Feb 1, 2023 –

Rosacea

Rosacea

The diagnosis and treatment of rosacea is one of the specialties of Prof. Steinkraus, who is also a member of the German Rosacea Aid.

Rosacea is an inflammation of the skin on the face that can affect virtually anyone of any gender due to a genetic predisposition or genetic factors. Those affected are usually middle-aged, but rosacea occasionally occurs in very young and very old people. Rosacea can occur acutely within a few days, but most often it develops over weeks and months and becomes chronic. The inflammation manifests as redness, small papules and pustules, and occasionally, as the disease progresses, small sebaceous gland growths in the central regions of the face, particularly on the nose, forehead, cheeks, and chin. Rosacea is an inflammatory skin disease that is non-infectious and therefore not contagious. It is excellently treatable. A confirmed diagnosis is a prerequisite for effective therapy.

Manifestations and progression of rosacea

Rosacea is a non-infectious inflammation of the facial skin that manifests as redness, small papules, and pustules (pimples and pus-filled spots) on the face. These skin changes primarily affect the central areas of the face, such as the nose, cheeks, forehead, and chin. They are almost always asymptomatic, meaning there is no burning sensation, pain, or discomfort.

Rosacea is typically divided into 3 stages:

  • Stage I
    An early form of rosacea in which the skin is permanently reddened due to an increase in the number of dilated blood vessels. When there are more dilated blood vessels in the skin, more blood flows through them, which explains the persistent redness (rosacea telangiectatica).
  • Stage II
    The inflammatory form of rosacea, in which papules and pustules, i.e. small inflammatory nodules (pimples) and pus-filled spots, occur particularly in the central areas of the face (rosacea papulopustulosa).
  • Stage III
    The maximum severity, which is characterized by sebaceous gland proliferation (usually on the nose) and swelling of the facial skin.

Difference to acne

Rosacea is an acne-like inflammation, but has nothing to do with acne. Acne is an inflammation of the sebaceous glands that begins with blackheads (comedones) and typically occurs in young people during puberty. Because acne is triggered by male hormones (androgens), it primarily affects men, although women (women also have androgens) can also develop severe acne. Acne also affects all areas of the body rich in sebaceous glands, including the face, décolleté, and upper back. None of this is the case with rosacea. Rosacea is usually a disease of the facial skin only, occasionally also affecting the eyes and/or scalp.

Age at first signs of rosacea

Rosacea affects people of all genders, with a slight predominance in women. Symptoms usually first appear between the ages of 20 and 50.

Causes of rosacea

The causes of rosacea are unknown. It is believed that there is a genetic predisposition that favors rosacea.

Provoking factors of rosacea, i.e. what leads to the outbreak of the disease and what irritates or worsens rosacea?

The direct reasons why rosacea breaks out are unknown. A genetic predisposition alone is not a cause for the disease. Causes of an outbreak can include stress, hormonal factors or even incorrect skin care with products that irritate the skin. What is certain is that rosacea is irritated by events that affect the skin's vascular system, i.e. which are vasoactive. These include excitement and stress or emotionally stressful situations, thermal stimuli such as cold or heat (e.g. saunas), hot or spicy foods, alcohol or cleaning or skin care products that irritate the skin. The sun also generally leads to a worsening of rosacea through heat or by dilating capillaries or blood vessels in the skin. The heat from the sun's rays increases blood circulation in the skin and thus promotes inflammatory processes in the skin.

Treatment of rosacea

  • Stage I
    Early forms of Roasacea, characterized by redness and dilation of capillaries (blood vessels in the skin), can only be effectively treated with appropriate laser therapy. All other therapies (e.g., treatments with creams that stimulate alpha-adrenergic receptors in the skin's blood vessels with the goal of constricting them and thereby improving redness) have not proven effective, despite appropriate concepts. The white streaks on the skin resulting from the therapy are also cosmetically disturbing, do not solve the problem, and are therefore even counterproductive. Meditative therapies such as autogenic training or psycho-vegetative rhythmization are certainly useful, but usually fail because it is difficult for those affected to learn the therapies effectively and then implement them regularly. This requires a great deal of time, peace, and leisure. These approaches can therefore only be recommended as complementary measures.
  • Stage II
    The inflammatory form of rosacea with papules and pustules is excellently treatable. With proper treatment, complete healing usually occurs. If this is not done, either the treatment is incorrect or the diagnosis is incorrect. Treatment with anti-inflammatory creams and creams against infestation by the hair follicle mite Demodex folliculorum has proven effective. While this mite is not the cause of rosacea, it is often involved in the inflammatory process. A standard therapy, for example, is a cream containing metronidazole (e.g., Metrocreme) in the morning and a cream containing ivermectin (e.g., Soolantra Cream) in the evening. In addition, this form of rosacea must be treated with tablets from the very beginning. Anything else is a waste of time. Creams alone can slightly improve this stage of rosacea, but they cannot cure it. Tetracyclines or isotretinoin (off-label) are available as tablets. I prefer isotretinoin for various reasons and it is excellently tolerated, but it must be discussed in detail with a dermatologist and closely monitored.
  • Stage III
    This stage can also be treated excellently, namely with isotretinoin tablets and, if necessary, with ablative surgical measures or even with surgical laser procedures.

Medical cosmetics for rosacea

A relatively unknown but extremely effective adjuvant treatment for rosacea is manual therapy with anti-inflammatory masks containing nicotinic acid, which train the skin's circulatory system. This active ingredient, in combination with certain massage techniques on the facial skin, causes brief, very pronounced redness due to dilation of the skin's blood vessels. After removal of the mask, a reflex constriction of the blood vessels occurs (reflex vasoconstriction), which goes beyond the initial state. As a result, the face is less red a few hours after the medical cosmetic treatment than before the treatment. The effect is impressive and permanently trains the vascular system of the facial skin.

Special features of rosacea

Couperose is a special form of stage I rosacea that never progresses to stages II or III. It is treated in the same way as stage I rosacea. Rarely, rosacea of ​​the eyes (ophthalmorosacea) can be treated only with cleansing rinses and tablets (tetracyclines). Isotretinoin is less effective in this case, but can be used in individual cases. Also rare in rosacea are small, inflamed, reddened or reddish-yellow, occasionally slightly glassy nodules, which represent a special form of rosacea (rosacea granulomatosa). This form has a prolonged, somewhat more persistent course and can usually only be improved with isotretinoin. Another rare special form of rosacea is the severe rosacea fulminans, which must be treated with cortisone and isotretinoin and whose therapy should be carried out exclusively by specialists who are extremely familiar with the treatment of rosacea and the possible side effects of the therapy.

Care for skin prone to rosacea

During acute flare-ups, rosacea must be treated as described above. However, during symptom-free intervals, rosacea-prone skin can be gently cleansed and cared for normally like any other skin, ensuring that the skincare is free of irritating ingredients, especially aggressive emulsifiers. This should be the case with most modern, carefully formulated skincare concepts. Likewise, during symptom-free intervals, rosacea-prone skin usually tolerates serums containing vitamin A, vitamin C, and hyaluronic acid well. However, as always, vitamin A should be applied cautiously and gradually, and then only in the evening.