Rosacea on the face: causes and treatment
Rosacea is a chronic dermatological disease that is accompanied by damage to the vascular network of the face. The pathology is manifested by redness and thickening of the skin, purulent rashes and a deterioration in the natural exfoliation process.
The disease takes on a chronic form with periods of exacerbation and calm. If there is no therapy, then rosacea can cause the formation of a pronounced cosmetic defect.
- What causes rosacea?
- Rosacea symptoms
- Swelling with rosacea
- Forms of rosacea
- How to distinguish rosacea from rosacea?
- Complications of rosacea
- Diagnosing rosacea
- Rosacea treatment
- After rosacea treatment, redness remains, what should I do?
- Preventing rosacea
- Is sunbathing allowed for rosacea?
What causes rosacea?
Until now, the exact cause of rosacea has not been established by scientists. Doctors used to think rosacea was a consequence of demodicosis. However, later it was found that these are two completely different diagnoses. Therefore, modern medicine classifies rosacea as a polyetiological disease. This means that several factors are capable of provoking its development at once.
People who have hypersensitive skin from birth are prone to rosacea: if it reacts too violently to such environmental factors as temperature changes, increased dry air and mechanical injury, then the risk of rosacea will be higher.
The following reasons can influence the development of the disease:
- The use of creams and ointments containing hormonal components. If a person uses such drugs too often and unreasonably, this entails a thinning of the skin and blood vessels, an increase in capillary fragility, which can trigger the appearance of rosacea.
- Diseases of the digestive system. Pathologies such as gastritis and duodenitis increase the risk of developing rosacea. Doctors have established a direct relationship between rosacea and Helicobacter pylori infection.
- Dermatological diseases. In terms of the occurrence of rosacea, contact and allergic dermatitis are dangerous, which contribute to the disruption of the normal state of the skin.
- Endocrine system diseases.
- Genetic predisposition. It has been proven that rosacea is 1.5 times more common in people who live in the North.
- Vegetovascular dystonia proceeding according to the cardiovascular type.
- People with red and light hair color are at risk for the development of rosacea, since their skin is highly sensitive.
- The entry of a woman into menopause can affect the onset of rosacea. Although rosacea occurs with the same frequency in women and men, during menopause, fragility of blood vessels increases, which can trigger the disease.
- Living in adverse weather conditions, when the skin is often exposed to frost and dry air, contributes to the development of rosacea.
Experts are sure that any negative factors that affect the body as a whole are capable of provoking the appearance of this disease:
- Postponed stress;
- Frequent contact with too hot or icy water on the skin;
- Regular drinking of alcoholic beverages;
- Sudden changes in ambient temperature and humidity.
During the period of bearing a child, women often develop a fulminant form of the disease. After delivery, such rosacea resolves on its own. The more often a woman becomes pregnant, the higher the risk of the disease recurring.
The main symptom of rosacea is red patches on the face. They appear immediately after a provoking factor has been exposed to the skin. The forehead and cheeks, nose bridge and chin redden. If a person has rosacea, then the spots do not go away for a long time, but in the early stages of the development of the disease, they do not give the patient any physical discomfort. It's easy to disguise them, just use a regular foundation.
As the disease progresses, the spots appear more often. Moreover, a slight effect on the skin of the face is enough to cause intense redness. In parallel, a burning sensation is added.
As the blood supply to the face area increases, this will provoke the activation of microorganisms that constantly exist on the skin. As a result, small bumps and pustules will appear on the face.
Depending on the stage of the disease, the following symptoms of rosacea are distinguished:
- Prerosacea. Erythema and hyperemia of the skin is transient.
- Vascular rosacea. Edema forms, ophthalmic rosacea develops with a transition to the eyelids, cornea and conjunctiva. Superficial vessels of the skin expand (telangiectasia), erythema becomes persistent.
- Inflammatory rosacea. Pustules and papules form on the face.
Late rosacea with rhinophyma formation. The entire surface of the nose becomes hypertrophied, which can disinfect a person's face. Most often, rhinophyma is observed in men. If you ignore this condition, then blindness may develop.
The further course of the disease leads to the fact that the skin becomes rough to the touch, thickens. The vascular mesh on the face is clearly visible, it is no longer possible to hide it with the help of cosmetics.
The final phase of the disease is called lupoid. The rash spreads to the area around the eyes and mouth. They are represented by spots and dark red nodules, capable of merging. Rosacea in its late stages resembles the symptoms of systemic lupus erythematosus.
