Related articles: Rosacea
Definition
Rosacea (acne rosacea) is a chronic inflammatory disease of the skin, which mainly affects the central part of the face (cheeks, nose, chin and forehead).
The causes of the onset of rosacea are unknown, but it is considered probable that it is due to a fragility of the capillaries of the face, due both to a genetic predisposition, and to environmental and lifestyle-related causes. The involvement of follicle mites ( Demodex folliculorum ) and an infection with Helicobacter pylori has also been hypothesized.
In most cases, rosacea affects adults (30-50 years) with a light complexion. Aggravating factors are emotional stress, cold or hot climate, the ingestion of spicy or spicy foods, physical efforts, wind, cosmetics, the consumption of hot or alcoholic drinks. Furthermore, those who have the habit of smoking, drinking too many coffees or frequently using saunas and Turkish baths are predisposed to rosacea. Certain drugs, especially contraceptives and cortisones, are also responsible for a vasodilator effect on the capillaries. Finally, sun exposure increases the inflammatory nature of the problem and makes the defect more evident (heat causes vasodilation).
Most common symptoms and signs *
- Redness of the face
- Burning eyes
- Conjunctivitis
- Edema
- Erythema
- Fotofobia
- Eyelid swelling
- Tearing
- Bulbous and reddened nose
- Eyes reddened
- papules
- itch
- Pustules
- Telangiectasia
- Hot flashes
Further indications
Rosacea is characterized by a reddening of the face, associated with telangiectasia (dilation of superficial blood vessels, which become visible on the nose and cheeks), papules and pustules. The appearance of redness on the face may be accompanied by burning, heat and slight swelling. In the most serious cases, there is a thickening of the skin, which sometimes becomes particularly evident above and around the nose, which appears bulbous and swollen (rhinophyma). Some symptoms of acne rosacea can also develop on the neck, scalp and ears. In addition to skin problems, the disease can cause eye and eyelid symptoms (ocular rosacea): dryness, burning sensation, swelling of the eyelids, redness of the conjunctiva, heightened sensitivity to light and tearing.
Acne rosacea tends to have a progressive course, so the symptoms tend to worsen over time. Four sequential phases are generally recognized. The pre-rosacea phase can start with flushing and a tendency to blush easily, often accompanied by an annoying tingling sensation. In the vascular phase, patients develop erythema and edema of the face with telangiectasias. An inflammatory phase follows, during which papules appear (small red bulges) and pustules (pads filled with pus). During advanced rosacea, the redness of the skin and the number of visible blood vessels increase. This last phase of rosacea is also characterized by a coarse tissue hyperplasia of the cheeks and nose (rhinophyma) due to tissue inflammation.
Due to the progressive course of rosacea, early diagnosis is important and treatments tend to be more effective if started earlier.
Diagnosis is based on clinical evaluation. In moderate and severe forms, the disorder sometimes takes on an appearance similar to acne vulgaris, but differs from this essentially in the age of onset (adult rather than pubertal) and the absence of blackheads (blackheads). The differential diagnosis must also be made with regard to systemic lupus erythematosus, photodermatitis and drug eruptions.
Treatment can control and reduce the signs and symptoms characteristic of rosacea. Therapy implies avoidance of the triggering factors (important is the use of sunscreens) and generally involves the use of oral and topical antibiotics (eg metronidazole and azelaic acid). Some forms can be attenuated by vascular laser treatments (eg Dye laser and KTP), pulsed light (IPL) and photodynamic therapy. Furthermore, for severe rhinophyma forms, surgery (dermabrasion and tissue excision) may be indicated.
