Rosacea on the face and other areas of the skin: treatment, symptoms, diagnosis

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Papular-pustular stage	Single or multiple inflamed dense pink-red papules( knots) 3-5 mm, mainly located on the cheeks, forehead, chin, above the upper lip begin to appear against the background of erythema. Often the nodules are covered with whitish small scales, the largest papules at the base have a compaction zone. After a while, most of the papules are transformed into pustules - vesicles with exudate. At the same time, first the microbial flora is not detected in the contents of the pustules. But the persistent expansion of the capillaries and the influx of blood causes a local increase in temperature, enabling pathogenic organisms to multiply actively. Then pustules begin to form. Suppuration processes increase with frequent attachment to rosacea of ​​tick-borne infection( demodecosis). Itching, tightening of the skin and burning becomes more pronounced. Eruptions extend to the neck area, the skin behind the ears. Because of the deterioration of the blood and lymph flow in many patients at this stage, pronounced puffiness of the face is formed. instagram viewer
Pustuzno-knotty	Against the background of the already existing erythema, vascular structures, ulcers, puffiness there are inflamed nodes, seals and cystic growths in the form of tumors, gradually transforming the appearance. These pathological changes occur due to stagnant vascular disorders, enlargement of sebaceous glands and excessive production of sebum, proliferation of connective tissue.
Rhinophyma( synonyms: pineal nose), final, rosacea stage. Often combined with other manifestations of the disease.	Tumor growths become more pronounced, causing considerable aesthetic discomfort, disfiguring the patient's face. The rhinophyma is most often formed with the following features: asymmetry of the nose due to single and multiple lobular seals in the form of groinlike, pineal nodes of blue-purple color; with fibrous type the skin on the nose is smooth, dense, purple, the tissue is hypertrophied; multiple large telangiectasias on the surface of the nose( excluding the actinic form); from the expanded pores, when pressed, a thick mass is produced that contains sebum, dead cells of the stratum corneum of the epidermis, bacteria, and often demodex mites. In the fiboangiomatous form of rhinophyma, the nose greatly increases, acquires a copper or purple hue, is covered with pustules. The actinic form is expressed in the formation of yellowish seals with wide pores like "lemon peel"( actinic elastosis), cystic nodes, acne eruption, and scaling on the nose. With the development of a fimatose form, extensive seals can be concentrated: on the chin( gnathofima); in the forehead area( metaphyma); on the earlobe( otofim) in the form of growth, similar to cauliflower; on the eyelids( blepharopharma).
Ocular rosacea( 20 -60%)	The main symptoms of ophthalmicosis sometimes manifest themselves long before the initial manifestations of the disease on the skin. Basic manifestations: burning, itching; blurred vision; dryness and soreness of the eyes, sensation of "sand"; lacrimation, sensitivity to light; Then follows the adhesion of inflammatory processes with the development of: blepharitis, chaliazion, conjunctivitis, iritis, iridocyclitis, keratitis. In severe cases of keratitis, probably corneal opacity and blindness.
Steroid rosacea	The most common manifestations: telangiectasia; atrophic changes on the skin( wrinkles, thinning, shrinkage); enhanced pigmentation or discoloration; the appearance of papules, pustules. A few days after the removal of external hormonal ointments, a sharp exacerbation of the pathology may occur with the development of acute erythema, edema.
Erythematous-telangiectatic stage	Transient character of erythema passes into a stagnant phase. Redness of the skin acquires a blue-purple hue, extending to previously healthy areas. Observed: persistent expansion of capillaries, lymphatic vessels in the erythema, moderate swelling, telangiectasia( red vascular spots, meshes).

This article is intended to tell you about the diagnosis, the first symptoms and the procedure for treating rosacea.

Symptoms of rosacea

Basic

The main common signs of rosacea acne typical of all forms of the disease include:

• persistent redness of the face( neck, chest);
• puffiness, vasodilatation and development of red vascular network( telangiectasia);
• compaction of individual parts of the epidermis;
• sensation of itching, tingling, tightening of the skin, burning sensation.

Rosacea on the face in women before treatment( photo)

Specific features of

Initial in the classical course of

The earliest signs of rosacea, which often go unnoticed, are expressed in a rapid transient( temporary, transient) face redness( tidal erythema). Red spots appear with sudden temperature fluctuations, exposure to cold wind, frost, sun exposure, contact with cold and hot water, after taking alcohol, spicy foods, hot drinks.

On the areas of periodic redness, the skin becomes denser. Redness is often confined to the cheeks, nose, forehead and chin.

The doctor in the video below will tell you about the symptoms of rosacea:

At different stages of

Diagnosis of

In case of obvious classic signs of usual forms of rosacea, the dermatologist is able to immediately diagnose after examination, taking into account complaints that indicate a recurring or persistent erythema of the face for 2 to 3 monthsand all additional attributes. But the effectiveness of treatment depends on detailed examinations, especially with different types of disease. In addition, rosacea must be distinguished( differentiated) from other pathologies with similar symptoms.

