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Rosacea is an involuntary reddening of the skin that can be treated.
Rosacea is a chronic inflammatory skin condition that affects 7-8% of the Italian population. The age of onset is usually between 25 and 50 years of age, but sometimes it begins earlier (pubertal or post-pubertal).
Constant redness on the face is the most obvious symptom that can have major repercussions on daily life, relationships, and one’s self-esteem causing clear emotional distress.
The face, cheeks, nose, forehead, but also neck and chest are areas where rosacea redness has a symmetrical distribution and is usually its first developmental stage.
A characteristic sign of rosacea is rhinophyma, a benign pathologic change in the skin of the nose that causes it to take on a globular, “cocooned” shape due to hyperplasia and hypertrophy of sebaceous glands and skin nodules. In case of involvement of other skin areas, the term “phimatosis” is used.
Ocular involvement is evident in 50% of patients with rosacea: the conjunctivae, but also the corneas (in advanced stages) and eyelids may be affected.
Telangiectasias (persistent dilation of small blood vessels) are another characteristic sign of rosacea. There may also be the presence of papules, reddish in color, which tend to arrange in small groups and are rarely accompanied by pustules.
According to the severity of the disease, several stages can be identified:
The mildest stage characterized by redness on the cheeks and fine telangiectasias;
In the second stage there are small papules and pustules with also the presence of pus;
Lesions are more prominent and subcutaneous nodules also appear.
Acting early can lead to significantly important results because if you can intervene in the early stages of the disease you can stop its evolution.
Of course, it is also possible to treat rosacea at a stage where the disease is already advanced, but in this case the results, though good, are likely to be followed by recurrence. Especially in these cases it is strategic to combine physical therapy, which acts more concretely on the vasculature, reducing the erythema.
The forms of rosacea were described and defined by the American National Rosacea Society in the early 2000s.
It is important to act early; if this disease is treated at an already advanced stage, there will be less definitive chance of managing it most effectively.
This is because the triggers are all those stimuli that lead to vasodilatation and thus cause direct or heat-mediated vascular damage: intense emotions, alcohol or coffee, spicy and hot foods, but also temperature changes, transition from cold to hot, and sun exposure.
For the diagnosis of rosacea we can rely on primary and secondary criteria. The primary criterion is based on the presence of at least one of these symptoms: fleeting or persistent erythema, papules, pustules, telangiectasias; the secondary criterion is based on itching or burning sensation, dryness or edema of the skin, presence of plaques, ocular manifestations, lesions in peripheral areas (away from the face), and phimatosis.
Based on these criteria, the severity of the situation can be distinguished from four subtypes of rosacea:
Persistent presence of erythema, telangiectasias (“capillaries”), itching and burning. Flushing (flushing) on the face and décolleté can usually be frequently observed.
The skin tends to be very dry as well as very sensitive. Signs of this subtype may appear, in addition to the face, on the neck, décolleté and ears, sparing the periorbital area.
The name anticipates its characteristic, which is the presence of fimatosis and particularly rhinophyma. This rosacea mostly affects a male audience in old age and is characterized by thickening of the skin, irregular nodular aspects, and hypertrophy and hyperplasia of the sebaceous glands.
Important phimatosis can be seen on the nose (rhinophyma), but also on the chin (gnathophyma), forehead (metophyma), ears (otophyma) or eyelids (blepharophyma).
Sometimes this can be mistaken for common acne, as pustules and papules are present with erythema. In this case the most copied target is middle-aged woman and classically manifests with an acneiform rash and erythema on the face.
Conjunctivitis with dry eye, blepharitis, and photophobia are the most common symptoms. Because the eyes are more susceptible to infection, patients who show signs of Erythematous-telangiectasic and Fimatous rosacea often also have eye symptoms.
The etiology of rosacea is multifactorial and can be triggered by a combination of environmental and hereditary, psychological and immunological factors. In addition, rosacea may be susceptible to excessive sun exposure, stress, frequent transitions from hot to cold and vice versa, Helicobacter pylori infections, alcohol intake, and prolonged use of medications that dilate blood vessels, as well as hormones that seem to play a role in this disorder, which is often aggravated by taking oral contraceptives or the initial phases of menopause.
Treatment of rosacea involves both a behavioral approach (improving lifestyle) to eliminate or reduce triggers and physical therapy.
Based on the severity and various symptoms, the doctor will decide what would be the best approach to proceed and treat rosacea.
Rosacea treatments are noninvasive, painless, and allow the patient to return to his or her life routine immediately, with no recovery time, precisely because state-of-the-art technologies are used.
With enough treatments, this method can also completely eliminate redness and telangiectasias, although additional periodic maintenance treatments will be necessary in many cases to remove newly reformed capillaries.
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