Rosacea is a common chronic inflammatory dermatosis that affects the global population, showing higher incidences in western countries. Patients may present with recurrent flushing, erythema, telangiectasia, papules, or pustules on the nose, chin, cheeks, and forehead. Typically diagnosed between the ages of 30 and 50 years, it affects both genders, but it is more common in women, with a higher occurrence of phymatous changes in men. Moreover, rosacea tends to be more prevalent in fair-skinned individuals than in those with darker skin tones.
There are 4 internationally recognised subtypes:
1. Erythematelangiectatic Rosacea (ETR)
This subtype is characterized by central facial redness, along with telangiectasia and flushing. Individuals may exhibit only one of the mentioned signs and symptoms, and commonly, these symptoms can be exacerbated by factors such as hot beverages, spicy food, alcohol, sunlight, and heat. It's important to note that your skin type is sensitive and irritable; therefore, adopting a proper skincare routine is crucial to prevent the progression of symptoms.
2. Papulopustular Rosacea (PPR)
Also known as 'classic rosacea,' this subtype manifests with papules, pustules, and erythema (redness) on the central face. The erythema is typically persistent, accompanied by episodic breakouts of papules and pustules. This subtype is often mistaken for acne. However, a key differentiation lies in the fact that Papulopustular Rosacea (PPR) occurs after precipitating factors such as spicy food or hot weather. It is distinct from acne as it lacks comedones but exhibits telangiectatic vessels.
3. Phymatous Rosacea (PR)
Phymatous changes are easily identified by the thickened and uneven skin on the nose, displaying an irregular surface and nodularities caused by fibrosis and hypertrophy of sebaceous glands (Oil glands). This condition, often referred to as the 'cauliflower nose,' primarily affects the nasal area but can also manifest on the malar area and chin. It is more prevalent in men, and most patients have been affected for many years. Treatment options for phymatous changes include isotretinoin, laser resurfacing, and surgical intervention.
4. Ocular Rosacea (OR)
The ocular manifestations of rosacea are typically nonspecific, presenting with symptoms such as a burning sensation, stinging, itching, or watering of the eyes. Additional signs may include photosensitivity, telangiectasias of the lid margin or conjunctiva, and erythema around the eyes. Interestingly, children experiencing styes are more prone to developing rosacea in adulthood.
Causes of Rosacea
The exact causes of rosacea are not fully understood. Known factors contributing to its development include genetics, immune reactions, microorganisms, environmental factors, and neurovascular dysregulation. Additionally, exposure to ultraviolet (UV) radiation is identified as a trigger for rosacea. Among microorganisms, Demodex mites (Face Mite) seem to play a role in rosacea, as they are found in higher numbers on skin affected by rosacea.
***Demodex is a type of mite living inside of human hair follicles.
Know A Little More
Demodex mites are tiny eight-legged parasites that primarily inhabit hair follicles and oil glands on your face, neck, or chest. There are two species commonly found on humans: Demodex Folliculorum and Demodex Brevis. Despite the initial alarm, Demodex infestations typically remain asymptomatic and harmless. However, they may take on a pathogenic role and cause demodicosis only when present in high densities or due to immune imbalances.
The presence of a Demodex infection often goes unnoticed until symptoms such as skin redness, acne-like eruptions, inflamed papules, and pustules develop. Dermoscopy, skin scraping, or a skin biopsy under a microscope are required for an accurate diagnosis.
The association between acne-like demodicosis and Demodex infestation has been established in certain clinical studies. As adolescents age, increased androgen secretion, the maturation of sebaceous glands and proliferation of Propionibacterium acne lead to pubertal acne. The maturity of sebaceous glands may heighten the likelihood of Demodex infestation. The damage to hair follicles and sebaceous glands caused by the multiplication of Demodex mites coincides with pubertal acne, potentially exacerbating the symptoms. Conversely, Demodex infestation may directly contribute to the pathogenesis of adult acne-like demodicosis.
The treatment for mite infestation typically involves using a cream, gel, lotion, or wash containing an acaricide, such as benzyl benzoate, crotamiton, metronidazole, permethrin, and salicylic acid. While it's not possible to completely wash or scrub away all Demodex mites, you may help prevent infestation by maintaining clean skin. It is advisable to avoid thick, greasy skin products that can clog pores with skin cells and oil. Moreover, follow a skincare routine of washing your face twice a day and gently exfoliating your skin once a week to remove excess oil and dead skin cells, which can serve as nutrients for the mites.
What is The Treatment Options Available For Rosacea?
In this article, let's primarily focus on erythematelangiectatic rosacea and papulopustular rosacea. Maintaining good hygiene and adopting an effective skincare routine, including the use of moisturizers and sunscreens, is crucial to prevent rosacea. Adequate moisturization helps prevent the trans-epidermal water loss often associated with rosacea. Topical treatments, such as metronidazole 1% cream and azelaic acid 15% gel or 20% cream, can be beneficial. Current systemic therapies encompass oral antibiotics, beta-blockers, and isotretinoin. Tetracyclines, a class of antibiotics utilized in rosacea for over 50 years, have shown efficacy in numerous clinical studies, particularly for Papulopustular Rosacea (PPR).
Procedural Therapies Available In Dream Clinic
Various forms of lasers have been employed in treating rosacea, especially for telangiectasia, as medical therapy yields limited effects. At our Dream Clinic, we are excited to introduce our innovative and cutting-edge technology, the Fotona SP Dynamis NX Line, for managing rosacea. This laser utilizes the long-pulsed neodymium-doped aluminum garnet (Nd:YAG) laser, known for its safety and ability to target deeper vessels, effectively delivers heat to the red pigment in blood without impacting surrounding structures. Nd:YAG has demonstrated efficacy in improving vascular lesions in rosacea and reducing facial erythema.
Moreover, polynucleotide injections, such as Plinest and Rejuran, derived from trout and salmon, respectively, have gained prominence. Polynucleotides exhibit positive effects on wound healing and regeneration, skin barrier protection, hydration, vascular stabilization, and anti-inflammation. They are also known to accelerate the repair of damaged DNA caused by ultraviolet B (UVB), a factor that can trigger rosacea. Notably, studies have demonstrated that the combination of polynucleotides with energy devices, including lasers, radiofrequency, and LED, produces a synergistic effect. This not only aids in managing facial erythema but also improves pigmentation and reduces scar size.
Conclusion
Currently, no single modality exists to cure rosacea, necessitating treatment tailored to individual symptoms and the severity of the condition. While rosacea is considered benign, it may induce substantial psychosocial distress, potentially resulting in a decreased quality of life. At Dream Clinic, we offer effective treatments in a comprehensive manner to help you achieve long-lasting relief from the symptoms of rosacea. We invite you to schedule a consultation with us to discuss your specific concerns and develop a personalized treatment plan!
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