These include:

• true polycythemia and leukemia infiltrate;
• demodicosis;
• connective tissue disease, carcinoid( tumor) and mastocytosis( blood disease);
• usual acne;
• folliculitis;
• Haber syndrome;
• is a peripheral, steroid dermatitis, contact dermatitis, including photodermatitis and seborrheic form;
• , lupus erythematosus, tuberculosis, "refurbished" Bénie-Tenesson;
• mushroom mycosis;
• is a perioral dermatitis;
• red nose granularity;
• Pringle-Burneville disease;
• small-node sarcoidosis, carcinoid;
• tubercular syphilis.

The disease is usually differentiated with other pathologies, by eliminating them, since no specific samples have been developed to confirm rosacea.

Basic diagnostic tests:

• blood and urine tests are common;
• blood biochemistry;
• bacteriological culture to identify the type of pathogenic organisms in the biomaterial and their response to antimicrobial agents;
• definition of blood coagulability( coagulogram);
• lipidogram to the level of triglycerides, cholesterol;
• scraping from the skin of the face and eyelids for examination for tick-borne infection Demodex folliculorum
• skin biopsy and histological examination for the detection of psoriasis, dermatological diseases, cancerous changes in cells, systemic autoimmune diseases;
• bacteriological examination of the flora of the stomach and intestines;
• of the ultrasound of organs.

Elena Malysheva in this video will talk about the treatment of rosacea:

Treatment of rosacea

Rosacea is treatable, especially in the early stages, but complete recovery in the process is usually not predicted, because for the pathology typical unpredictable relapses. The choice of treatment tactics is associated with the form, severity and duration of the pathological process, the tolerability of medications, the presence of demodectic and internal diseases, age, sex of the patient.

Therapeutic

The complex therapy of rosacea uses physiotherapy methods:

1. Cryotherapy .At any stage of the disease. To reduce vascular manifestations and improve the condition of the epidermis, low temperatures( liquid nitrogen) are used. Up to 10 procedures.
2. Electrocoagulation .To remove papulo-pustular nodes, telangiectasias, on the sore spot are narrowly directed by a point electrode. The method requires caution, since sometimes a burn occurs on the skin. It takes from 20 to 100 sessions.
3. Rotary massage .It is performed in the initial and erythematous stages. In order to activate the outflow of lymph and reduce puffiness, the affected areas are gently massaged twice a day in a circle.
4. Method of microcurrents .A positive result of microcurrent therapy is associated with fluid leveling in the facial tissues, restoration of lymph drainage, skin lesions, suppression of microbial activity.
5. Plasmapheresis .Used in severe, not amenable to traditional treatment, forms of rosacea.
6. Laser low-energy therapy .The procedure is very effective and will allow for a long time to get rid of telangiectasias with the help of a directional laser beam on vascular formations that are destroyed by light and heat exposure. The technique excludes damage to neighboring tissues. Conduct in a day, for 20 - 25 minutes, a course of 6 procedures. A diode, neodymium KTP laser, alexandrite laser, an IPL photolaser, an Nd YAG laser on an alumina garnet are used.

Medication

Complex, local and systemic treatment is performed. The combination of external drugs and medications can reduce manifestations of rosacea, suppress the development of pustular lesions, prevent exacerbations and the progression of the disease for a long time.

