Skin care rules for rosacea (rosacea)

Rosacea (or, as they are also called, rosacea) is a facial skin disease that occurs in a chronic form with relapses, characterized by damage to the sebaceous glands, hair follicles and skin capillaries. The disease is one of the most common in dermatological practice: according to medical statistics, it affects about 10% of patients. Most often it affects fair-skinned people, in particular women over the age of thirty.

The dermatovenereology department of CELT offers a course of treatment for rosacea in Moscow. Our clinic has been operating in the paid medical services market for almost 30 years and has a powerful diagnostic and treatment base. Thanks to it, our specialists are able to accurately diagnose and individually select treatment that will be carried out in accordance with modern international standards.

At CELT you can consult a dermatologist.

• Initial consultation – 3,500
• Repeated consultation – 2,300

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Etiology of rosacea

Experts identify a number of factors that initiate the development of acne. Most often this is severe overheating or, on the contrary, hypothermia of the skin, as well as:

• Exposure to sunlight, including in a solarium;
• Frequent stress;
• Local use of glucocorticosteroids;
• The use of harsh scrubs not intended for facial skin;
• Independent use of chemical peeling;
• Bad habits: drinking alcohol and smoking;
• Constant inclusion of too hot and spicy foods in the diet.

If the patient has a history of individual intolerance to certain substances, manifested by allergic dermatitis, the risk of developing acne is quite high. It was previously thought that acne could be caused by demodex mites; recent research has found that this is not the case. Their presence in the follicles is not the cause of the development of the disease, but enhances its clinical manifestations.

Based on the method of exposure, it is customary to divide the factors for the development of acne into two groups:

• Exogenous - acting externally, represented by the physical effects of high and low temperatures, insolation, as well as nutritional - hot drinks, spices, etc.;
• Endogenous - gastrointestinal diseases caused by the bacterium Helicobacter pylori, infectious lesions of the skin, diseases of the endocrine system, decreased immunity.

Introduction

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis.
The central part of the face is mainly affected.1,2 The disease has no gender preference. It occurs at any age; however, the typical onset is after age 303. The course of the disease usually manifests itself in remissions and exacerbations. In people with fair skin, the prevalence of the disease reaches 10%. However, the disease is not limited to fair skin; it can also be seen on dark and dark skin tones. Clinical manifestations of the disease include facial erythema (transient or persistent), telangiectasia, edema, papules and pustules. The patient may have one of these or a combination of them. Patients may have no symptoms or complain of burning, tingling, pain or itching.

Initially, the disease was divided into 4 main subtypes. These were:

1. erythematotelangiectatic (subtype 1),
2. papulopustular (subtype 2),
3. phymatous (subtype 3)
4. ophthalmic (subtype 4).

Granulomatous rosacea was considered a variant of rosacea rather than a subtype. However, not only can a subtype transform into another, but these subtypes can also arise simultaneously. Thus, in 2017, there has been a shift from subtypes to phenotypes in the diagnosis of rosacea, and diagnosing a patient with rosacea requires at least one diagnostic phenotype or two major phenotypes.

These phenotypes are summarized in Table 1.

Diagnostic phenotypes

1. Persistent erythema of the central part of the face, which is aggravated by provoking factors
2. Phymatous changes (most often rhinophyma)

Large phenotypes

1. Transient central facial erythema/redness
2. Inflammatory papules and pustules
3. Telangiectasia
4. Ocular changes: blepharitis, keratitis, conjunctivitis, telangiectasia of the eyelid margins.

Small phenotypes

1. Burning
2. Tingling
3. Edema
4. Dryness

Because rosacea is a disease with a complex pathogenesis and multiple manifestations, its treatment poses a challenge for dermatologists. The following sections will review the main problems in the treatment of erythema, hyperemia, telangiectasia, inflammatory lesions and phymatous changes, and discuss possible solutions.

Redness, transient and persistent erythema

Transient or persistent facial erythema is the most common finding in patients with rosacea of ​​all subtypes. It is a very common clinical problem that dermatologists encounter in daily practice.6 Symptoms of rosacea often begin with redness of the skin and lead to persistent erythema.

Facial erythema usually has a diffuse distribution and is located in the central part of the face. Although the inflammatory lesions may resolve over time, the erythema may persist. Increased innate immunity, neurovascular and neuroimmune dysregulation play a central role in the development and maintenance of facial erythema through vasodilation.

Currently available treatments for rosacea target inflammatory changes rather than erythema; these are: topical metronidazole, topical azeleic acid and systemic tetracyclines. Although topical metronidazole and topical azeleic acid should theoretically treat erythema on a molecular basis, current research suggests that they are generally not helpful in treating erythema, especially if it has become persistent.

The therapeutic challenge for dermatologists is that there are a limited number of effective topical agents that can be used in the treatment of diffuse facial erythema in patients with rosacea. Among them, topical steroids are very commonly used.

However, with the use of topical steroids, skin atrophy is inevitable, and exacerbations are observed after discontinuation of therapy. For these reasons, the use of topical corticosteroids should be avoided in patients with rosacea. Topical calcineurin inhibitors may help reduce facial erythema in some cases, but in most cases they actually worsen rosacea.

Lasers are increasingly used in the treatment of vascular lesions. The 595 nm pulsed dye laser (PDL) is a common treatment option for diffuse facial erythema. Treatment with PDL at purpuragenic doses usually produces sufficient cosmetic improvement in 2 treatment sessions.

In addition, it reduces burning, tingling, sensitivity, itching and dryness; This dramatically improves the patient’s quality of life. However, due to patient discomfort and facial bruising resulting from the procedure, PDL should not be used at purpuragenic doses. PDL is effective in reducing facial erythema and at subpurpurogenic doses, but more treatments have recently been required.

Recently, intense pulsed light (IPL), which is a flashlight emitting incoherent light with a wavelength of 400–1400 nm, was compared with PDL (at nonpurpuragenic doses) in the treatment of diffuse facial erythema. Not only was IPL found to be as effective at 560 nm filtration as PDL in treating facial erythema, but patients treated with IPL showed significant improvement than patients treated with PDL at 90 days of follow-up.

In addition, it did not cause any serious side effects.13 Thus, in patients with persistent diffuse facial erythema; Both PDL and IPL can be used for cosmetic enhancement.

Brimonidine tartrate 0.5% gel is a topical treatment approved for the treatment of transient and persistent facial erythema in patients with rosacea over 18 years of age. It is a potent vasoconstrictor that selectively binds to alpha-2 adrenergic receptors on the smooth vessels of muscle cells in the peripheral cutaneous vasculature.

Patients treated with topical brimonidine clinically experience a 60–70% reduction in erythema with minimal side effects. Moreover, its effect begins within 30 minutes.

However, the disadvantage of its use is that the effects of brimonidine gel are temporary; erythema reappears within 9–12 hours. Therefore, one dose per day may not be sufficient and twice daily use may be required. However, it is important to note that worsening of erythema may occur due to the use of brimonidine. This side effect can be overcome by using barrier creams correctly and avoiding excessive use of brimonidine.

Another new topical agent that has recently been approved for the treatment of facial erythema is oxymetazoline hydrochloride 1% cream.15 It is an alpha-1a adrenergic agonist that is used to treat moderate to severe persistent facial erythema in patients with rosacea. At higher concentrations, it also binds to alpha-2 adrenergic receptors.

Bauman et al followed patients with facial erythema using oxymetazoline cream for 29 days and concluded that topical oxymetazoline is a safe and effective treatment for moderate to severe facial erythema when applied once daily.

Tangetti et al demonstrated that oxymetazoline is effective in reducing facial erythema starting within the first hour of its initial application.19 Thus, oxymetazoline cream is an effective and easy-to-use topical alternative in the treatment of persistent facial erythema with its once-daily regimen. applications.

In addition to topical antihypertensive drugs, systemic antihypertensive drugs are used in the treatment of off-label facial erythema. Beta blockers may be used in the treatment of refractory facial erythema. Nadolol and propranolol, which are non-selective beta-adrenergic antagonists, are effective in reducing hot flashes.

However, their use was abandoned due to possible side effects: hypotension and bradycardia. Carvedilol, a non-selective beta-adrenergic agent and alpha-1 antagonist, is a better alternative in the treatment of refractory facial erythema. When used at a dose of 3.125–6.25 mg 2–3 times daily, carvedilol results in clinical improvement within 3 weeks without the side effects of nadolol and propranolol. Carvedilol differs from other non-selective beta-blockers in that its metabolites are powerful antioxidants.

This feature further increases its therapeutic effectiveness for facial erythema. On the other hand, the use of calcium channel blockers in the treatment of facial erythema is not recommended because they may aggravate rosacea.6 Clonidine is a centrally acting antihypertensive agent that acts through alpha-2 adrenergic receptor agonist activity.

Wilkin investigated the use of systemic clonidine hydrochloride for the treatment of hyperemia. Patients were given 0.05 mg clonidine hydrochloride twice daily for two weeks. Although clonidine did not cause a significant change in blood pressure, it also did not reduce flushing caused by red wine, chocolate, and hot weather. Cunliffe et al also examined the effect of clonidine on hot flushes. Similarly, patients were administered 0.05 mg of clonidine hydrochloride twice daily. Similar to Wilkin's findings, clonidine was found not to suppress hot flashes.

Intradermal injection of botulinum toxin type A (Botox) is a promising treatment for facial flushing and erythema. The release of acetylcholine leads to vasodilation of cutaneous vessels, which manifests itself in the form of facial flushing and erythema.

Botox inhibits the release of acetylcholine and provides symptomatic relief in patients with facial flushing and erythema. 23 Park et al reported two patients whose erythema was successfully treated with Botox injections. The first patient received a total dose of 50 units, and the second patient received a total dose of 65 units. Each patient received the full dose over two treatment sessions, and noticeable cosmetic results were achieved one week after the second treatment session in both cases.

Symptomatic relief persisted for 4 months in both cases, and patients returned to the clinic for a second course of treatment24. Bloom et al. conducted a study in 15 patients with facial erythema, each of whom received 15–45 units of intradermal Botox injection.

They concluded that intradermal injection of Botox is an effective and safe treatment for facial erythema in rosacea.25 Intradermal injection of Botox has been shown to help relieve facial erythema in several patients with rosacea; Further research with a larger sample size is needed to illustrate this treatment in detail.

Telangiectasia

Telangiectasias cause cosmetic discomfort to patients, and they often seek treatment. However, topical or systemic agents are ineffective in the treatment of telangiectasia. Currently, physical methods, that is, laser and light-based devices, are used to treat vascular manifestations of rosacea. To obtain cosmetically acceptable results, an average of one to four sessions is required.

The basis of these treatments is that hemoglobin absorbs the energy emitted by these devices, resulting in the disappearance of vascular lesions24. Neodymium doped yttrium aluminum garnet (Nd-YAG), 532 nm Potassium Titanyl Phosphate (KTP), 595 nm PDL, IPL and dual wavelength long pulse 775 nm alexandrite/1064 nm neodymium: yttrium aluminum (LPAN) are examples of these methods. 26, 27

The most common examples of these are PDL, Nd:YAG and IPL. A review article by Anzegruber et al. It was concluded that IPL is recommended at level A, and Nd:YAG laser (including KTP) and PDL are recommended at level B. Due to the larger spot size, IPL causes fewer side effects compared to PDL; therefore, its use is more advantageous compared to PDL. Additionally, PDL is more effective than Nd:YAG in treating vascular manifestations, but Nd:YAG is associated with less pain.

