To date, the problem of treatment is much better than the pathogenesis and etiology of rosacea. Therapeutic tactics depend to a large extent on the clinical type of the disease. However, the success of treating rosacea is based on the joint efforts of the doctor and the patient to identify provoking factors that are strictly individual. Most often they include meteorological factors: exposure to solar radiation, high and low temperatures, wind and related abrasive effects; alimentary: the use of hot and carbonated beverages, alcohol, spicy foods and excess food; neuroendocrine: emotional effects, climacteric syndrome and other endocrinopathies, accompanied by increased blood circulation in the pool of carotid arteries; iatrogenic, including both systemic drugs, erythema-causing individuals (for example, nicotinic acid preparations, amiodarone) and external preparations, including cosmetic preparations and detergents, which have irritating effect (waterproof cosmetics and toning preparations, the removal of which requires the use of solvents , as well as detergents containing soap). The exclusion or reduction of these factors significantly influences the course of the disease and reduces the costs of medical therapy.
The basis of therapeutic measures is to ensure adequate daily skin care. First of all, it includes sunscreen preparations. They should be selected taking into account the increased sensitivity of the skin of patients with rosacea. The least irritating effects are indifferent preparations (titanium dioxide, zinc oxide) blocking ultraviolet irradiation of the skin due to their physical properties. Preparations containing chemical ultraviolet filters that can be recommended for patients with rosacea should not contain sodium lauryl sulfate, menthol and camphor, and, on the contrary, should contain silicones (dimethicone, cyclomethicone) that significantly reduce the irritant effect of sunscreens and ensure their water resistance and low comedogenicity.
The basis for recommendations for daily skin care is the regular use of light in consistency, dyed green, obesity preparations for daily use. It is desirable to apply them in a thin layer 2 times a day and as a makeup base, which is preferably present in the form of a powder or agitated mixture. It must be remembered that the restoration of barrier functions is a very important component of rosacea therapy, which is characterized by increased sensitivity of the skin.
Currently, it is believed that external treatment is preferred for all types of rosacea, except for hypertrophic, in which the most effective are surgical treatment and systemic synthetic retinoids. Numerous comparative studies conducted in independent centers in compliance with the principles of evidence-based medicine demonstrated the absence of statistically reliable data on the superior effectiveness of systemic treatment. For example, it has been shown that the effectiveness of systemic administration of tetracycline antibiotics does not depend on the dose and frequency of administration of the drugs, and, apparently, is not related to their antimicrobial effect. The same applies to systemic applications of metronidazole, although it can serve as an alternative to tetracycline antibiotics in cases where the latter are contraindicated. Unsustainable were the assumptions about the effectiveness of metronidazole against Demodex spp., Which survive in conditions of high concentrations of metronidazole. These drugs, however, continue to be widely used, but their use is not authorized by organizations such as the Federal Office for Food and Drug Administration (FDA) of the United States. With lupoid rosacea, systemic tetracyclines are prescribed, there are indications of the efficacy of phtivazide.
The most effective is the combined use of external azelaic acid preparations with external preparations of metronidazole or clindamycin. There are numerous publications on the efficacy of tacrolimus or pimecrolimus. They retain their actual sulfur-containing preparations and benzoyl peroxide, although a side effect of these drugs is noted. At initial manifestations of the fimatose type of rosacea, monotherapy with isotretinoin in usual doses turned out to be the most effective. Whereas in the treatment of the formed rhinophyma, one can not do without the methods of plastic surgery, which are often combined with various thermal effects. In connection with this, modern photo and laser therapy deserve special attention. Sources of incoherent intense light radiation (IPL), diode, KTP, alexandrite and, most modern, long-pulse neodymium lasers based on alumium yttrium garnet (Nd; YAG lasers) are used. Laser treatment appears to be more effective and less expensive both with respect to telangiectasias (selective photothermolysis) and with respect to collagen reorganization due to thermal stimulation of fibroblasts, although it is often better to use IPL sources. In the treatment of hypertrophic type of rosacea, laser dermabrasion has recently taken one of the leading positions in sitting its safety.
As a physiotherapeutic treatment, the method of microcurrent therapy is widely used. Its effectiveness is mainly associated with the redistribution of fluid in the tissues of the face and restoration of lymphatic drainage. It was also noted that microcurrents effectively contribute to the restoration of the damaged skin barrier and prevent dissociation of the saprophyte microflora.