1. Dermabrasion to treat rosacea

1) Tags: Surgery, primary to secondary surgery

2) Technical principles

< p>Dermabrasion is one of the common methods to treat rosacea. The depth of skin invaded by rosacea is about 2mm. The grinding instrument is used to perform controlled mechanical treatment on the nasal epidermis and/or superficial dermis. Abnormal skin on the nose can be removed by grinding. After grinding, when the nasal wound heals, the pathological changes on the skin surface can be improved, and the collagen fibers and elastic fibers under the skin can be rearranged. The remaining skin appendages, such as sebaceous glands, will quickly form new epidermis, as long as it is not grinded. When it comes to the reticular dermis, there will be almost no scars left on the wound surface. Better results can be achieved if dermabrasion, incision, and cryotechnology are combined to treat rosacea.

3) Applicable groups and taboo groups

① Applicable groups: those with mild pre-rhinophyma rosacea and those who are willing to have beauty treatments.

② Contraindications

a. People with hemophilia or abnormal bleeding.

b. People with active infectious hepatitis.

c. Those who are emotionally unstable and have excessive demands.

d. Those with keloid constitution and larger and deeper scars.

e. The skin lesions are suspected to be malignant or have been diagnosed as skin malignant tumors.

f. Those with obvious local skin infection.

g. Those who have a history of radioactive treatment within six months, or have radioactive dermatitis.

h. Menstrual and lactating women.

4) Cost: about 3,000 yuan.

5) Technical methods

① Disinfect the surgical area and surrounding tissues.

② Anesthesia: Subcutaneous anesthesia is generally used.

③ Use grinding instruments for grinding, and determine the grinding range according to the specific conditions of the lesion.

④ Rinse repeatedly with disinfectant after surgery.

⑤ Cover with Vaseline oil gauze strips and thick gauze for pressure bandage.

6) Risks and complications

① Skin penetration: If the grinding force is out of control during the operation, there is a possibility of skin penetration.

② Pain: Most people have no pain or only mild pain after surgery, and can take general analgesics as directed by the doctor.

③ Edema: Mild edema sometimes occurs after grinding, which usually disappears in 3-6 weeks.

④ Skin redness: It is the first complication after grinding. Its duration varies from person to person, and it usually disappears within 1-3 months.

⑤ Miliary papules: often occur 2-6 weeks after surgery, and should be taken to the hospital for further treatment.

⑥ Scar hyperplasia: It can appear in any part of the grinding area, and is more common in women. Generally, mild scar hyperplasia will subside and flatten on its own in about 1 year. If necessary, dermabrasion can be performed after 1 year to smooth out the hypertrophic scars.

⑦ Infection: The incidence is low, mainly caused by excessive wound contamination and improper postoperative treatment.

⑧ Pigmentation: The incidence is relatively high, usually appearing about 1 month after surgery, peaking at 2 months, usually 6-12 months, and a few disappearing after more than 1 year

< p>7) Recovery time

Clear blood may ooze out 1-3 days after the operation. Just change the gauze. Use antibiotics for 3-5 days at the same time. Remove the outer dressing about 10 days and remove the inner dressing. The layer of dressing usually falls off on its own in 10-14 days. After the postoperative wound heals, post-flush pigmentation may occur within 2 weeks. Normal color can return to normal after 2-6 months. You can also take an appropriate amount of vitamin C to prevent it. If multiple grindings are required, the interval between two grindings is generally 3-6 months.

8) Precautions

1) Preoperative precautions

① Stop drinking, aspirin, vitamin E and other vasodilator drugs one week before surgery.

② Makeup should not be worn before surgery.

2) Precautions after surgery

① Avoid direct sunlight after surgery and wear a mask or wide-brimmed hat.

② Makeup is not allowed within two weeks after surgery.

③ Keep the surgical site clean and hygienic, and try to avoid getting water in the surgical area within 7 days after surgery.

④ Avoid eating irritating foods, such as chili peppers.

⑤ Strictly abide by the doctor’s instructions on medications and follow-up visits.

Method/Step 2:

Excision to treat rosacea

1) Tags: surgery, primary surgery

2) Technical Principle

It is difficult to achieve the treatment goal of middle-to-late stage rosacea with drugs alone. Rosacea incision is mainly used for middle-to-late stage rosacea. This method can destroy and cut off the dilated capillaries and proliferated sebaceous glands and fibers. Connective tissue is used to cut off excessively thick nasal excrescences to regenerate hair follicle epithelial cells. After the wound heals, a normal or nearly normal epidermis can be formed, thereby achieving the purpose of treatment.

