acne rosacea

acne rosacea

Pink acne is a chronic inflammatory disease of the sebaceous glands caused by constitutional angiopathy, neuroendocrine disorders and dysfunction of the digestive organs. Frequency – 4-5% of patients (most often women 30-50 years old) who applied to a dermatologist. Etiology. Endocrine and vegetative-vascular disorders (dysfunction of the thyroid or sex glands), diseases of the gastrointestinal tract, leading to angioedema with peripheral circulatory failure. Sometimes the chronic course of the disease is supported by a mite that lives in the sebaceous glands – the gland (Demodexfolliculorum).

Risk factors

• • Insolation, overheating
  • stressful situations
  • Excessive consumption of alcohol, coffee, tea, spices
  • Hypothermia.

Clinical picture

• • There are 3 stages in the development of rosacea
  • I (erythematous) stage: hyperemia appears, which is aggravated by heat, excitement, and spicy food. Telangiectasias gradually appear (a characteristic sign is blanching of the affected vessel when pressed)
  • II (papular-pustular) stage: against the background of congestive erythema with telangiectasias, plaques with many pustular elements are formed from confluent red nodules, upon opening of which purulent exudate is released, shrinking into crusts
  • III (infiltrative) stage: the skin thickens, inflammatory infiltrates, voluminous nodes are formed, from which pus can be released when pressed.
  • The process is localized on the skin of the nose, cheeks, rarely forehead. If the growths in the nose become significant, then a pineal nose (rhinophyma) is formed.
  • The disease is often combined with blepharitis, uveitis, seborrheic dermatitis of the scalp and eyelids.

Research methods

• • Biopsy: inflammation within the hypertrophied sebaceous glands with the formation of papules, pustules; lack of comedones, telangiectasia and lymphocytic infiltration of the skin
  • Examination for Demodex fo/liculorum.

Differential Diagnosis

• • Drug allergic rash (for example, after taking iodides and bromides)
  • SLE
  • Carcinoid syndrome
  • skin candidiasis
  • acne vulgaris
  • Seborrheic dermatitis.

Treatment:

Lead tactics. Restoration of microcirculation processes in the skin (xanthinol nicotinate), correction of disorders of the digestive organs (enzyme products [festal, digestal, mezim forte, panzinorm forte, salt-zim], with colon dysbacteriosis – hilak-forte, bifidumbacterin, acilact), elimination of foci chronic infection. Course treatment with multivitamins with a predominant content of vitamins A, E and group B contributes to the rapid regression of elements. Drug therapy is complex and pathogenetically substantiated, taking into account the stage of the process and concomitant diseases.

• • Antibacterial therapy: metronidazole 0.25 g 2 r / day for 10-14 days or tetracycline 500-1000 mg / day
  • Tetracycline is contraindicated in pregnant women, children under 8 years of age
  • Tetracycline can cause photosensitivity, therefore it is recommended to avoid sun exposure
  • Tetracycline is not prescribed simultaneously with antacids, dairy products and iron products
  • Broad-spectrum antibiotics can reduce the effectiveness of oral contraceptives, recommend the temporary use of barrier methods of contraception.
  • With severe infiltrates and inflammation – glucocorticoids (prednisolone 25-30 mg / day for 1-2 weeks with a further gradual dose reduction until complete withdrawal).
  • In torpid and severe cases, the use of retinoids (retinol palmitate or isotretinoin 0.1–0.5 mg/kg for 4 months) is likely
  • Isotretinoin is contraindicated in pregnant women and women of reproductive age who do not use reliable methods of contraception; may also have a hepatotoxic effect.
  • Local therapy is carried out taking into account the stage of the disease
  • In an acute process – resorcinol, boric, tannin lotions
  • As the process subsides – pastes with tar, ichthyol, sulfur
  • 10% benzyl benzoate ointment or suspension
  • Metronidazole (1% ointment or 0.75% gel) should be applied in the morning and at bedtime after cleansing the skin
  • Ointments with erythromycin or clindamycin
  • Glucocorticoid ointments are used with caution (probably an increase in the skin process); recommend ointments that do not contain fluorine. Surgical treatment is indicated for rhinophyma.

Complications

• • Rinofima
  • Conjunctivitis
  • Blepharitis
  • Keratitis.

Current and forecast. Slowly progressive course, sometimes there are spontaneous remissions. The prognosis, subject to the regimen and adequate treatment, is favorable. Pregnancy. Oral isotretinoin and tetracycline are contraindicated. Taking isotretinoin during pregnancy can lead to the development of an embryopathic syndrome (multiple anomalies of the auricle, micrognathia, cleft palate, damage to the aortic arch, hydrocephalus). An inherited isotretinoin-like embryopathy is known (243440, p).

Prevention

• • It is necessary to observe a sparing regime: prolonged exposure to the sun, visiting a bath, working outdoors and in rooms with a high temperature are not recommended.
  • Showing a diet with a restriction of spices, smoked and salty foods, chocolate, coffee, cocoa, fatty broths and the exclusion of alcoholic beverages
  • The use of cosmetic products based on oils and fats is contraindicated. Synonym. Acne red

See also Blepharitis, Uveitis, Acne vulgaris ICD. L71 Rosacea