Rosacea is a chronic inflammatory disease that affects facial blood vessels, hair follicles, and sebaceous glands, commonly found in the central area of the face. Clinically, it is divided into four types: erythematous telangiectasia, papular pustule, hypertrophic hyperplasia, and ocular type. Skin lesions can present as transient or persistent erythema, telangiectasia, papules, pustules, and proliferative changes, accompanied by discomfort such as dryness, itching, tightness, and tingling sensation. Rosacea has a complex etiology and currently lacks specific treatment drugs, making it widely recognized as one of the most challenging skin diseases to treat. Due to its tendency to occur in women and mostly on the face, as well as having a certain degree of disfigurement, it has a certain psychological impact on patients. This article will take you to understand the different skin damage situations and related treatments of rosacea.
1、 Persistent erythema and paroxysmal flushing
1. Persistent erythema
The most common symptom in patients with rosacea is persistent erythema. Manifested as persistent facial erythema that does not completely disappear. For persistent erythema, alpha adrenergic receptor agonists (including alpha 1 and alpha 2) are usually applied topically. Representative drugs commonly used are 1% hydroxymetazoline hydrochloride cream and 0.5% bromomonidine tartrate, once a day. They not only constrict blood vessels but also have anti-inflammatory effects, mainly used for the treatment of persistent facial erythema in adult rosacea. But both are ineffective against capillaries, dilated capillaries, papules, and pustules.
2. Paroxysmal flushing
Some patients with rosacea may experience a burning sensation subjectively due to their dark skin color, making it difficult to detect flushing. Changes in the external environment and spicy and stimulating foods often cause patients to experience symptoms within seconds to minutes. Symptoms such as flushing, burning, dryness, and itching are often manifestations of skin barrier damage. Therefore, when patients with rosacea experience these symptoms, they should avoid triggering factors and pay attention to the use of skin repair agents.
2、 Capillary dilation
Patients with darker skin tones can use dermatoscopy to assist in determining whether capillary dilation has occurred. External medication has no significant effect on the treatment of capillary dilation. With the continuous development of optoelectronic technology, research has shown that optoelectronic therapy can effectively improve abnormal vascular dilation and proliferation.
1. Pulse dye laser: Energy is released in a pulsed manner, selectively photothermal effects act on blood vessels, and has effects such as damaging blood vessels and regulating endothelial growth factor, which can effectively improve capillary dilation. Research has shown that for linear capillary dilation, the combination of 595nm pulsed dye laser (10mm × 3mm, 3-5 weeks apart, 3 times in total) and 1% hydroxymetazoline hydrochloride cream (once a day) has a more significant effect.
2. Intense pulsed light: It is a non laser technique with multiple pulse modes and wavelengths (500-1200nm) that can reduce symptoms such as capillary dilation or hyperplasia.
3、 Papules and Pustules
Patients with rosacea usually have red papules in the middle of their face that are round in shape, and pustules that are needle sized superficial pustules. For the above skin lesions, topical and oral medications are usually chosen for treatment.
1. Metronidazole
Metronidazole is a broad-spectrum nitroimidazole antibiotic against anaerobic bacteria, with dual effects of anti demodex and anti-inflammatory. Topical metronidazole gel is effective in the treatment of papular pustular lesions and rosacea erythema. Cold compress of metronidazole and sodium chloride injection on the affected area for 15 minutes can improve redness, papules, and sensitivity symptoms.
2. Ivermectin
Ivermectin is a semi synthetic macrolide antibiotic with anti-inflammatory and insecticidal effects. The incidence of Demodex mites in patients with rosacea can be as high as 60% to 80%, and an increase in their number can worsen the symptoms of rosacea patients. Ivermectin cream can not only resist hair follicle and sebaceous follicle mites, but also improve the inflammatory skin lesions of rosacea.
3. Azeoic acid
Azeoic acid is a natural organic acid derived from the ozone decomposition of oleic acid. Azeoic acid treats rosacea by clearing reactive oxygen species and inhibiting the expression of inflammatory factors. 15% azelaic acid gel is safe and effective in the treatment of moderate papular pustular rosacea, and is superior to 0.75% metronidazole gel in improving inflammatory lesions and erythema.
4. Salicylic acid
Salicylic acid has anti-inflammatory and lipophilic properties. Research has shown that salicylic acid can not only improve skin barrier function but also improve the moisture and oil content of the stratum corneum, and has an effect on symptoms such as dryness, itching, pustules, and papules.
Rosacea is difficult to treat due to its complex etiology, long course, and easy recurrence. Currently, there is no single treatment method that can cure rosacea. Topical medication treatment is simple, convenient, and has good patient compliance. It can improve or treat patients with flushing, erythema, papules, and pustules as the main symptoms and signs. However, comprehensive treatment is needed for capillary dilation and proliferative changes.