3) Applicable groups and taboo groups

① Applicable groups: People with severe rhinophyma stage rosacea and those who are willing to have beauty treatment.

② Contraindications

a. People with high blood pressure, heart disease, etc.

b. Those with infectious diseases.

c. People with allergies to blood diseases.

d. Those with scar hyperplasia.

e. Menstrual and lactating women.

4) Cost: about 3,000 yuan.

5) Technical methods

① Disinfect the surgical area and surrounding tissues.

② Anesthesia: Generally, infiltration anesthesia is used.

③ Select an appropriate blade according to the condition, and cut repeatedly in criss-crossing the affected area with appropriate strength and speed until the skin surface becomes hairy.

④ Use gauze to apply pressure to stop bleeding, apply Vaseline gauze and bandage.

6) Risks and complications

① Pain: Most people have no pain or only mild pain after surgery, and can take general analgesics as directed by the doctor.

② Edema: Mild edema sometimes occurs after surgery and usually disappears in 3-6 weeks.

③ Skin redness: It may be caused by damage to normal capillaries during the operation, or the color caused by infection may cause skin redness.

④ Infection: There is a possibility of infection during the operation. Once discovered, you should seek medical treatment in time.

7) Recovery time

The Vaseline gauze will fall off on its own 5-7 days after the operation, and the wound will scab and heal. At the same time, antibiotics will be taken. It usually takes about 3 months after the operation to gradually heal. Back to normal. If re-operation is needed, it can be done within 3 months after the wound has healed.

8) Precautions

① Preoperative Precautions

a. Stop drinking, aspirin, vitamin E and other vasodilator drugs one week before surgery.

b. Makeup should not be worn before surgery.

② Precautions after surgery

a. Makeup is not allowed within two weeks after surgery.

b. Keep the surgical site clean and hygienic, and try to avoid getting water in the surgical area within 7 days after surgery.

c. Avoid eating irritating foods, such as chili peppers.

d. Strictly abide by the doctor’s instructions for medication and follow-up visits.

Method/Step 3:

Physical Treatment of Rosacea

1. Laser Treatment of Rosacea

1) Label: Non Surgery

2) Technical principle

Laser treatment for rosacea uses the principle of selective absorption. Laser has a specific absorption effect on hemoglobin in red blood cells in blood vessels. Clinically Generally, a laser with a wavelength of 452-577nm is used. When it irradiates the nose, the energy of the laser is specifically absorbed, the hemoglobin coagulates, and the red blood cells are destroyed to form microthrombi, thereby blocking the capillaries, causing local hypoxia, and capillaries are blocked. After destruction, the local temperature of the formed microthrombi increases and the heat spreads to the vascular endothelial cells, causing irreversible damage to the latter. That is, the purpose of treating rosacea is achieved. However, laser is difficult to completely cure and requires multiple treatments.

3) Applicable groups and taboo groups

① Applicable groups: those with mild rosacea and those who are willing to have beauty treatments.

② Contraindications

a. Absolute contraindications

i. Some autoimmune diseases such as systemic lupus erythematosus;

ii . Keloid-prone areas;

iii. People with photosensitive skin and those currently using photosensitive drugs;

iv. People who have used isotretinoin in the past year;

v. Pregnant women;

vi. Patients suspected of having skin cancer;

b. Relative contraindications

i. Chemical peeling in the near future , physical abrasion, other skin resurfacing and skin radiotherapy;

ii. Smokers;

iii. Diabetics;

iv. People with hyperplasia Those with a history of scars;

v. Patients with pigmentation abnormalities;

vi. Those with excessive expectations.

4) Cost: 2,000-10,000 yuan.

5) Technical method

① After cleaning the face, the patient lies on his back and applies condensation ointment. .

② You may or may not apply topical anesthetic cream as needed.

③ Aim the laser at the rosacea and irradiate it.

6) Laser

Laser interacts with the skin mainly through four pathways: reflection, scattering, conduction and absorption. When a laser beam irradiates the skin surface, 4%-7% of the light is reflected, and the remaining 93%-96% of the light enters the skin and is scattered, conducted or absorbed. The occurrence of scattering limits the penetration depth of light. Light is conducted while traveling through tissue. The therapeutic effect occurs only when light is absorbed. When the laser irradiates the nose, the energy of the laser is specifically absorbed, the hemoglobin coagulates, and the red blood cells are destroyed to form microthrombi, which block the capillaries, leading to local hypoxia, capillary destruction, and the local temperature of the formed microthrombi rises and By spreading heat to vascular endothelial cells and causing irreversible damage to the latter, the purpose of treating rosacea is achieved.

