Facial redness, burning and tightness, dryness, pimples, eye irritation and nasal enlargement can all be symptoms of rosacea. The most recognizable is the redness of the face, but this picture is only one of the many faces of rosacea. Its different forms have different treatment approaches, which is why their correct recognition is key to successful therapy. Food, drink and our lifestyle also affect the course of the disease and making changes to these are part of a comprehensive approach to dealing with rosacea.
THE FACES OF ROSACEA
In the medical classification of rosacea, four forms are distinguished, which can be combined with each other – erythemato-telangiectatic, papulo-pustular, ocular and phymatous.
The first form of rosacea (erythemo-telangiectatic) is the most common and the changes associated with facial redness predominate. They can be temporary or permanent. Temporary redness, usually provoked by factors such as cold, heat, alcohol and others is known as flush or transient erythema. It can be accompanied by subjective sensations – burning, pinching, tightening and stretching. Over the years, episodes of redness become more frequent and it can become permanent – persistent erythema. Against its background, dilated blood vessels in the central part of the face and cheeks often make an impression.
The second form of rosacea (papulo-pustular) can easily be mistaken for acne. Pimples on the face are predominant – raised red or purulent, hence the name papulo-pustular rosacea. They are concentrated in the central part of the face, and the surrounding skin, as a rule, is red – overlapping with the first form.
The ocular or ocular form of rosacea is difficult to recognize, as it may be its only manifestation. Irritation and tearing of the eyes, redness of the conjunctiva and eyelids without changes in the rest of the face often lead to repeated visits to the ophthalmologist without thinking in the direction of rosacea.
The phymatous form of rosacea affects men more often and is represented by the growth of sebaceous glands, most often in the nose, which leads to its progressive enlargement.
The condition is called rhinophyma and causes a significant deterioration in the quality of life due to the association of the large red nose with excessive alcohol consumption.
REASONS FOR THE APPEARANCE OF ROSACEA
Behind the many faces of rosacea are many factors, which is why it is classified as a multifactorial disease. The causes of the development of rosacea are divided into “internal” and “external”. Of the internal ones, genes play a key role – they are inherited, and often patients share that one of their parents is “the same as them” in terms of redness. Other internal causes are the dysregulation of molecules in the skin. These lead to an imbalance and the appearance of some of the symptoms such as redness and dilated blood vessels. The collection of microorganisms that live on the skin of all of us is called the microbiome, and it is altered in some patients with rosacea.
Without the internal factors, the influence of the external alone will not lead to the appearance of a disease. For this reason, they are referred to as triggers or triggers. The most important of the external factors are UV rays. Other triggers are sudden temperature changes, consumption of alcohol and spicy foods, smoking, physical activity, mental stress. Just as all these factors affect the disease, so does rosacea affect the lives of patients. Although it has no impact on general health and is mainly considered a cosmetic problem, forms of rosacea significantly impair the quality of life. Therefore, its early recognition is key to successfully dealing with the problem.
TREATMENT OF ROSACEA
The treatment of rosacea is concentrated in combating the symptoms and excluding the provoking factors. We cannot change our genes, but we can change some of the factors that influence them. The solutions that medicine offers start with creams for local use and reach the use of surgical methods.
LIFESTYLE CHANGES ARE THE FIRST LINE OF ROSACEA TREATMENT
Stopping smoking, as well as avoiding alcohol consumption, in addition to having many other positive health effects, are also an effective measure to limit the manifestations of rosacea, in particular the complex redness. The consumption of spicy foods is a prerequisite for the appearance of a flush and should be eliminated from the diet. Hot showers, saunas and similar procedures with extremely high temperatures have the same effect as the consumption of hot drinks or alcohol – they dilate blood vessels and lead to redness, even in people who do not suffer from the disease. Living a more relaxed lifestyle and avoiding strong emotions is rarely something we have complete control over, but if we can reduce stress, it would also improve the picture of rosacea.
Sun exposure for patients with rosacea should be kept to a minimum, and every time you go outside, the use of a sunscreen with the highest factor is a must. Cosmetic measures do not end only with sun protection – suitable gentle washing products twice a day are highly recommended, and in case of dryness, the skin must be hydrated. There are lines of cosmetics designed specifically for people with rosacea and this makes it easy to choose the right product.
AFTER LIFESTYLE CHANGES COMES DRUG THERAPY
When all lifestyle measures are taken there is usually some improvement in condition, but this is rarely satisfactory. Then comes the turn of the dosage forms and apparatus procedures for the treatment of rosacea. In inflammatory forms, antibiotic and acaricidal creams are used, which soothe the face and the purulent pimples wither. For the prevention of flushes, blood medications from the beta blocker group can be taken. There are also creams containing vasoconstrictor medications that can be applied immediately before an important event to prevent flushing at inopportune times. In phymatous forms with tissue growth, surgery and ablative lasers are the only remaining options. Physical methods also have an important role in the treatment of rosacea. These include IPL and non-ablative laser procedures. IPLs reduce overall redness and inflammatory forms of rosacea, as well as reduce skin reactivity. In order to achieve a visible and lasting effect, several consecutive visits are required, as well as maintenance therapies.
LASERS – A MODERN AND EFFECTIVE METHOD FOR THERAPY OF THE MOST COMMON FORM OF ROSACIA
Nd:YAG lasers are a non-invasive method to remove dilated blood vessels on the skin of the face and reduce persistent redness. There are two approaches – elimination of individual dilated vessels and complete treatment of the face. Facial capillary laser treatment uses single pulses of high energy that are absorbed by the blood. This energy is released in the form of heat, which destroys the blood vessels. The procedure is highly effective and even with just one visit, a visible and satisfactory effect is achieved. In the complete treatment of the face, a fractionated laser beam is used, which constricts the small blood vessels, and also stimulates the release of collagen in the subcutaneous tissue. So, in addition to reducing overall redness, the fractionated laser tightens the skin and has a rejuvenating effect. Laser radiation also soothes inflammation and successfully deals with purulent pimples on the face. The absence of a recovery period and the duration of the procedure of 20 minutes make it easily performed during the lunch break. And here, as with IPL, several consecutive visits and periodic maintenance therapy are required.
EARLY AND CORRECT DIAGNOSIS BY A DERMATOLOGIST WITH CHOICE OF APPROPRIATE THERAPY ARE KEY TO THE TREATMENT OF ROSACIA
The many faces of rosacea are why it sometimes remains hidden for years or is mistreated. The more advanced the disease is, the more difficult it is to influence treatment methods. Even the most effective drugs and lasers do not help if they are not used correctly. For accurate diagnosis and treatment, a visit to a dermatologist is key. The specialist will give all the necessary information to deal with the problem – from lifestyle changes to the appointment of drug therapy and apparatus procedures. Only then can we be sure that we have taken the most effective measures to deal with rosacea.