Concomitant symptoms of the disease:
- Itching and burning in the area of the rash;
- Dry and tight skin;
- Feeling of "creeping" on the skin.
Swelling with rosacea
One of the manifestations of rosacea is facial edema. It develops regardless of the form of the disease.
The formation of edema leads to the expansion of blood vessels on the skin, which occurs for the following reasons:
- Eating spicy or spicy foods, drinking alcohol or very hot drinks.
- Pathology of the nervous regulation of vascular tone. This often occurs after a stroke or neurosis, as well as after a head injury.
- Hormonal surges.
- A parasitic or bacterial infection affecting the skin of the face.
It is possible that rosacea develops against the background of the simultaneous influence of several provoking factors. Therefore, edema is always present, but in the acute stage of the disease it is poorly distinguishable, since the inflammation of the skin is already very intense, and is also accompanied by the appearance of rashes.
Edema affects the following parts of the face:
- Wings of the nose;
- The skin around the eyes (against the background of the development of ophthalmic rosacea);
- Forehead and cheekbones (against the background of Morbigan disease).
Edema comes to the fore precisely in the rare Morbigan disease, which is a form of rosacea. The hypertrophied skin of the face contributes to the clamping of the capillaries and the failure of the venous outflow. If you press on sore skin, then dents remain on it. She herself has an unnatural color: from purple to bright pink.
Edema also causes pruritus, frequent hot flashes, abnormal epithelial proliferation and engorgement of the facial skin.
Only 10% of all patients with rosacea do not suffer from edema, in 90% of cases it does develop. Treatment is needed to reduce its severity. Otherwise, the disease will continue to recur and progress. Normal skin cells are gradually replaced by scar tissue, the face loses its usual appearance.
Forms of rosacea
Rosacea has several forms, each of which differs in the mechanism of tissue damage and the extent of the spread of inflammation. However, the appearance of acne is typical for all types of the disease.
Determining the form of rosacea allows you to choose the most effective treatment:
Episodic rosacea. With an episodic form of the disease, the skin on the nose and cheeks turns red. In this case, the patient indicates a feeling of heat and slight tingling in the face. These manifestations can intensify when sun or wind hits the skin.
The episodic form of the disease is characterized by periods of exacerbation and extinction. The classic course of the disease is accompanied by three stages:
Stage 1. Redness captures not only the cheeks, but also the chin and nose, telangiectasias are formed.
Stage 2. Telangiectasias become larger, redness intensifies, red papules with a diameter of 3-5 mm begin to form. The skin gradually hardens due to the proliferation of collagen fibers.
Stage 3. The redness takes on a purple hue, rashes, spots and vascular networks merge, which greatly changes the patient's appearance. Suppuration of the skin often joins, since the sebaceous glands are not able to work normally. Rhinophyma is a complication that most often develops at stage 3 of rosacea. The skin on the nose thickens, becomes dry, flabby, bluish and loose.
Ophthalmic rosacea. With this form of the disease, the skin surrounding the organs of vision suffers. First of all, the eyelids and eyebrows are involved in the pathological process. At the same time, the skin turns red and thickens. Inflammation of the mucous membrane of the eye is possible. This is accompanied by a burning sensation, cutting and pain in the conjunctival region. Excessive dryness of the eyes is possible. Rarely, but still possible, the development of blindness.
Granulomatous rosacea. Acne in this form of the disease is localized around the lips and eyes. At first, the rashes are single, but as the disease progresses, they are able to multiply and merge, forming bumps. Scientists have come to the conclusion that tuberculosis bacteria that have got on the face are capable of provoking this form of the disease. However, they are not sown in all patients.
Steroid rosacea. This form of the disease is a consequence of the irrational use of hormonal preparations for topical application. The most affected people are those who use fluoride corticosteroid ointments. The skin gradually becomes thinner, begins to peel off, then persistent hyperemia forms on it. If the patient at this stage of the development of the disease does not begin to receive adequate therapy, then rosacea progresses and goes through all three stages of development. Treatment of the steroid form of the disease often requires the use of hormones.
Conglobata rosacea. This form of rosacea often affects the female population of the planet. The reason is hormonal imbalance in the body or serious gynecological diseases. The face becomes covered with inflammatory nodules, but they are formed in small quantities. Over time, they merge, they can be complicated by suppuration.
