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DERMATOPATHOLOGICAL INSTITUTE

DR. PABLO UMBERT

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ROSACEA

Rosacea is a chronic skin disease which can sometimes develop in the eyes as well. Symptoms include redness, pimples and in more advanced stages, the thickening of the skin. In most cases, rosacea only affects the face. They are lesions that resemble acne, but differ from it by the age in which it appears and that no blackheads develop. Typically, this redness ("hot flashes"); show up spontaneously or it may be due to stress, after drinking hot beverages, alcohol, eating spicy foods or a sudden climate change from cold to warm. Being a chronic disease, it has periods of exacerbations ("flares") and more stable periods.

It is a common skin disease and occurs mainly to people between 30 and 50 years of age. It is more common in fair-skinned women.

Why does it develop?

The exact cause is not known. It has been linked to multiple factors, one of which is genetic predisposition. It has also been seen that people with rosacea have a facial vascular hyper reactivity. A mite called Demodex Folliculorum; which appears in the hair follicle is related to the development of the disease. The sebaceous glands play a significant etiopathogenic role. It has also been associated with other factors such as the use of topical or oral corticosteroids, psychological factors, sun exposure and the presence of a bacteria in the stomach called Helicobacter Pylori.

There are multiple triggers, including:

  • Hot/cold weather or wind
  • Sudden changes in temperature
  • Hot drinks, spicy food, fermented cheeses and alcohol
  • Sun Exposure
  • Anxiety and stress
  • Prolonged use of topical corticosteroids
  • Some women may notice the disease onset or worsening during menopause

Types of Rosacea

Rosacea is classified into 4 subtypes

  • Erythematous, telangiectatic, in which redness dominates (erythema) in the center of the face especially forehead, cheeks and chin. Small blood vessels called "telangiectasias" may also develop as well as hot flashes.
  • Pustular Papules, when spots or pimples show up over the red zones.
  • Rhinophyma, is common in older men. The skin around the nose thickens.
  • Ocular, when there is inflammation of the eyelids (blepharitis), and inflammation of the conjunctiva of the eye (conjunctivitis). These can cause itching, a foreign body sensation in the eye and intolerance to light (photophobia).

Treating Rosacea

There are many treatments available, so the correct treatment to use will depend on the clinical manifestation presented by the patient.

In mild cases, topical treatments such as metronidazole, azelaic acid, ivermectina and some of the anti acneic drugs are used. Individualized formulation with different active ingredients and excipients for sensitive skin are superior to standard pharmaceutical products. There are cases of intolerance to any external topical product.

For more severe cases, oral drugs are used. The most commonly used drugs are antibiotics such as tetracycline and its derivatives and oral metronidazole. In extremely severe cases, isotretinoin can be used at low doses.

To improve the small vessels that appear on the face, different laser therapies can be performed. The colorant pulse dye laser has improved the recalcitrant vascular telangiecatatic rosacea. For the granulomatous anddeformingrhinophyma there are several surgical methods or laser treatments as well.

Outbreak Prevention

Apply a sunscreen with sun protection factor greater than 30 on a daily basis. Avoid topical steroids in the facial region. Also avoid triggers such as: alcohol, hot foods, spices and other stimulants.

The skin is more sensitive, in some cases, you mayneed to avoid using irritating soaps and cleaners containing alcohol, and exfoliating agents, among others. Cosmetics with green pigmentation are available to camouflage redness.

Currently, the available treatments are: cryosurgery, electrosurgery + spoon, surgical excision, photodynamic therapy, laser surgery, topical immunomodulators, drugs etc.

Doctor Pablo Umbert

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