الفهرس 
RosaceaOnly 14 pages are availabe for public view
 |  | from | 150 |  |  |
| | | from | 150 | | |
Abstract
Rosacea is a common chronic cutaneous disorder characterized by flushing, persistent erythema, papules, pustules and telangiectasia that are usually confined to the central portion of the face. It occurs mot often in fair-skinned females between 20-60 years old.
The cause of rosacea remains somewhat a mystery. Several factors have been implicated in its pathogenesis including; vasculature, climatic exposure, matrix degeneration, chemical and ingested agents, pilosebaceous unit abnormalities, microbial organisms, psychological factor and immunological factor, however, none of these theories alone can explain all cases of rosacea.
In addition, the blood vessels are innervated by substance (P) containing fivers and it is well established that the cutaneous substance (P) containing sensory fibers are associated with blood vessels and are responsible for mediating antidromic phenoma such as vasodilation.
There are four basic stages of rosacea; the first stage or pre-rosacea stage, the second stage or the vascular stage, the third or the inflammatory stage, the fourth or advanced stage.
Rosacea was also classified into four broad subtypes: erythemato-telangiectatic, papulopustular, phymatous and ocular, which helps to find the proper treatments for each subtype.
Rosacea was found to have several variants including granulomatous rosacea, rosacea fulminans, steroid rosacea, extrafacial rosacea, persistent edema of rosacea and rosacea conglobata.
Histopathology of rosacea varies according to the stage. In erythemato-telangiectatic rosacea, a sparse perivascular lymphohistiocytic infiltrate is accompanied by dermal edema with elastic venules and lymphatics. Severe elastosis may be present. Similar features are found in the papulopustular subtype, but the inflammatory’ infiltrate also surrounds hair follicles and sebaceous glands. Phymatous rosacea is characterized by prominent elastosis, fibrosis, dermal inflammation, sebaceous hyperplasia and hypertrophy of sebaceous follicles. Demodex folliculorum mites may be found in all types of rosacea within the follicular infundibula and sebaceous ducts.
Patients with rosacea may have several complications including; psychological complications with feelings of low self-esteem, ocular complications like punctuate keratitis, corneal infiltrates, ulcers or marginal keratitis which can be severe enough to cause loss of vision or require corneal replacement and malignant changes with rhinophyma, including basal or squamous cell carcinomas.
Rosacea should be differentiated from other cutaneous diseases including; acne vulgaris, seborrheic dermatitis, photodermatitis, perioral dermatitis, contact dermatitis, pityrosporum folliculitis. dermatomyositis, sarcoidosis and systemic lupus erythematosus.
Long-term treatment of rosacea is required. The choice of treatment depends primarily on the severity of the disorder and range from avoiding the factors that can trigger a flare up, to the use of surgery for rhinophyma. Many patients could be successfully treated with topical agents such as metronidazole, azelic acid and sulfacetamide agents. The addition of oral tetracycline, metronidazole or isoretinoin enabled physicians to treat those with severer or persistent cases, as well as to control papulopustular rosacea and ocular rosacea and to arrest the progress of rhirnophyma, however, no medical therapy can reverse erythema or visible telangiectases.
A variety of different laser systems have been reported to be effective in the treatment of telangiectasia and erythema. These include PDL, Nd-YAG laser, Argon laser, Copper Bromide laser, Krypton laser and KTP laser.
The aim of this study was to compare the effect of Nd-YAG laser and PDL on erythemato-telangiectatic rosacea, both clinically and immunohistochemically for cutaneous substance (P) expression.
Fifteen patients with erythemato-telangiectatic rosacea were treated by 1064 nm Nd-YAG laser on the right side of the face at fluence 22 J/cm2, 18 mm spot size, 10 ms pulse duration and 595 nm PDL on the left side of the face at fluence 12 J/cm2, 6 ms pulse duration and 7 mm spotsize for three sessions at four weeks interval.
Each patient was photographed before and after each session using the same camera and in the same light source to compare the degree of erythema and telangiectasia on both sides of the face and also cutaneous expression of substance (P) was assessed before and after laser treatment on both sides of the face.
Eighty six percent of patients showed significant improvement after one month of PDL treatment and ninety three percent showed significant improvement after 1 month of Nd-YAG laser treatment. In addition, there was a significant decrease in substance (P) expression after treatment on both side of the face with a significantly lower substance (P) concentration after Nd-YAG laser than after PDL. The positive correlation between the decrease in erythema and telangiectasia scores and the decrease in substance (P) concentration supports substance (P) involvement in the pathogenesis of rosacea.
In conclusion, this work supports the use of Nd-YAG laser and PDL as safe and effective measures in the treatment of erythemato-telangiectatic rosacea. Both types of laser decrease facial skin sensitivity by decreasing the intensity and concentration of substance (P) in the skin, an effect which is more pronounced with Nd-YAG laser. Further studies are needed to determine the ideal maintenance schedule of laser treatment to maintain a rosacea - free interval and to evaluate the effect of other types of laser on cutaneous expression of substance (P) and other neurogenic mediators in rosacea. Studying the effect of using different parameters on such an expression is also warranted.