Fulminant rosacea. This form of the disease is a type of rosacea conglobata. Only young girls suffer from it. Rashes appear on the skin in just a few days, quickly merge, and suppuration often joins. In some cases, it is possible to cope with the disease only with the help of a surgeon. At the same time, the state of health of the patients does not deteriorate, but the cosmetic defect forces the patients to immediately consult a doctor.
Gram negative rosacea. This form of the disease develops on the condition that microorganisms that are atypical for it have gotten onto the skin of the face and have taken root. We are talking about enterobacteria, Pseudomonas aeruginosa or Proteus.
Rosacea with persistent edema. This form of rosacea is also called Morbigan disease. The disease goes through only two initial stages of development. The skin does not undergo hyperplasia. The skin of the face becomes swollen, dry and smooth, rashes appear on it. Engorgement gradually occurs, which entails a change in the outlines of the face.
How to distinguish rosacea from rosacea?
Rosacea and rosacea are two different concepts. Rosacea is a disease that is characterized by a chronic course and manifests itself as defects in the skin, and subsequently leads to its coarsening. Couperosis is one of the symptoms of rosacea, but it can also develop on its own.
Cosmetologists often tell their clients about rosacea. By this term, they mean a thin, branched vessel that shines through the skin. Dermatologists often refer to this pathology as "telangiectasia". Although the difference in fact exists only in the names.
Couperosis can occur against the background of rosacea, or it can be triggered by other reasons:
- Persistent increase in blood pressure;
- Chronic liver disease;
- Violations of the autonomic nervous system;
- Facial skin care errors;
- Alcohol abuse;
- Expressed physical activity.
Couperosis cannot lead to the development of rosacea, but rosacea can provoke rosacea. As the disease progresses, the vascular pattern becomes more and more noticeable. With rosacea, itching and hyperemia of the skin join, and skin engorgement occurs. With rosacea, only the size of the vascular network increases. Therefore, these two conditions can be confused only at the initial stages of the development of pathology. To prevent this from happening, you must seek the advice of a dermatologist.
Complications of rosacea
Rosacea is associated with a number of complications:
- In the early stages of its development, rosacea can be complicated by increased dryness of the conjunctiva, sharp eyes. In the future, lacrimation may join. In this case, doctors indicate the development of ocular rosacea.
- The most formidable complication of the disease is characterized by damage to the cornea of the eye with the formation of ulcers and seals on it. If you ignore this condition, then it can lead to complete blindness of the patient.
Most often, the diagnosis is not difficult for the doctor. A standard examination is enough for a dermatologist to understand what kind of disease the patient has.
The following symptoms are of leading importance:
- The presence of acne in the affected area;
- Hyperemia of the skin on the cheeks and nose;
- Patient complaints of itching and hot flashes of the face;
- Pathological dryness of the skin.
Most often, the disease manifests itself in people over the age of 30. Gradually, the symptoms gain strength. Over time, a secondary bacterial infection joins, pustules appear.
It is not possible to stop the process with the help of anti-inflammatory drugs. A noticeable effect occurs only after the therapy is supplemented with antibiotics. Acne with rosacea does not spread to other parts of the body, but is localized exclusively in the face. Moreover, even the forehead, chin, neck and scalp are often not affected.
To make sure that the diagnosis is correct, additional research is needed. The same analyzes make it possible to establish the form of the disease.
Bacterioscopy. During the procedure, the doctor takes a swab from the patient's skin and sends it to the laboratory. There, a smear is examined under a microscope to determine the type of infectious agent. This method of diagnosis becomes relevant when the rash with rosacea is complicated by suppuration.
LHC seeding. This method is more accurate than bacterioscopy. The material obtained from the patient is placed in various nutrient media to determine which infectious agent is present on the skin.
Conducting a study on the sensitivity of microorganisms to antibiotics. This allows you to select the most effective drug and targeted treatment of the disease. The results of the antibioticogram will become known no earlier than in a week. Therefore, such an analysis is performed only for those patients for whom the first course of treatment with antibacterial drugs did not help. Most likely, they have bacteria on their skin that have developed resistance to a particular drug, so it needs to be replaced with a stronger drug.
Histological examination can distinguish rosacea from skin tumors. This method becomes relevant when the rash begins to merge. To conduct the study, a scraping from the patient's skin is required. The laboratory assistant examines the obtained material under a microscope and analyzes it at the cellular level.
Analysis for demodicosis. This disease is characterized by the colonization of the ciliary bed with mites. Rosacea and demodicosis often accompany each other.
To detect the parasite, one of the studies will be required:
- PCR for the detection of mite DNA elements in skin scrapings.
