Those who are “lucky enough” to encounter a disease such as rosacea know very well how it can poison their lives. Symptoms, causes, facts and methods of treatment - Vasily Viktorovich Firsov, a dermatovenerologist-cosmetologist, a member of the All-Russian Society of Dermatovenereologists and a member of the All-Russian Association of Mesotherapists, talks about all this.
A little-studied and extremely unpleasant skin disease can ruin our existence - people cannot take a walk in sunny weather, they are forced to follow a diet, they stop liking their reflection in the mirror... Rosacea / rosacea / angioneurosis is a chronic skin disease that manifests itself as rashes on the face in the form of papules , vesicles and spots. A long-term disease is characterized by hypertrophy of the middle layer of the skin with increased production of elastin fibers - over time, these fibers are replaced by connective tissue and fibrosis begins to form. Externally, it is a lumpy skin structure with persistently enlarged pores and blood vessels.
The disease most often affects the skin of the face: it begins to grow from the nasolabial folds and spreads to the cheeks and wings of the nose in the form of dilated small vessels of the skin and rashes in the form of nodules and blisters (papules and vesicles). In some publications, doctors note complications of secondary flora, but in my practice I have never seen this - perhaps there really are patients in whom a complicated form of rosacea is manifested by pustular elements. But if this is a full-fledged pustular process, then the assumption is incorrect, and this is clearly not rosacea.
A change in the structure of the skin on the nose is called rhinophyma. In Soviet schools, even children knew what it was like, reading the story “Childhood” written by Gorky: “He (author’s note – face) was spoiled very much by his loose nose with swollen nostrils and red at the end.” This is the typical appearance of a formed process called rhinophyma. Medical science still does not know why such a process occurs at all. But the epidemiology is known: most often the disease occurs in fair-skinned and light-eyed women aged 30 to 50 years. Men get sick with rhinophyma extremely rarely, but if they do get sick, the process is much more severe. The most severe form of rosacea, ophthalmic rosacea, even affects the eyes, and men and women suffer from it in equal proportions.
Typology of Quincke's edema
Angioedema is classified based on the frequency of its manifestation, the presence or absence of complications and the mechanism of development. A reaction to external stimuli lasting 4-6 weeks is considered acute. Swelling for one and a half months or more is considered by doctors as chronic.
In the absence of complications such as urticaria, Quincke's edema is classified as isolated. When dermatitis is added, the disease acquires the status of complicated.
The mechanisms of development of the pathological condition allow us to talk about hereditary, acquired and idiopathic edema. The first is formed against the background of the patient’s genetic predisposition, the second becomes the result of a person’s interaction with an allergen. The idiopathic type of swelling does not have an established cause.
Forms and causes of the disease
Rosacea has only 5 forms, and they all vary in severity:
- erythematous: with a predominance of erythema - persistent redness of the skin;
- papular: accompanied by the almost constant presence of small nodules - papules;
- papular-vesicular: small bubbles filled with colorless cloudy liquid are added to the papules - vesicles;
- phimosis: accompanied by severe swelling, enlarged pores and hyperplasia of the dermis;
- Ophthalmic rosacea: the most severe form, which affects the eyes and eyelids.
Both the causes of the disease and the mechanisms of its development have not yet been fully studied. Reasons often given are:
- genetic factor (which, frankly speaking, gives me great doubts);
- dysregulation of vascular tone (this may very well be the case - rosacea is often combined with migraines);
- violation of lymphatic drainage;
- lymphostasis (also questionable, because patients with rosacea do not have swelling, unless during a period of severe exacerbation of the process);
- hormonal imbalance (exacerbation of the disease can begin simultaneously with menstruation or the onset of menopause);
- changes in the functioning of the sebaceous glands (and again, this is not a fact, because rosacea and seborrhea are completely different processes).
In addition, different roles are assigned to biologically active substances (hereinafter referred to as BAS), which are synthesized in immunocompetent cells (macrophages, mast cells) - such cells synthesize a huge number of inflammatory mediators.
