This disease, which has been seen more frequently in our society recently, is also known as “laughing disease” among the people. It is a skin disease characterized by recurrent redness, hot flashes, acne-like blisters, inflamed blisters and superficial vascular enlargement called telangiectasia, seen on the cheeks, nose, chin and forehead. In the initial period of the disease, a general rash may be observed on the face. It has different forms with redness and telangiectasias, redness and edema, and nasal enlargement due to overgrowth of the sebaceous glands on the nose.
Laughing disease is a disease that usually occurs in women in their 30s. It is seen in 10% of the normal population. The main pathology is thought to be in the small vessels of the skin. Sun-damaged subcutaneous tissue and inflammatory response contribute to this condition. The blood vessels expand, causing redness, warmth, and fluid leakage into the skin, resulting in an inflammatory reaction.
The genetic predisposition in rosacea is 30-40%. The fact that it is more common in fair-skinned people supports this factor. Environmental factors thought to trigger the disease in a survey study conducted by the American National Rosacea Society on 1066 patients: 81% sun, 79% stress, 75% hot air, 57% wind, 56% exercise, 52% alcohol, 51% hot bath, 46% cold. air, 44% humidity, 45% spicy food, 41% cosmetic products, 36% hot drinks. It is also thought that caffeine, nuts, and chocolate may increase symptoms. Digestive system diseases, problems in the biliary tract, sensitivity to sunlight, a parasite called Demodex Follicularum are held responsible in the etiology.
Since it is a skin disease that is clinically located on the face, it can cause serious psychological disorders, cause a feeling of shame, anxiety, lack of self-confidence and ultimately depression.
Classification is made according to the dominant lesion. It was determined by the National Society Rosacea Expert Committee in 2002.
one. Erythematelengiectatic type: Persistent erythema (redness) is the main finding. Telangiectasia may not always be present. Papules and pustules telangiectasias can hide. They become visible after treatment.
2. Papulopustular type: This picture, which is characterized by inflammatory lesions called papules and pustules on persistent erythema, occurs in attacks.
3. Phymatous type : It is a moderate rosacea type. It is characterized by enlargement of the dermal connective tissue, sebaceous glands, prominence at the follicle openings and telangiectasias. The skin becomes coarse, nodules may form. Enlargement can be seen on the forehead, chin, ears and eyelids, mostly in the nose.
4 .ocular type : Ocular involvement is present in 1/3 of rosacea patients, and it usually affects both eyes. Since keratitis may result in blindness, patients should be evaluated by an ophthalmologist.
Laughing disease, like many chronic diseases, requires long-term treatment. Treatment principles are determined based on the cause and observation. Therefore, patients have a great responsibility. Patients should be protected from the sun by using sunscreen regularly. Hot bath, cold, windy weather, trauma (irritant cleaning agents, alcoholic solutions), stress, alcohol, spicy foods, hot drinks, topical corticosteroid drugs and excessive exercise should be avoided, and moisturizers that restore the skin barrier should be used.
The first-choice agents in the treatment are topical drugs applied externally to the skin, which are used to relieve the acne-like inflammatory picture. These are metronidazole, clindamycin, permethrin cream, tretinoin and azelleic acid cream forms. If skin lesions are more extensive and severe, systemic antibiotics are taken orally. If it is very severe, treatment with isotrethionine may be needed. Hypotensive drugs can also be used to prevent redness and warmth. Treatment steps are determined according to the severity of the disease and the resulting picture. In the treatment of a picture with increased redness and vascularity; Laser therapy is applied. However, when vascularization becomes evident, the treatment is long.
In my opinion, rosacea (laughing) is a disease that requires the highest level of cooperation between physician and patient. Preventive measures, attention to food, and regular application of the treatment are the main and most important factors in the success of the treatment. It is extremely important that patients do not despair despite everything, so that the disease does not increase in the stress cycle.