Form and stage	Medications
Erythematous-telangiectatic form	External remedies and medicines: cold lotions from infusions of herbs, with 1% solution of resorcinol, boric acid 2% with weak tea, to reduce itching and burning. neutral creams with olive oil; Tolerance Extreme, Wedge AK, Rosaliac, Aven Spray to reduce the likelihood of pathological scarring; with increased fat release, irritation: gel Klinans, kerasalitsa series Klerasil Ultra with antibacterial, sebocidal effect( reducing the activity of the sebaceous glands); gel and lotion Setafil; Gel Cercnil with a tendency to develop acne; Dyrosale, Antitzer - therapeutic creams against redness, vascular manifestations on the skin; Antiinflammatory treatment cream Bio-skin Sensibio AR, which removes redness and blood flow to the surface vessels already at the first application; cream with antimicrobial effect, does not contain antibiotics and effectively narrows the blood vessels;Vitamins of group B, E, C, P; means, removing the sensitivity of the body to allergens - sodium thiosulfate, antiallergic drugs.
Papulopustular form	External use of drugs with antimicrobial, anti-inflammatory effect: Metronidazole: 1%, Metrogil, Noritate, Rosamet( allowed for blepharitis), Rosex. Contraindicated in the first trimester of gestation and during lactation; Azelaic acid( 15, 20%); Skinorene gel; cream Ivermectin 1%( anti-inflammatory and antiparasitic in demodicosis); pastes containing tar up to 5%, ichthyol, ichthyol and sulfur broth; complex "erythromycin plus acetate zinc dihydrate", suppressing the development of comedones; antibiotic creams Sulfacetamide, Azelik or Finacea, Erythromycin ointment( at least 10,000 U / g); Biaron AS.Active with serious microbial aggression, especially accompanied by demodicosis. With the progressing bacterial process and the development of ulcers, in addition to ointments, the use of antibacterial and antimicrobial drugs in tablets becomes mandatory. Inside designate: Metronidazole, suppressing the growth of anaerobic bacteria and the activity of Demodex mites in demodicosis. Doxycycline, Minocycline, Erythromycin, Clindamycin. Dosage and duration are determined only by a dermatologist. Important! Contraindicated treatment of rosacea hormonal ointments and tablets( especially with the content of fluoride), as this can lead to the development of steroid rosacea. Glucocorticoids are prescribed in rare cases with very severe conditions, short courses to eliminate exacerbation.
Severe forms of	In refractory flow, when there is no positive reaction to the traditional remedies, it is possible to use the drugs of the group of external retinoids( analogues of vitamin A), exclusively under the strict supervision of the doctor, because the side effects are very pronounced. Retasol, Retinoic Ointment 0.05%, 0.1%, Tazarotene, Tretinoin, Adapalene, Etretinate, Roaccutane( isotretinoin). Important! Absolutely all retinoids are contraindicated in pregnancy and when planning conception in order to avoid severe deformities of the fetus. Men should not take retinoids inside if their intimate partners are pregnant or are about to conceive a child. Assign a combination therapy that combines isotretinoin and antiandrogens( Spironolactone, Cyproterone).Sometimes treatment with immunosuppressors is successful.

Rosacea "before" and "after" treatment( photo)

If demodicosis

is attached

If demonidosis is diagnosed in rosacea, then taking into account its strong negative effect on the course of the disease, immediately after the acute inflammation subsides, proceed to getting rid of parasitic mite.

Extinguishing media:

1. Anti-fungal preparations: Spregal spray, Benzyl benzoate 20%, Sulfur ointment, Demalan, Permetrine, zinc, ichthyol ointment, yellow mercury ointment, Lindan( avoid contact with eyes);
2. Gray ointment, Demothen gel;
3. ointment with metronidazole: Rosamet, Rosex, Metrogil, Clion, Glikodem( more active), Ornidazole;
4. Keratolytic ointments: Skinoren, Azelik;
5. for ulcers: antibiotics gel Dalacin T, Duak, Fusiderm, Erythromycin ointment or Zinerit, ointments with clindamycin( Dalacin, Clindovit, Zerkalin, Clenzite-C);
6. Veterinary drugs effective in demodicosis in humans: Amitrazine, Ivermek gel, Amidel, YAM ointment, aversectin ointment;
7. In the case of demodectic eyelids: Blepharogel No. 2, Demazol, Demalan. If demodicosis affects the eyeball: Tosmilen, Armin, Physostigmine. When joining a bacterial infection: Levomycetin, Tobrex, Tsipromed, Dexona.

Additional pharmaceutical preparations

Because many dermatologists associate neurological disorders with one of the provoking factors of rosacea development, it is necessary to prescribe:

1. Vitamin complexes including group B, vitamins E, A( only if retinoids are not taken), C, PP.
2. Soothing medicines: Novopassit, Afobazol, motherwort tincture, valerian, deviant peony, herbal decoctions, stronger ones - Bellataminal, Relanium, Teralzhen.
3. Gel Kontratubeks, stimulating cell regeneration and suppressing unnecessary growth of connective tissue( 2 to 3 times a day, up to 4 - 5 weeks) is used to reduce scarring.
4. With increased probability of infection in areas with damaged dermis, it is prescribed: Siclafate is a regenerating and antibacterial cream, Epithelial A with an active restoring effect.

Surgical

• If the disease is complicated by severe abscesses, fistulas, cystic elements or goes into a fimatose form, surgical care is needed.
• Excessively overgrown tissues on deformed areas of the face with rhinophyma and other forms of hypertrophied rosacea are excised.
• Pathological foci are opened with excision of affected tissues. In the case of abscesses, the surgeon establishes drainage to completely remove the purulent discharge. Further, antibiotics and anti-inflammatory medications are prescribed, anesthetizing, disinfecting and accelerating the healing of tissues.

Treatment of pathological changes in the skin that develop secondary after inflammatory processes, that is, excessive pigmentation, atrophy, scar deformations, is carried out with a course of microcrystalline dermabrasion( mechanical resurfacing) 5-10 procedures under local anesthesia. All types of dermabrasion are performed strictly after complete relief of all inflammatory manifestations on the skin.

In parallel, supportive treatment( metronidazole) is performed to prevent relapse after 2 to 6 months. The skin is protected from sunlight during treatment and for 30 to 40 days after it.

On the treatment and prevention of rosacea tells the video below: