[vc_row][vc_column width=”2/3″][vc_column_text]By GIORGOS KIOUSI
Rosacea, also known as adult acne, is a chronic inflammatory dermatosis of the face with general characteristics of intense erythema and vascular dilation. It has been found that 5-10% of the population worldwide has rosacea. The exact reasons that cause rosacea are multifactorial, genetic and immunological. They are more susceptible if they have thin, transparent and fair skin. In this condition there is a malfunction of the glands that produce sebum (fat). Pathogenic microorganisms such as Propionibacterium Acnes and Demotex play an important role in the pathology of the disease. Mechanisms of vascular irritation (vasoconstriction and vasodilation) as well as the endothelial inflammation of the vessels (neoangiogenesis) contribute to the manifestation of the disease. Rosacea is common in both men and women who are in their fourth decade or more and have mostly light skin. Rosacea is not a dangerous disease, but it seriously affects the appearance and self-confidence of people who suffer from it. This inflammatory skin disease does not depend on the type of skin, and may initially appear as a transient redness in some parts of the face such as the cheeks, nose, forehead or chin. Dr. Efi P. Markou, Dermatologist-Venoresiologist, explains. Curator Karolinska Institute & Central Hospital of Karlstad, Sweden, Scientific Director Norsk Legesenter-Oslo, Norway.
Specialized in Environmental Dermatology & Allergology (Karolinska Institute-Enviromental Medicine), Specialized Dermatologist: Plastic Surgery Clinic – University Hospital of Örebro, Sweden, Member of scientific societies: EADV, SSDV, NFDV, NLF, ESCD, EDAE.
What are the symptoms of Rosacea?
Acne rosacea, in its initial stage, manifests as an erythematous dermatosis with vasculature and central facial erythema. In the second stage, there are papules and pustules, usually itchy, while there is intense seborrhea. A special form of rosacea is the tubercular form with persistent swelling and hyperplastic swelling of anatomical areas of the face, e.g. in the nose-rhinophyma. Finally, rosacea can affect the eyes with inflammation (blepharitis, conjunctivitis, keratitis, glaucoma).
What can the patient do on his own?
Beyond the personalized treatment plan, the patient must necessarily follow a specific treatment with special creams and facial care steps at home. There is a combination of environmental and lifestyle factors that affect the symptoms of rosacea. It would be good to avoid intense climatic changes of the microclimate, e.g. very high and low temperatures, hot food, hot water in the coke bath. Other situations that favor the flare-up of rosacea are strenuous sports activities and of course stress or anger.
Smoking does not help rosacea and can make it worse. It is also important to gently remove make-up so as not to irritate the skin. The use of a high protection factor is recommended even on sunny winter days. Many times the advice of friends and non-experts is wrong, especially when it comes to using topical corticosteroids (cortisone cream), hot or cold packs, and vigorous rubbing of the face with scrubbing devices.
How is the diagnosis made?
The diagnosis of rosacea is made by a Dermatologist after evaluating the clinical characteristics of the skin. New skin analysis technologies using e.g. polarized light, dermoscopy and appropriate medical lighting.
The etiology of rosacea has been associated with the presence of Demodex mites, and in particular the species Demodex folliculorum, present on human skin. Demodex folliculorum infection usually remains asymptomatic. With a direct preparation, the presence of mites can be identified in the doctor's office under the microscope.
It is important to rule out other possible diagnoses that cause a similar clinical picture (eg, discoid lupus erythematosus, allergic contact dermatitis, photodermatitis). The doctor's knowledge and experience guarantee early diagnosis and correct treatment, which is why we turn to a Dermatologist.
When does the patient seek the help of the specialist Dermatologist-Venoretologist?
Rosacea remains lifelong, as genetic and environmental factors act independently of time. Treatment consists of relieving the symptoms, not eliminating the disease. By regularly visiting a dermatologist twice a year, the disease can be kept in remission and severe flare-ups can be avoided.
How is rosacea treated?
The therapeutic approach follows the phenotype, i.e. the clinical picture of the patient, despite the staging of the disease. Treatment for a few days or weeks is not enough to treat the disease. The treatment can be local treatment, a combination of local treatment and oral treatment and finally a combination of these with personalized and specialized treatments in the clinic (chemical peeling, Laser, LED phototherapy, PDT-Photodynamic Therapy). Topical preparations with a therapeutic effect contain substances such as: azelaic acid, metronidazole, sodium sulfacetamide, sulfur, retinoids, benzene peroxide, ivermectin and the newer brimonidine. Oral treatment can be an antibiotic (mostly tetracyclines) and isotretinoin. On a smaller scale, antihistamines and nicotinamide, propranolol or clonidine are administered. The international guidelines for the treatment of rosacea suggest the combination of treatment regimens for optimal results.
What's New in Treatment for Rosacea?
Laser machines, pulsed light devices and LED phototherapy are modern tools for the treatment of erythema and telangiectasia. Short-wavelength lasers emit light, which is selectively absorbed through the absorption peaks of oxyhemoglobin (541 nm and 577 nm). This allows destruction of superficial vessels without collateral tissue loss.
In Laser technologies, the following are successfully used: pulsed dye lasers with a wider pulse duration at 595 nm, the pulsed KTP laser at 532 nm, the pulsed Nd:YAG laser at 1064 nm, the diode laser at 800-810 nm and the pulsed Alexandrite laser at 755 nm. Fractional carbon dioxide (CO2) lasers may also be useful for the re-formation of skin collagen and renewal in a non-invasive way, especially in the advanced phase of the disease.
In general, two to four laser treatment sessions are required to achieve the optimal result for rosacea, although the number of sessions is always determined individually. The newest therapeutic tool is LED (Light Emitting Diode) Phototherapy. In more detail, with the red light spectrum (633 nm) an anti-inflammatory effect is achieved, i.e. a reduction of inflammation, while with the blue light spectrum (415 nm) an antibacterial effect is achieved. LED Phototherapy is painless, effective and non-invasive.
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