What are the dangers of rosacea
The red danger
Doxycycline for inflammation
The authors of the guideline recommend that systemic therapy should be used in particular for severe as well as therapy-resistant lighter forms of rosacea. Tetracyclines, especially doxycycline and minocycline, are most commonly used. Doxycycline has a more favorable risk-benefit profile and is therefore preferable to minocycline. In addition to its antibiotic effect, doxycycline can inhibit the activation of kallikrein-related peptidases and thus reduce the formation of pro-inflammatory athelicidin fragments. As a result, it also has an anti-inflammatory effect.
The previously usual daily doses of 100 and 200 mg doxycycline should no longer be used, as there is a low-dose agent on the market that, due to its special galenics, achieves the same effects as the high dose. The hard capsules contain 30 mg immediately available doxycycline plus 10 mg doxycycline, which is released in a delayed manner (example: Orayzea® 40 mg). When used as intended, the drug is not antimicrobial, so that neither severe adverse effects, in particular gastrointestinal disorders, candidiasis, photosensitivity and hyperpigmentation, nor an increase in bacterial resistance are to be expected.
In several studies, the vitamin A acid derivative isotretinoin, applied systemically, was able to improve rosacea. The effect can be delayed. Isotretinoin led to a noticeable reduction in papules, pustules, erythema and telangiectasias. Even the reduction of rhinophyma could be achieved. In contrast to the usual dosage for acne, a lower dose of 10 to 20 mg daily is sufficient. Although isotretinoin has long been known as an effective drug for the treatment of severe forms of rosacea, it has not been approved for it and is used off-label.
Caution: Isotretinoin has a teratogenic effect! It is therefore contraindicated in women of childbearing age or may only be prescribed under strict conditions.
The combined use of topical and systemic therapeutic agents is particularly suitable for more severe rosacea. The combination of partially retarded doxycycline orally with the topical application of metronidazole or azelaic acid is recommended. Since rosacea as a chronic disease tends to recur after discontinuation of systemic treatment, one can try with metronidazole topicals to maintain the improved skin condition over a longer period of time.
With laser and light
Laser therapy can improve telangiectasia and erythema and can also be used ablatively for phyma. With telangiectasias the success is very good, with flat erythema sometimes less. The side effect rates are low for all procedures. Hypopigmentation, scarring, blistering, and pain have been reported rarely.
Another option is therapy with an intensive pulsed light source (IPL), in which a larger spectrum of wavelengths is used. This allows a larger area to be treated. The success rate corresponds to that of laser therapy.
Options for rhinophyma
Many patients suffer from having to justify themselves for years for their red, swollen nose. Sometimes they are mistakenly referred to as alcohol addicts.
The growths of the nose primarily require surgical procedures. Doctors used to take a very radical approach: entire parts of the nose were circumcised. That has changed today. So-called dermashaving and dermabrasion are somewhat older methods, but - in comparison to other methods - they can be controlled well. With the scalpel (dermashaving) and the milling cutter (dermabrasion), the skin thickening is removed in layers. The dermatologist takes care to model the "original" nose.
Procedures with ablative lasers are also used, especially for fine modulation of the nose. Complications are rare. Despite a lengthy healing phase, the success of the therapy - especially with regard to the psychosocial component - cannot be ignored. /
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