7) Risks and complications

① Pigmentation: Most of them are initially hypopigmented after treatment, but pigmentation may appear soon. Generally, no treatment is needed. Pigmentation can disappear on its own within 4 months.

② Local swelling: Mild to moderate local swelling occurs after all laser treatments. It is the most severe 2-3 days after surgery and gradually subsides in 5-7 days.

③ Itching: rare. It may mean wound healing, but also the possibility of infection.

④ Infection: If the wound is ulcerated due to scratching or contaminated by water, erythema and exudate may appear. Once infection occurs, seek medical attention as soon as possible to promote wound healing as quickly as possible, but superficial scars may remain after healing.

⑤ Scar formation: Due to the high accuracy of laser, the size and depth of treatment can be strictly controlled, and generally no scars will be left after surgery. However, a few may form residual depressed scars or stimulate the formation of hypertrophic scars. After scar formation, you should seek medical treatment as soon as possible to reduce the degree of scarring.

8) Recovery time

The skin lesions and scabs will fall off after about 2-3 weeks. Generally, laser treatment for rosacea requires 2-4 times depending on the specific situation, and the treatment interval is generally 8-16 weeks.

9) Precautions

① Clean the face before treatment and do not leave any cosmetics.

② People who have been exposed to the sun recently need to explain to their doctor before treatment.

③ After treatment, the treated area should not be exposed to water or rub until the scab falls off. Avoid spicy food, tobacco and alcohol. In the recent period, dark-colored foods such as coffee, cola, etc. should be avoided. The scab will fall off on its own and should not be peeled off by force.

④ Do not participate in strenuous exercise before the scabs fall off to avoid infection caused by sweating.

⑤ Pay attention to sun protection after surgery: avoid direct sunlight, wear a sun hat and umbrella when going out, and use external sunscreen products. Choose products with high safety and good sun protection effect: UVB sun protection index (SPF)>30; UVA sun protection factor (PFA)>++; physical sunscreen with a large R index.

Method/Step 4:

Photon treatment of rosacea

1) Tag: non-surgical

2) Technical principle

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Photon therapy is more effective in treating rosacea. When light irradiates the skin, it generates heat, which can raise the temperature of the lesion to a high enough level to destroy it. The specific principle is that hemoglobin and oxyhemoglobin in blood vessels can highly absorb light energy and generate heat. When the blood temperature is high enough, coagulation occurs and destroys the blood vessel wall (the effect is best when the heating ratio of blood vessels to the epidermis reaches the maximum), thus Destroys dilated capillaries to treat rosacea.

3) Applicable groups and taboo groups

① Applicable groups: those with mild rosacea and those who are willing to have beauty treatments.

② Contraindicated groups

a. People who have recently been exposed to the sun or will be exposed to the sun;

b. People with photosensitive skin and those currently using photosensitive drugs People;

c. People who have taken isotretinoin recently;

d. Pregnant women;

e. Diabetic patients;

< p>f. People with scarring constitution;

g. Patients suspected of having skin cancer;

h. People with excessive expectations.

4) Cost: 3,000-9,000 yuan.

5) Technical method

① The patient lies down after cleansing.

② Wear eye protection to protect your eyes.

③ Apply cold gel to the nose.

④ Apply a test light spot below the earlobe.

⑤ Observe the test response and select appropriate treatment parameters.

⑥ Treatment is performed on the rosacea area.

⑦ Apply local cold compress at any time.

⑧ Repeat the treatment according to the response.

6) Photon

When photon treats rosacea, it generates heat by irradiating the skin. This heat can increase the temperature of the lesion, and the hemoglobin and oxyhemoglobin in the blood vessels also increase. It can highly absorb light energy. When the blood temperature rises, it will coagulate and destroy the blood vessel wall (the effect is best when the heating ratio of blood vessels to the epidermis reaches the maximum), thereby destroying the dilated capillaries and achieving the purpose of treating rosacea. .

7) Risks and complications

① Postoperative reaction: slight burning sensation may occur, which may last for 0.5-2 hours; slight redness, which may last for 12 hours;

② Pigmentation: Different degrees of pigmentation may occur after treatment. You can take vitamin C and other whitening drugs as directed by your doctor.

