Treatment of rosacea

The rosacca and 'an idiopathic cutaneous disorder, a chronic course, characterized by a clinical point of view from various evolutionary phases, which are different degrees of gravity'. 

The point of departure of rosacea and 'represented by a strong REACTIVITY' vascular level cephalic district, which is expressed through a particular tendency to flushing (pre-pink) and the consequent formation of teleangiectasie. Proceed with time, these issues may increase - with teleangiectasie presence of diffuse erythema and persistent - and most injuries associated with 'proper character of inflammation, type papulopustoloso, for edema, and during most' late hardening and thickening of the skin until under extreme hyperplasia given by rinofima. In about half 'of cases you can' be a concomitant ocular involvement, although it is often misunderstood and underestimated, with disturbances of various kinds. Since the etiology of rosacea and 'unknown, treatment is based on principals of type symptoms, which are an indication to the phase of clinical dermatitis. Rather frequent e 'pero' the observation of recurrences at a distance variable from the suspension of drug treatment. 

Next to the targeted medical treatment or surgery, and 'required the adoption of preventive measures aimed at avoiding the risk of self dermatitis and worsening of the party-specific triggering factors (drugs, thermal stress, spices, alcohol, topical irritants, and other ). In typical forms-pustular papules are effective oral tetracycline, which reduce the inflammatory component and also acting on the ocular complications. Their mechanism of action and 'still unknown, although it is considered that the therapeutic effects mainly result from a' anti-infiammatoria/antiossidante. Among the oral tetracycline is usually the preferred minocycline and doxycycline for the most's easy daily frequency of administration (single or double) and the lesser interference of food sull'asssorbimento. 

Typically, these molecules are taken in full dosage for the first 3-4 weeks and then you make a reduction in the dosage according to clinical response. Are contraindicated in pregnancy and in cases of hepatic or renal insufficiency, and can induce skin pigmentation, and photoallergy phototoxic reactions, gastrointestinal disturbances and Candida vaginitis. 

Other proposed oral antibiotics for the treatment of rosacea are clarithromycin and erythromycin, while the topical antimicrobial substances are included, in addition to tetracycline, erythromycin and clindamycin also. Metronidazole and 'synthetic nitroimidazole derivative that is active in rosacea is topical to that for systemic (250 ing bid orally for about four weeks). Also the agent for this mechanism of action in rosacea, and 'unknown, although there are statements about its properties' antioxidants. Metronidazole topical and 'available in two different concentrations: 1% cream and 0.75%, in the form of gels, and recently also in cream. 

Clinical studies have demonstrated the effectiveness of the product formulation of the gel to 0.75% and 1% cream in proportions of patients with rosacea varying from 68 to 96%. The safety 'and' good, and the only side effects observed on different populations of study and clinical practice are limited to the presence in some cases of mild local reactions of entities'. Metronidazole topical may 'also be associated with oral therapy in most cases,' severe, which requires a systemic shock therapy to achieve more 'fast. At the same time, the use of topical metronidazole would be valid even in the long term in preventing recurrence of rosacea and to maintain remission induced by previous treatments. 

In cases not responding or even as a first approach, especially in severe forms papulopustolose can 'be useful to use of isotretinoina average daily dose of 0.5 mg / kg. In several clinical experience, however, the daily dosage used, and 'was extremely variable, as well as the duration of therapy. (12 to 28 weeks). The answer seems, at least in part, is not closely related to dose. A significant clinical improvement involves the inflammatory lesions, the shearing component edema and rinofima, while smaller or much delayed effects are sull'eritema. The results are maintained for a variable time after the end of therapy, with a follow-up generally negative after one year of suspension, but not's infrequent occurrence of relapse, as also occurs with other treatments used in our rosacea.

Experience a treatment with 0.5 mg / kg / day of oral isotretinoin for 8 weeks and 'sufficient to cure most patients. The drug is tolerated very well, and cheilitis and dry skin mucus-are almost's constant. About the mechanism of action in rosacea of isotretinoina you can 'assume that at least in part be due to the effects of anti-inflammatory drug. It's s not known whether the action sebostatica can play an important role or only secondary to the clinical response, as in rosacea, unlike of acne, not' demonstrated a significant pathogenetic role of the sebaceous glands or iperproduzione of sebum. Isotretinoin and 'can also exert various effects on the immune system that may contribute to its mechanism of action. 

Can not be 'ruled out that the drug may stabilize function' microvascular, as the action on these structures has not yet been well elucidated. Even forms and combined granulomatosis and rinofima seem to respond well all'isotretinoina hearing. However, in rinofima isotretinoin particolarirnente would be effective if used with the same doses as those of acne, but for more time 'long. A rare complication of rosacea, the lymphedema can 'be treated in the opinion of Jansen and Plewig with isotretinoin (0.1-0.2 mg / kg / day) for 24 months, possibly associated with chetotifene. 

Would have been even more alternative treatments used on small case studies and uncontrolled manner. As regards oral therapies include, for example, experience with spironolactone in patients of male and with dapsone in granulomatous forms. 

Other principals are topical alternative: Azelaic acid 20%, permethrin and thiabendazole. Although the association between rosacea and Helicobacter pylori infection is still controversial, some authors believe that the eradication of the bacterium may have significant effects on dermatitis. The treatment of elective rinofima mode is done through 'various types of surgery (laser therapy, cryotherapy, dermabrasion, electrocautery, surgical excision of pathological tissue) while teleangiectasiche lesions respond to treatment with vascular lasers. Among those most's recent introduction, we mention the laser diodes with a wavelength of 810 nm, which has a good profile of efficacy and tolerability'. 

A precaution to be taken in patients with rosacea and 'abstention from the use of topical corticosteroids, which can cause a worsening of the dermatitis. The only form of rosacea in which corticosteroids are given and 'the rosacea fulminans. Defined in the past "pyoderma face ', and' a rare variant of rosacea, very debilitating to an aesthetic point of view, which affects female subjects, often in eta 'postadolescenziale with iperseborrea base. It's characterized by a sudden onset and the presence delI'eritema persistent, and above all of teleangiectasie of inflammatory lesions (papules and nodules) confined to the face and tending to confluence. 

The disease does not relapse if treated properly. Is very sensitive all'isotretinoina oral, associated in the early stages to systemic or topical corticosteroids to induce a more 'rapid and impressive improvement inflammatory component. Some Authors suggest to use for 2-4 months, a dose of 0,2-0,5 mg / kg / day, gradually increasing it if necessary ', while on systemic steroids are administered for 10-14 days at full dosage (prednisone 0.5 ~ 1 mg / kg / day) and then reduced gradually. 

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