For example, bradykinin and histamine. Bradykinin is an inflammatory mediator that is responsible for skin redness. An excessive amount of this mediator in the tissues leads to persistent dilation of small vessels, swelling and the formation of a red skin color. But why an excess amount of bradykinin is formed precisely in this zone, medicine does not know to this day. It can be assumed that the release of an increased amount of BAS occurs under the influence of stimuli that come from the central nervous system (hereinafter referred to as the CNS), but exactly which ones and why this happens is also unclear. One thing is clear - having received stagnation, we get the rest of the “pleasures”: the formation of inflammation and small nodules with blisters. If the inflammation in the tissues is prolonged, then their partial sclerosis occurs - that same hyperproduction of elastin fibers. As a result, the matter ends with fibrosis. And as another possible reason, I can add here cathelicidins - special proteins that negatively affect the internal vascular wall, which is confirmed by research.
However, there is no 100% evidence for this either.
Symptoms
The symptoms of Quincke's edema do not differ significantly. In most cases, the reaction is acute - the area of swelling becomes visible a few minutes after the patient interacts with the allergen. The pathology is localized in areas of the body with loose subcutaneous tissue, these include the eyelids, cheeks, lips, tongue, oral mucosa and the male scrotum. When swelling appears in the larynx, the patient loses his voice, breathing becomes wheezing and intermittent.
If the gastrointestinal tract is affected, acute intestinal obstruction may develop. In a similar way, swelling can affect the urethra when localized on the mucous membrane of the bladder.
Allergic swelling in half the cases is accompanied by dermatitis, severe itching and the formation of vesicles. The most dangerous complication of Quincke's edema - first aid is required within a few minutes - remains anaphylactic shock.
Patients under the age of 20 tolerate the pathological process relatively easily. Symptoms increase slowly and gradually subside (within 3-5 days). With the hereditary nature of the pathology, relapses become common. Their appearance is the result of injury to the mucous membranes, viral infections, consumption of alcoholic beverages, and taking hormonal or steroid drugs.
Provoking factors
A person who is struck by this disease is forced to give up a lot. The fact is that rosacea is provoked and aggravated by many aspects of our lives that we have never given importance to.
Smoking
Quitting smoking for such patients is no option. It is this bad habit that becomes one of the most powerful factors in the development of the disease.
Spicy and fried foods
Such food affects both seborrheic processes and rosacea. Therefore, patients should avoid such products.
Sun and solarium
Frequent visits to the solarium in winter (applies to our latitudes) or intense sunbathing are considered factors that aggravate the process. There's no time for sunbathing here anymore.
Chemical agents
Contact with them is often associated with a person’s professional activity - chemical agents that can get on the skin or emit intense chemical odors also provoke an exacerbation.
Medicines
Patients with rosacea should avoid medications containing bromine and iodine derivatives and be careful when taking topical steroids (taken to stop the exacerbation of the disease itself).
Decorative cosmetics
You also need to be very careful with this - decorative cosmetics that contain aggressive allergic components can be immediately thrown away.
Using it means provoking illness. During the treatment process, the patient must provide himself with the most gentle psychological regimen, sometimes even to the extent of changing jobs. Such patients should not experience neuro-emotional overload either at work or at home, because this greatly affects the disease. Sometimes viral infections also lead to an exacerbation of the process, but if you hear the phrase “let’s strengthen your immunity” from a doctor, know that the phrase is absolutely meaningless. The immune system can neither be strengthened nor weakened - it is the way we received it from nature, so we need to act differently.
Diagnostics
The clinical picture, characteristic of a pathology localized on the face, allows the doctor to quickly make the correct diagnosis. Difficulties arise when the gastrointestinal tract or breast cells are damaged. An allergist or therapist will need to conduct a differential diagnosis and establish the cause of swelling. This is facilitated by collecting anamnesis and identifying side effects from medications taken.
Patient complaints and medical history data make it possible to distinguish between hereditary and acquired types of edema. Often patients have to deal with an emergency team - angioedema with a risk of asphyxia requires the fastest possible action from doctors.