- Serological blood tests for the detection of antibodies to the tick.
- Examination of skin scrapings under a microscope to detect the parasite.
If, according to the results of the study, an ciliary mite was detected, then it is necessary to carry out specific treatment using ointments based on Metronidazole.
As a rule, after the diagnosis of rosacea is made, a number of other studies and visits to narrow specialists are required. This will allow you to identify the cause of the disease and eliminate it. Otherwise, rosacea will recur again and again. The dermatologist can refer the patient to a consultation with an endocrinologist, gastroenterologist, hepatologist, etc.
Additional examination includes the following procedures:
- Passage of FGDS for the detection of diseases of the upper parts of the digestive system. About 70% of patients with rosacea have gastritis, or stomach ulcers, or esophagitis.
- X-ray of the stomach (provided that it is impossible to perform EGD).
- Blood test for hormones. It's no secret that rosacea often manifests itself against a background of hormonal imbalance. Such a study allows you to identify various disorders in the hormonal sphere.
- Immunological tests assess the state of the immune system. Sometimes, to permanently get rid of relapses of rosacea, it is enough to strengthen local and general immunity.
Of course, not every rosacea patient will need to undergo all of the above studies. Most often, a standard examination and collection of anamnesis is sufficient. However, if the ongoing treatment does not give stable results, then it will not be possible to do without additional tests.
The earlier the patient turns to the doctor, the more effective the treatment will be. If the disease is neglected, more complex therapy will be required. This is especially true of the stages at which telangiectasias or rhinophyma have already formed.
To get rid of purulent rashes, the doctor recommends topical application of antibacterial ointments. If they do not have the desired effect, then systemic antibiotics are required.
Ointments used to treat rosacea:
- Most often, an ointment with Metronidazole in the composition is used to treat suppuration with rosacea. It is recommended to be applied to patients who have been diagnosed with demodicosis. It is also possible to use combined ointments, for example, Metroruboril. This drug is supplemented with extracts of medicinal herbs, therefore, it allows not only to eliminate the infection, but also promotes the regeneration of the skin. Metronidazole is applied to the affected area 2 times a day for several weeks.
- Ointment Erythromycin 2-4%. This drug is effective against gram-negative bacteria. The therapy is carried out for 14 days, but not longer.
- Tetracycline. This ointment for rosacea is rarely prescribed, only when, according to the results of the antibioticogram, microorganisms sensitive to this drug were found. The ointment should only be recommended by a doctor, since its independent use is fraught with the risk of side effects.
In parallel, you need to treat the skin with herbal tinctures that have an antiseptic effect. For example, thyme or chamomile.
Self-treatment of rosacea is dangerous with the development of complications, therefore, prior consultation with a specialist is necessary. If you ignore medical recommendations, then it is possible to form an abscess of the skin against the background of its suppuration. An abscess will require the help of a surgeon. The abscess is opened, cleaned and drained.
If the disease is in an exacerbation stage, then it is necessary to remove the inflammation. This usually takes several weeks. Further therapy is reduced to preventing recurrence of rosacea and to eliminating a cosmetic defect in the form of dilated blood vessels.
To get rid of telangiectasias, you can go through the following procedures:
- Cryotherapy. The skin is exposed to extremely low temperatures, which causes vasospasm. After several sessions, the dilated capillaries become overgrown.
- Laser therapy. It is an effective treatment for rosacea. If the disease is in the early stages of development, then the effectiveness of the procedure is equal to 95%.
An instant result cannot be achieved. However, after a few visits to the doctor, it will be possible to evaluate the first effect. The spots turn pale, the burning and itching disappear. If the treatment period for rosacea falls in the warm season, then sunscreen should be used before going outside.
After rosacea treatment, redness remains, what should I do?
Getting rid of such a rosacea symptom as facial redness can be difficult at times. It can persist even after all rashes and acne have disappeared.
The reasons why the redness does not go away for a long period of time may be:
Allergization of the body. With rosacea, the skin becomes vulnerable to any influence, including the effects of allergens. A variety of substances can provoke an allergic reaction: cosmetics, antibacterial drugs, skin care products, the use of certain foods. To make sure that redness after rosacea treatment is due to an allergic reaction, you need to go to the doctor's office. After finding out the reason, the doctor will prescribe a hormonal ointment to the patient, which will reduce the inflammatory response. It should be borne in mind that the application of corticosteroid drugs to the skin is possible only if rosacea has been completely eliminated. If the disease has not receded, then this can aggravate its course.