The effectiveness of Nd:YAG lasers in treating erythema, telangiectasia and skin texture in patients with rosacea can be increased by combining it with topical retinoic acid preparations. Independent evaluators found that topical retinoic acid increased the effectiveness of Nd:YAG laser treatment by 47%.

Radiofrequency (RF) devices cause focal damage to the dermis by producing heat and electrical current through electromagnetic radiation. This damage stimulates the formation of new collagen through a rapid healing process. Compared to laser treatment, RF is a newer treatment option for rosacea. A study by Kim et al compared the effectiveness of RF and PDL treatment for rosacea. Both methods were used for 3 sessions at a monthly interval.

RF and PDL produced similar results in the treatment of erythematotelangiectatic rosacea; there was no statistically significant difference. Thus, both RF and PDL are effective in the treatment of erythema and telangiectasia. On the other hand, RF was more effective than PDL in patients suffering from papulopustular telangiectasia. In a study of 21 patients with moderate to severe rosacea, PDL was combined with RF.

It was concluded that combination therapy is more effective than PDL alone in the treatment of erythema, hot flashes, and telangiectasia. Thus, in the treatment of refractory erythematous ectatic rosacea, PDL and RF may be considered for treatment alone or in combination.

Recently introduced combination treatments have been found to be more effective in treating patients with refractory rosacea than single treatments. The addition of PDL treatment to oral minocycline therapy has been found to reduce relapse rates in patients suffering from erythema and telangiectasia. The relapse rate with minocycline alone was 48%; however, the relapse rate of minocycline plus PDL was 37%.

Additionally, Nd:YAG laser treatment can be added to topical brimonidine therapy. Brimonidine itself is effective in treating erythema, although the effect is temporary. However, telangiectasias persist after treatment with brimonidine. Cosmetically, better treatment results were obtained when patients with erythematotelangiectatic rosacea were first treated with Nd:YAG laser and topical brimonidine therapy was added 1 month later.31

Papulopustular lesions

Inflammatory papules and pustules are the main phenotypes observed in patients with rosacea. For mild lesions, local treatment is sufficient. On the other hand, in moderate and severe cases, systemic and local treatments should be combined. A variety of topical medications are used to treat papulopustular rosacea (PPR): metronidazole, azaleic acid, ivermectin, pimecrolimus, retinoids, permethrin, benzoyl peroxide, erythromycin, and dapsone.

Nd:YAG laser, PDL and RF are also effective in treating papulopustular lesions. 26,29 Systemic treatments for papulopustular lesions are oral antibiotics, oral zinc sulfate, and oral ivermectin.

Metronidazole cream 0.75–1% is effective in treating PPD when used twice daily. 26 In a randomized controlled trial of 51 patients, the clearance rate of topical metronidazole was found to be 90%, which is similar to that of oral tetracyclines.

In a study by Dahl et al. the effectiveness of topical metronidazole 0.75% and 1% was compared and no difference was found between the two concentrations.

When applied topically, azaleic acid suppresses the production of reactive oxygen species and induces the production of proinflammatory cytokines.

Azaleic acid gel 15% applied twice daily for 15 weeks produced significantly better results for papules and pustules compared to metronidazole 0.75% cream. 12 weeks.35 Moreover, azaleic acid foam causes fewer side effects than azaleic acid gel when both are used at 15% concentration.36 Thus, metronidazole (0.75–1%) and azaleic acid (15%) are effective in the treatment of PPR when applied topically.

Ivermectin is an antiparasitic drug that reduces the density of demodex on the skin of patients with rosacea. Demodex mites are commonly found in human flora; however, their density increases in patients with rosacea. Ivermectin has anti-inflammatory effects against these mites.

Ivermectin cream 1% is a safe and tolerable alternative to first-line treatment for the treatment of PPD. It is more effective for the treatment of PPD than metronidazole cream 0.75%. However, its effectiveness has not been compared with topical azaleic acid 15%, which is also more effective than topical metronidazole 0.75%. Dall'Ogllio et al conducted a study that examined the effectiveness of 1% ivermectin cream in the treatment of PPD .

They used erythema-directed photography to evaluate the results. Thirty-two percent of cases achieved complete resolution with 8 weeks of topical ivermectin. In addition, a significant reduction in erythema was observed. Ivermectin is a safe and effective topical treatment alternative for patients with refractive error and is registered in Europe and the USA.

Pimecrolimus cream 1%, which is a calcineurin inhibitor, is also an effective alternative in the treatment of PPD. It is as effective as metronidazole 1% cream. However, it is also a drug that triggers rosacea.

Retinoids are also an alternative for treating inflammatory lesions of rosacea. However, keep in mind that the irritant side effects of retinoids may be more pronounced in rosacea patients with delicate skin. Of the retinoids, only tretinoin 0.025% and adapalene gel were tolerable and used successfully for the treatment of PPD.

Permethrin 5% cream, when applied topically twice daily for 2 months, is as effective as metronidazole in treating PPD. It is even more effective when combined with other anti-inflammatory agents.40 Topical permethrin 5% is effective in treating erythema and papules in patients with rosacea, but is not effective in treating telangiectasias and pustules. However, it is recommended as class A for the treatment of PPD.

Topical erythromycin gel 2% is as effective as metronidazole cream 0.75% in the treatment of PPD. 26 When combined with benzoyl peroxide, topical erythromycin produces better results than topical metronidazole. Thus, this combination is a good alternative for the treatment of rosacea.41 The combination of 5% benzoyl peroxide gel with clarithromycin gel is also recommended for the treatment of rosacea. 26 Dapsone 5% gel, when used for 12 weeks, is also as effective as metronidazole cream 0.75%, so it can be used to treat PPD.

Regarding systemic antibiotics, low-dose oral tetracyclines (eg, doxycycline 40 mg/day) are effective in treating PPD. Azithromycin and clarithromycin are also used in the treatment of PPD. Although one randomized clinical trial found azithromycin 500 mg per day to be as effective as doxycycline 100 mg per day, in general azithromycin and clarithromycin are considered less effective than doxycycline for the treatment of PPD.

Ampicillin can also be tried in refractory cases. However, it is not as effective as oral tetracyclines. 26 Although antibiotic resistance is a serious problem worldwide, daily use of doxycycline 40 mg/day does not result in antibiotic resistance even with long-term use.

Retinoids, topically or systemically, are used to treat rosacea for their anti-inflammatory properties at lower doses (eg, 0.3–0.5 mg/kg/day). Isotretinoin at a dose of 20 mg/day is effective in reducing erythema and inflammatory lesions. Oral isotretinoin not only provides rapid improvement, but also reduces relapse rates. Compared to topical retinoids, such as tretinoin cream 0.025%, systemic retinoids are more effective.

Zinc sulfate when taken orally at a dose of 100 mg/day is also effective in reducing the inflammatory lesions of rosacea. The only side effect reported was stomach upset in 12% of patients. Oral ivermectin (200 mcg/kg/day) is also an alternative treatment for PPD, although it is supported by level D evidence.

In patients with treatment-resistant rosacea, a combination of oral ivermectin and 5% permethrin cream may be considered, as this combination has been effective in reducing Demodex density in immunocompromised patients.

Phymatous changes

Phymatous changes occur due to hypertrophy of the sebaceous glands, proliferation of blood vessels and connective tissues. Most often, phymata occur on the nose, especially in the lower third of the nose, which is called rhinophyma. Other forms of phymata are gnathophyma (jaw/chin), metophyma (forehead), blepharophyma (eyelid) and otophyma (ear). Although all of these lesions are benign, they pose a challenge to patients due to their cosmetic and functional impairment.48 Systemic treatment options for phymatous lesions include low-dose doxycycline (40 mg/day) and low-dose isotretinoin (0.3 mg/kg / day). Both are supported by level A evidence. 26 Surgical techniques can also be used to treat phymatous changes and are in fact more effective. These techniques include excision, dermabrasion, electrocautery and laser ablation.48

Simple excision is a widely used method. However, since phymatous lesions have a large blood supply, removal of phymatous lesions may result in excessive bleeding, which is an undesirable complication. In addition, there is a risk of removing excess tissue. Dermabrasion can also be used to smooth the surface of the skin. However, like surgical removal, dermabrasion can also cause excessive bleeding.

Electrocoagulation is more effective in controlling bleeding compared to surgical removal. In addition, it is a faster method compared to simple excision. However, it hides the risk of necrosis of nasal cartilage due to excessive heat. In addition, atrophic scars and prolonged wound healing have also been reported when phymatous changes are treated with electrocautery.

The laser devices currently used to treat phymatous changes are the CO2 laser and the Erbium:YAG laser. Both of these lasers have a high affinity for water, which results in ablative changes because the skin has a high water composition.

Madan et al evaluated the effectiveness of CO2 laser in the treatment of rhinophyma. They demonstrated that during the three-month recovery period after a single treatment session, out of 124 patients, 115 were very satisfied with the results. In addition, the method had an acceptable side effect profile. CO2 laser is also good in hemostasis due to its coagulation properties.

Another combination therapy that can be used in the treatment of rosacea is Er:YAG and CO2 laser treatment.50 The CO2 laser is used for its coagulation properties when used together with the Er:YAG laser. Goon et al suggested that this combination therapy could achieve optimal cosmetic results with minimal scarring.

Conclusion

Rosacea is a common and lifelong condition that is distressing for patients. Although there are many treatments available for various manifestations of the disease, patients are usually not satisfied with the results. This is a challenge for dermatologists. There are many new treatments for erythema, telangiectasias, inflammatory lesions and phymatous changes that are resistant to conventional methods. Traditional and new treatments are summarized in Table 2. However, the relapsing nature of the disease reduces the likelihood of disease-free survival.

Rosacea Clinic

Clinically, it is customary to distinguish several forms of rosacea:

Rosacea: what is it and what is dangerous if left untreated?

This is a disease that affects blood vessels and is characterized by redness of the face or certain areas of it. Its appearance leads to a deterioration in appearance due to cosmetic defects, as well as related psychological problems. In addition, rosacea (rosacea) on the face, if the eyes are affected, can cause keratitis and corneal ulceration.

Complications also include:

• thickening of the skin of the chin with the skin acquiring a bluish or burgundy tint (this is extremely rare and appears mainly in men);
• thickening of the earlobe (also rare and can cause hearing loss);
• thickening of the skin of the forehead, which leads to severe asymmetry of the forehead, especially against the background of chronic inflammation and stagnation of blood;
• thickening of the skin of the eyelids, in which the palpebral fissure narrows in the horizontal direction and the upper eyelid droops (causing a feeling of serious discomfort);
• scleritis (inflammation of the sclera of the eye), which is accompanied by pain, blurred vision, and eye irritation; complete loss of vision is possible.

The disease occurs in several stages, and the early form of development is much easier to treat and stop, so at the first signs you should immediately contact a dermatologist

.

How to treat rosacea on the face and can it be cured forever?

Effective, high-quality and long-lasting treatment is possible only under the supervision of a specialist who will determine the cause and stage of the disease and prescribe a course of treatment according to the individual characteristics of the patient (gender, age, clinical picture, etc.).

In very rare cases, the disease can go away on its own, but generally rosacea (rosacea) is a disease that is chronic and can progress with age. This differs from rosacea to acne, which often disappears on its own once you leave adolescence. Therefore, treatment should be such as to increase the time of remission and reduce the frequency of relapses and their duration. Treatment, like prevention, must be comprehensive and, as already mentioned, carried out only under the supervision of a doctor.

Rosacea: symptoms and forms

Main symptoms:

• redness of the facial skin mainly in the T-zone (forehead, nose, chin) and on the cheeks (persistent redness);
• redness may spread to the back and chest;
• the appearance of pink bumps without treatment turns into pustules, acne and pimples;
• the skin on the affected areas thickens;
• profuse lacrimation in the final stages;
• rhinophyma (redness and thickening of the skin in the nose area, most often in men);
• redness, dryness, itching and flaking around the eyes.

There are different definitions of the stages of rosacea, as well as their symptoms. According to this, the severity of the disease, and the methods and timing of its treatment are determined. To get rid of symptoms, a whole range of measures is required, which must be selected individually.

Stages of rosacea

As a rule, the first stages occur unnoticed by the patient. But you need to see a doctor if you notice:

• the appearance of red, long-lasting spots after contact with hot or cold water, as well as after hot drinks or alcohol;
• persistent expansion of capillaries with a local increase in temperature;
• the appearance of tubercles and the formation of irregularities on the skin with their further transformation into pustules;
• expansion of the vascular network, that is, the appearance of redness and tubercles without provoking factors;
• the formation of brownish-red papules and nodules with thickening areas of redness.

As a rule, the intensification of symptoms occurs gradually, but in some cases, rosacea develops rapidly, for example, during pregnancy or after childbirth. If treatment is not started in time, subsequent pregnancies may be complicated by more intense forms of the disease and require longer treatment.

Diagnosis of rosacea in CELT

Before starting treatment, our dermatologist conducts a visual examination of the patient’s facial skin and pays attention to the presence or absence of blackheads - comedones. Since rosacea requires differentiation from acne vulgaris, tuberculous and lupus erythematosus, as well as perioral dermatitis, the contents of the abscesses are diagnosed. In order to determine the optimal treatment strategy for rosacea, microscopic examination of the follicles may be necessary for the presence of mites.

Atypical forms of rosacea

• Lupoid or granulomatous. Accompanied by the development of granulomas - yellow papules that leave scars on the skin after opening.
• Conglobat. Accompanied by large nodes, fistulas and the development of a purulent process.
• Halogen. Develops while taking bromine- or iodine-containing drugs.
• Steroid. Develops while taking steroid drugs.
• Gram negative. Develops against the background of uncontrolled or improper use of antibacterial drugs.
• Fulminant, or lightning fast. It most often occurs in young women and is characterized by the rapid development of all three stages of the disease. Accompanied by swelling and the formation of papules with purulent contents.

Treatment of rosacea in CELT

Treatment tactics for acne depend on the stage of its development and the form of the disease. Our specialists pay special attention to minimizing inflammation by changing the patient's behavior. They recommend:

• Eliminate any factors contributing to the appearance of rosacea;
• Provide optimal skin care, avoid irritation, do not use hot water or abrasives;
• Use sunscreen when going outside on sunny days.

It is important for patients to understand that it is impossible to completely eliminate rosacea... However, if you start treatment in a timely manner and carry it out comprehensively, you can achieve stable remission and eliminate scarring of the skin.

At CELT for rosacea, it is carried out by specialists with over 20 years of practical experience. You can make an appointment with them online through the website or by contacting our operators: +7 (495) 788 33 88.

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

How to treat rosacea or rosacea?

The diagnosis of rosacea must be made by a dermatologist. To do this, an examination is carried out, an assessment of the condition of the blood vessels and dermatoscopy (study of the microflora of the skin). At your appointment, it is important to tell your doctor about all your symptoms, as well as the length of time you have been experiencing symptoms.

Treatment for rosacea includes:

• Antibacterial therapy (if the infectious nature of the rash is identified)
• Vasoconstrictor and anti-inflammatory drugs
• Therapeutic creams and ointments that normalize the activity of the sebaceous glands and have healing, antibacterial and decongestant properties. These include ointments with azelaic acid, metronidazole, and thermal water.
• Physiotherapy: laser, microcurrents, cryotherapy, electrocoagulation. It is worth noting that laser therapy helps reduce the number of relapses and alleviate symptoms of rosacea.

Refusal of treatment and attempts to treat the disease with home remedies can lead to aggravation of its course.

Prevention of rosacea

In order to prevent the development of rosacea in people with a predisposition, it is necessary to follow a number of preventive measures:

• Choose the right skin care
• Avoid exposing your skin to too hot or cold water
• Avoid prolonged exposure to the sun and use creams with SPF
• Avoid cosmetics with hormonal and vasodilating components - steroids, alcohol, heavy oils
• Protect your skin from frost with thick creams
• Avoid exposure to steam (bath, sauna) and excessive physical activity
• Follow a diet containing large amounts of protein, vegetables and fruits, and dairy products. Avoid alcohol, smoked foods and fatty foods as much as possible.
• Timely detect the development of somatic diseases that can trigger a relapse of rosacea
• Visit a dermatologist once a year for a consultation and assessment of your skin condition.

Doctors at MC “Health” are convinced that the disease can be prevented or the severity of its symptoms can be reduced if you follow preventive recommendations and consult a dermatologist in a timely manner.

Unfortunately, the longer you wait to see a doctor, the more changes your skin undergoes. Scars and post-acne after rosacea are difficult to correct and can remain with a person for life. Don't wait, contact a specialist in a timely manner!

In our clinic, dermatologists with extensive experience are always ready to see you. You can take the necessary tests in our laboratory in order to get results as soon as possible. Sign up at any branch of the MC “Health” and receive qualified assistance in the treatment of rosacea.

Etiology and pathogenesis

There is no single point of view about the origin and course of the disease, but according to the most common one, rosacea is a disorder associated with disorders of capillary innervation, primarily trigeminal nerve dysfunction. This is a mixed type cranial nerve - the largest of the twelve and is responsible for facial sensitivity, because. consists of very sensitive nerve fibers. Possible causes of the disease:

• exogenous climate forcing;
• poor nutrition;
• pathologies that have developed in the upper layer of the skin;
• microbe epidermal staphylococcus;
• mites of the genus Demodex (rosacea-like demodicosis);
• disruption of the gastrointestinal tract (for example, gastritis or ulcers);
• weak immunity;
• oxidative stress – cell damage;
• increased anxiety;
• insomnia;
• severe irritability;
• negative emotions;
• individuality of body constitution;
• exposure to proteins (cathelicidins, etc.) that protect the primary skin barrier from infectious pathogens that regulate blood pressure;
• hereditary factors;
• endocrine dysfunction, pregnancy, menopause (a relationship has been established between hemodynamic parameters in extracranial vessels and the content of individual hormones in the blood).

Dystonia and spasms play a negative role in the development of rosacea. Due to disruption of innervation, blood vessels become clogged. Externally, this is manifested by redness of the face and vascular networks on it. The facial vein supplies blood to the conjunctiva, the outer layer of the eyeball, which is why ophthalmic rosacea develops.

Modern dermatologists disagree about the etiology of rosacea. For example, the connection between the appearance of microorganisms on the surface of the skin and primary symptoms has not been clearly established. It has not yet been reliably established why the use of antibiotics always alleviates symptoms and improves the general health of the patient.

Prevention

Along with treatment, preventative measures are also important. To prevent the development of rosacea, you need to avoid exposure to:

• sun and wind;
• unhealthy diet;
• harmful drinks;
• medicines;
• aggressive cosmetic procedures (peelings, surgical skin smoothing, rubbing, warming masks, etc.).

For prevention, specialists regularly prescribe short courses of antibiotics. It is recommended to constantly care for the skin with cosmetic products for gentle cleansing, moisturizing and protection from ultraviolet radiation (for sensitive skin). It is necessary to remember about the treatment of concomitant pathologies, especially diseases of the digestive tract. Getting rid of the consequences does not diminish the cause of the illness.