Treatment Options
Taking into account all of the above about the psychology of such patients, one of the necessary components of treatment here is long-term use of sedatives.
This includes valerian and sedative herbal infusions... If necessary, the patient must also take sedatives at night, which can be bought at a pharmacy without a prescription - the same afobazole, for example. I can say absolutely for sure - the better we eliminate the conflict between the parts of the autonomic nervous system (sympathetic and parasympathetic), the easier it will be to work with the process on the facial skin. Each of you can look at what recommendations are given on the Internet to people with this disease - among all of them you will definitely see the use of topical steroids, non-steroidal anti-inflammatory drugs and proretinoids. The last option is the most extreme, because proretinoids are quite toxic and, when taken, cause a lot of inconvenience to a person (dryness of all mucous membranes, a powerful effect on the liver, including changes in liver parameters in the blood). What you definitely haven’t read about, I’ll tell you myself - sometimes alternative medicine techniques (Voll diagnostics, autonomic resonance test) make it possible to determine the level of disorders in the central nervous system and restore the relationships between the departments of the central nervous system. Due to this, we may well get the process to subside, which, naturally, facilitates correction with the help of external means. With the help of ART-BRT, you can both determine the direction of searching for the organ that provokes such processes, and establish the levels of disorders in the body. Both can then be confirmed by laboratory tests or other methods - the same MRI. This will greatly simplify the doctor’s work when correcting the external manifestations of rosacea.
I won’t be conservative and say that sometimes you can’t do without working together with a psychologist, and one who knows how to work with the subconscious. And in general, any correction of underlying psychological problems, be it the help of a psychologist or ART-BRT, itself leads to a significant improvement in the patient’s condition.
Case from practice
About 15 years ago, a patient came to me for hair treatment.
Looking at her, I suggested treating rosacea - the severity of the changes on the skin was so strong that on a bright sunny day this woman could not appear on the street without an umbrella. All this led to a pronounced aggravation with all that it entailed - it was very difficult for her to live. I was lucky - at that time she was ready to work with only one specialist, so we started treatment. I included regular courses of mesotherapy, correction of the psychological state using ART-BRT and minimal correction with external medications. With mesotherapy, we received excellent results and did not work with a psychologist. The entire treatment took about 2 years, and this is considered a good result - sometimes a sudden exacerbation against the background of neuro-emotional stress ruins all plans for a bright future, which is why you have to start all over again. And this is also part of our work. Now this woman doesn’t even remember that she once suffered from a disease - she still sees me for the correction of aesthetic problems (after all, she first came to me 15 years ago!), but that she once her cheeks became a beetroot color with rashes that we had all forgotten. Rosacea is a chronic process, therefore, from the point of view of conventional medicine, it cannot be completely cured. Although my examples say the opposite. This process tends to occur with exacerbations, so when a person who was once cured comes to the doctor again, no one is surprised. And too much depends on the doctor here - for example, the use of proretinoids or topical steroids should be postponed as a completely last resort. And start from something completely different, in order to bring the patient’s psychological state back to normal and only after that deal with the correction of external problems.
It is important that you understand that there is nothing universal here. Since medicine has no idea where this disease comes from and how it is treated, the doctor has to draw up a strategy individually for each patient. Some will have to be sent to a psychologist, some will only be helped by the “last resort option” with proretinoids, and some will improve their condition with the help of ART-BRT. Be that as it may, try to stay with one specialist who will save both your appearance and psychological state. Rosacea contains too little that is pleasant and too much that poisons a person’s life. Therefore, the sooner you take action and work through this journey hand in hand with your doctor, the sooner you will begin to live life to the fullest again.
Relief of symptoms
Treatment of Quincke's edema begins with eliminating threats to the patient's life. The fastest way to restore airway patency is tracheal intubation. Against the background of an allergic reaction, a child or adult is given antihistamines and glucocorticoids. For this reason, relatives or friends of a person experiencing angioedema should call the ambulance service as quickly as possible.