Accession of infection. Pathogenic microorganisms can provoke redness of the skin. Moreover, the presence of acne is an optional condition for the development of inflammation.
To get rid of the infection, you can use the following drugs:
- Application of Metroruboril, Tetracycline or Erythromycin ointment.
- Use of drugs Rosamet or Rozex.
Most often, dermatologists prescribe these drugs in the treatment of rosacea. Therefore, if the redness does not go away immediately after completing the course of therapy, it may just take time.
Skin changes at the morphological level. Morphological changes occur at the third stage of the development of the disease. The skin becomes rough, as it undergoes inflammation for a long time. Against this background, redness remains. You can get rid of the redness caused by morphological changes using laser therapy. The doctor removes the top layer of the epidermis without affecting the tissues underneath. Over time, a new epithelium is formed, which has a normal color.
Edema. Dense edema is characteristic of Morbigan disease. At the same time, the rash is absent, or it passes quickly, but the redness can persist for a long time. This atypical form of the disease requires specific treatment. There can be many reasons for redness on the face after getting rid of rosacea. To find out what exactly led to the problem, you need to contact a specialist. If necessary, the doctor will make adjustments to the treatment. Normally, the redness should disappear within a few weeks of starting therapy.
It is impossible to guarantee the absence of relapses of the disease, but the risk of their occurrence can be reduced. To do this, you should regularly undergo cryo- and laser therapy sessions.
To less often appear at a beautician's appointment, you need to follow the following recommendations:
- Avoid prolonged sun exposure. If this is not possible, then a sunscreen should be used.
- In winter, you should avoid hypothermia of the facial skin, protect it with special creams.
- You need to exclude spicy, fatty and fried foods from the menu, enrich your diet with vitamins A and E.
- All diseases of the digestive system should be treated promptly.
- Without a medical recommendation, ointments containing a hormonal component cannot be used.
Is sunbathing allowed for rosacea?
Sunburn can cause the development of rosacea, or provoke an exacerbation of the disease. If a person is under the sun for a long time, he receives an impressive dose of ultraviolet radiation. The skin of patients with rosacea is highly sensitive to such radiation, which contributes to the aggravation of the course of the disease.
Mutagenic effects of sunlight on the skin. The longer the skin is exposed to solar radiation, the worse its cells work. In them metabolic processes are disturbed, natural regeneration and protection suffer, the process of tissue engorgement is started. All this increases the risk of infection, which is the cause of increased inflammation, acne and suppuration. In addition, a failure in the regenerative processes at the cellular level can lead to the fact that the defects caused by rosacea cannot be stopped.
Expansion of small vessels. With rosacea, the capillaries expand, their permeability increases. As a result, some of the blood elements can leave their bed. This leads to the formation of redness and increased itching. The sun contributes to the fact that blood vessels are damaged even more, which negatively affects the course of the disease.
Reduced local protection. Ultraviolet light weakens the protective function of epidermal cells, which is favorable for the development of bacterial infections. If a person is infected with demodicosis, then a tan will increase the number of ticks. In addition, the risk of infection with staphylococci, Pseudomonas aeruginosa, streptococci, enterococci and proteus increases.
Cell death. When the sun is exposed for a long time, it can burn the skin. The cells that form the upper layer of the epidermis die. This increases the swelling, redness and itching of the face. The more often a person is exposed to this effect, the faster the disease will progress.
Dehydration of the skin. The fluid from the skin cells evaporates faster when exposed to sunlight. Even in healthy people, sunburn contributes to increased dryness of the skin. In rosacea patients, this negative effect is even more pronounced. In addition, not all moisturizing ointments and creams can be used by patients, as they have a higher risk of developing an allergic reaction. Therefore, you need to limit your time in the sun.
So, sunbathing is not recommended for people with rosacea, as this will provoke an increase in the symptoms of the disease. The effect of the sun on the skin should be moderate; it cannot be completely abandoned. After all, it is only under the influence of the sun that the body produces vitamin D.
Sun exposure tips for people with rosacea:
- You can stay in the sun until 11-00 am and after 18-00 pm. During this time, the activity of the sun's rays is minimal, and they will not harm the skin.
- If you have to stay in the sun for a long time, then you should use sunscreen. You need to choose hypoallergenic drugs.
- The face must be covered with a wide-brimmed headdress. Sun exposure to other parts of the body does not aggravate the course of the disease.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).