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Video: Rosacea - Causes, Symptoms, Diagnosis, Therapy
Rosacea: causes & symptoms
Rosacea (acne rosacea, couperose, facial rose; phonetic transcription [roˈzaːt͜sea]) occurs more often in light-sensitive and fair-skinned people than in other skin types. Women get sick earlier and more often than men. Only the development of bulbous changes (phymes) occurs predominantly in men. The causes are not yet fully understood. The symptoms vary, depending on the severity, from temporary reddening of the skin to severe eye inflammation and bulbous growths…
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The mechanisms and causes of rosacea are still not fully understood. It is assumed that several factors interact, such as:
- Disorders of the innate immune system,
- UV radiation,
- local inflammatory reactions to germs in the skin (especially Demodex mites),
- Inflammation of the nerve tissue (neuroinflammation) as well
- Changes in vascular and possibly lymphatic regulation (e.g. hypersensitivity to spicy food, alcohol or abrupt temperature changes).
Rosacea occurs primarily on the face, especially on the forehead, nose, chin and cheeks ("centrofacial infestation"). The chest region, neck or scalp are also more rarely affected (“extrafacial infection”). The disease is characterized by a chronic, relapsing course.
Degrees of severity
Depending on the prevailing symptoms, the following degrees of severity are distinguished:
- Preliminary stage: At the beginning, volatile, attack-like redness (erythema) - so-called "flushes" - can occur, often as a reaction to various stimuli such as cosmetics (soap), heat or cold, UV radiation, spicy foods, alcohol, hot drinks or psychological ones Stress. The skin of those affected is easily irritated.
- Severity I: Those affected suffer from reddening that lasts for months (persistent erythema). Furthermore, telangiectasias ("enlarged veins"), burning, stinging, itching, dryness and flaking of the affected skin can occur.
- Severity grade II: A permanent reddening in the center of the face (forehead, nose, cheeks) with individually or grouped, usually symmetrically arranged, inflamed red nodules (papules) and pus-filled vesicles (pustules) is typical. Sometimes there is lymphedema. As the disease progresses, the entire face can be affected. In rare cases, the skin changes also spread to the scalp, neck, and chest. This severity can be similar to acne vulgaris, but there are no blackheads (comedones).
- Severity III: This form is characterized by growths (hyperplasias) of the connective tissue and / or the sebum glands, which occur locally in the form of bulbs (phyma) or diffuse. Phymas occur on the nose, chin / jaw, forehead, ear or eyelid. Men are preferably affected. The rhinophyma (also called bulbous nose, potato nose or - inappropriately - "drunkard nose") is particularly common, especially in men between the ages of five and six.
There are also various special forms of rosacea, for example:
- Ophthalmorosacea (ocular rosacea):A third to half of the patients with skin rosacea also develop eye involvement, with skin and eye symptoms being different in severity and occurring independently of one another. The focus is on a foreign body sensation, dry, burning or watery eyes as well as reddened and swollen eyelid rims as a result of inflammation of the eyelids (blepharitis) and dry eyes. Inflammation of the conjunctiva (conjunctivitis), the cornea (keratitis) - possibly with ulceration - and the iris (iritis) as well as hailstones (chalacia) or grains of barley (hordeola) can also occur. This can lead to temporary visual disturbances (blurred vision, increased sensitivity to light) up to severe visual impairment,which require surgical replacement of the cornea (keratoplasty).
- Rosacea fulminans: This maximum variant of the disease occurs within days or a few weeks only in young women on the face (on the forehead, cheeks and chin), more frequently during and after pregnancy. There are large, raised lumps, numerous pustules and increased sebum formation (seborrhea). In rare cases, fever and weight loss are observed. The disease is not prone to repetition.
- Therapy-related rosacea:In rare cases, so-called gram-negative rosacea can develop after months of rosacea therapy with antibiotics. This results in a selection of gram-negative germs (mainly Klebsiella, Proteus species, E. coli, Acinetobacter species, Pseudomonas species) that lead to inflammatory, pustular skin changes. A steroid rosacea can develop in the course of longer rosacea therapy with glucocorticoids. This is characterized by skin thinning (steroid atrophy), enlarged veins (telangiectasias), papulopustules, extensive reddening (erythema) and a feeling of tension in the skin. The clinical picture is accompanied by a massive skin colonization with Demodex mites. When the glucocorticoids are discontinued, the disease usually heals gradually after a temporary worsening of the disease.
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