Pathology of a hereditary nature requires a different approach to treatment. The patient needs fresh frozen plasma, antifibrinolytic drugs, and local glucocorticoids. If a person suffering from edema has contraindications to the use of antifibrinolytics, doctors prescribe an individually selected dose of tranexamic acid.
Treatment of angioedema with drugs
For each form of angioedema, specific drugs are used.
Their selection is carried out by the attending physician with preliminary consultation of specialists (if necessary):
- endocrinologist;
- allergist;
- surgeon;
- otolaryngologist;
- cardiologist;
- gastroenterologist;
- parasitologist;
- oncologist;
- rheumatologist.
Treatment tactics for angioedema include:
- relief of acute conditions;
- prevention in the current period of remission;
- long-term preventive measures.
Therapy for hereditary edema involves both non-drug measures and the use of medications. The first involves providing respiratory functions through tracheostomy or intubation.
Medicines for HAE and PAO are approximately the same (dosage and choice are made by the attending physician):
- C1 inhibitors;
- firazir;
- fresh frozen or fresh plasma;
- antifibrinolytics;
- danazol and analogues or methyltestosterone.
Antihistamines are ineffective for HAE. Treatment of AO of an allergic nature and non-allergic C1 inhibitor without pathology has its own characteristics.
Before prescribing medication:
- A hypoallergenic diet is prescribed.
- Medicines that may cause the disease are discontinued and replaced with others if necessary.
- Infectious and inflammatory processes of other origins identified during the examination are stopped.
The basis of the medicinal part of treatment is third generation antihistamines:
Second generation drugs can also be used:
- Rupatadine;
- Ebastine;
- Cetirizine;
- Fexofenadine;
- Loratadine;
- Levocetirizine;
- Desloratadine.
These pharmaceutical forms can be used for a fairly long period. The best effect is noted when they are used during the period of remission. First generation drugs are not recommended for use without additional indications in a specific case.
The reason is multiple side effects. Glucocorticosteroids are recommended in cases of severe disease. If there is a threat to life, the administration of adrenaline is recommended.
Questions and answers
What to do if Quincke's edema suddenly develops - first aid at home can save a person's life?
The person should be seated or laid down in a comfortable position and an unobstructed flow of fresh air should be ensured. You can place a towel soaked in cold water on your forehead and cheeks. If you have antihistamines in your home medicine cabinet, you should give them to the victim (if you have difficulty swallowing, you can grind the tablet into powder). The next action is to call the ambulance service.
First aid for eyelid swelling
Quincke's edema is a condition that can be fatal. Therefore, at the first symptoms, you must immediately call an ambulance. It is necessary to consult a doctor even if the patient seems that allergic swelling of the eyelids does not threaten his life, and the signs are mild. Before the paramedic arrives, the patient must be given first aid.
A person who has swelling of the eyelid should be placed on a bed or sofa. It is necessary to provide access to fresh air, that is, open the windows. If the victim was dressed during the formation of edema, you need to remove his clothes. Chains and other jewelry should also be removed to prevent them from scratching your neck. Quincke's edema of the eyelids often causes stress in the patient. If this happens, then he needs to be reassured and explained that a doctor will arrive soon and provide him with qualified assistance.
Next you need to give an antihistamine. The dose should not exceed the recommended one, so you must follow the instructions. If there is no medicine for allergies, you can drop Naphthyzin into your eyes or nose. This is a vasoconstrictor drug, also effective for swelling. If the reason for the formation of Quincke's edema on the eyelids is unknown, all possible irritants should be removed. In the absence of antihistamines, you can give the patient several tablets of activated carbon. It is better to dissolve them in water first. Coal can be replaced with Polysorb sorbent.
If swelling in the eyelid occurs after intramuscular injection of a drug or an insect bite, then the patient needs to apply a tourniquet or a pressure bandage. If this is not possible, a cold compress should be applied to the affected area. This will help slow down the spread of the allergen due to vasoconstriction.
