm with predominant localization in the mouth area and eyes;
- gram-negative rosacea – a disease caused by gram-negative microorganisms;
- conglobata rosacea to the diversity of the elements of the rash are added bluish-reddish nodes up to 2 cm;
- fulminant rosacea is characterized acute onset and very severe, all the elements appear on the back of strong edema; favourite localization – the forehead, cheeks and chin;
- rosacea with a solid persistent edema;
- oftalmologica, is a complication of the disease, which develop various pathologies of organs of vision (blepharitis, chalazion, recurrent styes, iritis, etc.);
- rhinophyma and other types of «Fima» in a different location – gnathophyma (chin), metafile (forehead), otophyma (ear), blepharophyma (lid).
The symptoms of rosacea
- The initial stage of the disease. Occurs transient erythema of the Central face area. Gradually it becomes persistent. Appear congestion in the form of moderate infiltration and single capillary telangiectasias. Subjective localization process, the patient feels itching, burning and tingling of the skin. Over time, the growing number of telangiectasia and erythema, progressing, becomes cyanotic and is spreading all over the face, capturing even the areas of the neck.
- Second, papular-pustular stage. At this time, appear on the skin of a single rigid papules pink-red up to 5 mm. Nodules do not coalesce, but can be grouped together. Their favorite place – the cheeks, forehead, chin, sometimes they appear even on the upper lip. A little later, around the nose, in the region of nasolabial triangle, and chin there are pustules, which gradually spread to the skin of the neck and chest. It’s part of translating papules. Often at this stage develop infiltration of the skin and swelling of the face.
- The third stage – pustular-knotted. Due to the high concentration of androgens begins to increased production of sebum that leads to hyperplasia of the sebaceous glands. Develops fibrosis of the connective tissue, resulting in deteriorating the blood and lymph circulation. Appear nodes, and plaques. Over time, there is an increase in all elements of the skin in size, and their subsequent merger, most often in the nose. Because of this, he greatly increases in size, making it disfigures the face. Occasionally instead of rhinophyma develop Atofina, metafile, gnathophyma or blepharophyma.
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Some patients with rosacea (20 – 50% of cases) there are signs of damage to the eye. Patients complain of a burning sensation, itching and soreness. There are lacrimation and photophobia. The specialists diagnose conjunctivitis, blepharitis, irity, iridocyclitis, keratitis or chalazion.
Diagnosis of the disease
In addition to the clinical picture and complaints of the patient, the physician must identify the cause of the pathology development. To this end, he may prescribe laboratory tests, including a number of tests:
- a detailed clinical analysis of blood;
- biochemical blood analysis shows the total bilirubin and its fractions, triglycerides, transaminase, cholesterol, alkaline phosphotase, creatinine and glucose;
- swabs from the affected skin for allocation, identification of pathogenic organisms and to determine its sensitivity to antibiotics;
- a skin scraping for the presence of Demodex folliculorum;
- smear for bacterial culture to determine the microflora.
Differential diagnosis of rosacea
With a clear clinical picture experienced diagnosis is not difficult. And yet, the disease should be differentiated with some pathologies, such as:
- Perioral (resizepolicy) dermatitis – a skin disease characterized by rashes on the nasolabial triangle. Unlike rosacea, in this pathology there is no telangiectasia and deep skin lesions.
- Acne vulgaris in which comedones are present, and the disease occurs in a slightly different age group of people up to 30 years.
- Sarcoidosis (including ozdoblennya lupus Besnier-Tenneson) is a systemic disease. But its manifestation on the face are rare.
- Seborrheic dermatitis is very similar to rosacea in the clinical picture of the disease. However, when the lesions are covered with scales, which is not in rosacea.
- Systemic lupus erythematosus is a diffuse connective tissue. Different from rosacea localization (it does not affect the region of nasolabial triangle). Besides, when there are no such lesions as papules and pustules
In addition, conduct a differential diagnosis of rosacea with the red grit of the nose (chronic disruption of the sweat glands), lupus erythematosus (a form of skin tuberculosis), Haber’s syndrome (a hereditary disease with rosaeodora rash).
How to treat rosacea at home?
Treatment of the disease is complex, but the choice of drugs and treatment regimens depends not only on the stage of disease and severity of cosmetic defects, but also from causes and clinical forms of the pathology. The special role played by the individual acceptability of medicines to patients. Besides monotherapy of any drug from the scheme does not lead to full recovery, and has only a temporary effect. Treatment of the disease is conducted in two directions:
- the reduction of the inflammatory process;
- eliminating the causes that caused the disease or precipitating factors that led to relapse.
Any treatment plan should include the following groups of drugs.
- Antibacterial agents. Recent studies have shown that in the initial stage of the disease the most effective antimicrobial agents for local application («Rosnet» cream rosacea, Metronidazole or azelaic acid). If severe rash in addition to the local treatment prescribed with oral broad-spectrum antibiotics (mainly tetracycline) and macrolides – Tetracycline, Doxycycline, Minocycline.
- Sebosuppressive drugs. In severe disease prescribe retinoids (Isotretinoin, Adapalene, retinoic ointment) and antiandrogens (Spironolactone or Cyproterone).
- Kertonegoro (Tretinoin, hydrocyclone). They are the Foundation of relapse prevention.
- Acaricidal drugs. The detection in scrapings Demodex folliculorum is necessary to assign means for the treatment of demodicosis (ointment «Yam» or other sulfur-tar preparations). They will improve the patient’s condition and relieve the discomfort.
- A tonic preparations. Vitamin-mineral complexes, and therapeutic agents containing vitamins B6, C, R.
- Desensitizing medications – antihistamines, sodium thiosulfate.
- Drugs to eliminate side effects (dryness, irritation, peeling). An effective cream «Wedge AK», «Aven», «Tolerans extra».
Methods of destruction of telangiectasia and other elements of the rash in rosacea:
- electrophoresis with Chloroquine or with EPI;
- cryotherapy (cryomassage);
- laser therapy (laser treatment).
Surgical treatments that are used for the correction of changes in the skin when rhinophyma:
- electrosurgery (is excision of the hypertrophied areas and the reshaping of the nose);
- laser therapy (excision – excision laser with long infrared waves);
- dermabrasion – a kind of mechanical peeling, which is based on layer-by-layer grinding of the skin.
To cure the patient, it is necessary to pay attention to his diet. Diet for rosacea is not strict, but from the diet should exclude animal fats, meats, alcohol, spicy or spicy meals. Correction be not only nutrition but also lifestyle. The patient needs to stay long in a stuffy room where the air temperature is very high. And completely avoid sun exposure, using sunscreen and clothing (e.g., wide-brimmed hats). Only under these conditions, rosacea is treatable and the patient can return to a normal lifestyle.