③ Burns: Photon therapy may cause burns of varying degrees, manifesting as temporary purpura, blisters, etc.

④ Hypopigmentation or depigmentation: may occur in people with darker skin or those who are exposed to the sun. For such patients, they must explain the situation to the doctor so that preventive treatment can be done in advance.

8) Recovery time

① Treatment is performed every 3-4 weeks, and the number of treatments required to achieve the desired effect is an average of 3-6 consecutive treatments.

② The postoperative reaction after photon therapy is mild and only lasts for a few hours, so it generally does not affect normal work and life.

9) Precautions

① Laser, dermabrasion, and acid peel cosmetic procedures are not allowed one week before treatment.

② People who have recently been exposed to the sun need to explain to their doctor before treatment.

③ Clean the face before treatment, and no cosmetics should remain.

④ Avoid washing with hot water within a few days after surgery. Instead, use cold water to clean the skin and pay attention to cleaning and protection.

⑤ You should avoid wearing makeup for a few days after surgery.

⑥ Avoid direct sunlight, wear a sun hat and umbrella when going out, and use external sunscreen products. Choose products with high safety and good sun protection effect: UVB sun protection factor (SPF) = 30; UVA sun protection factor (PFA) >++; physical sunscreen with a large R index.

⑦ Photon therapy should not be used too frequently, especially in summer, which is not suitable for long sunshine hours and hot weather.

Method/Step 5:

Cryotherapy to treat rosacea

1) Tag: non-surgical

2) Technical principle< /p>

Cryotherapy uses low-temperature technology to act on the skin of rosacea, and then ice crystals are formed inside and outside the tissue, causing cells to dehydrate, shrink, and cause necrosis of skin tissue, which will turn white, scab, and fall off. and the process of restoring color, thereby achieving the effect of treating rosacea. Rosacea mostly occurs in the epidermis and superficial dermis. For mid-to-late stage rosacea, dermabrasion and incision can be combined to improve the efficacy.

3) Applicable groups and taboo groups

① Applicable groups: those with mild rosacea and those who are willing to have beauty treatments.

② Contraindications

a. People with a history of temperature allergy, limb paralysis, skin sensation or local circulation dysfunction, and poor blood supply.

b. Female menstruation or pregnancy.

c. People with other systemic diseases, such as: hypertension, cardiovascular disease, coagulation diseases, diabetes; people who are elderly or young; people with low immune function, such as radiotherapy and long-term hormone therapy.

d. People with scar constitution.

e. People with mental disorders.

f. Severe cold urticaria, cryoglobulinemia and cold fibrinemia.

4) Cost: None

5) Technical method

Disinfect the surgical area and its surroundings, put the refrigerant in a special spray device, and aim it Spray the rosacea area to make the local ice turn white, and wait for the postoperative scab formation, peeling and color recovery process, which takes about a week.

6) Risks and complications

① Pain: There will be local pain within 1-2 days of cryotherapy, especially within 1-2 hours.

② Edema: The local area begins to become red and swollen after thawing, reaching a peak within 24 hours, and gradually subsides in 3-4 days. Those with obvious edema can follow the doctor's advice and use topical glucocorticoid cream 2-3 times a day.

③ Blisters: For those who have been frozen for a long time, local blisters or bullae may appear 2-3 hours after surgery. You should seek medical treatment immediately.

④ Infection: rare. It is often caused by the rupture of blisters formed after surgery, carelessness in cleaning and hygiene, and secondary infection. Once infected, you should go to the hospital for treatment immediately.

7) Recovery time

The cryotherapy treatment of rosacea takes one cooling and thawing cycle from turning white to returning to its original color. Each cooling and thawing cycle is about one week. Depending on the type of rosacea, The size of the invasion range and the freezing period can be flexibly selected. Generally, edema begins to subside 3-4 days after surgery.

8) Precautions

① Preoperative Precautions

a. Stop drinking, aspirin, vitamin E and other vasodilator drugs one week before surgery.

b. Makeup should not be worn before surgery.

c. Avoid sun exposure as much as possible during treatment.

② Precautions after surgery

a. After freezing, do not touch the area with water for a week and do not tear off the scab.

b. Makeup is not allowed within two weeks after surgery.

c. Keep the surgical site clean and hygienic, and try to avoid getting water in the surgical area within 7 days after surgery.

d. Avoid eating irritating foods, such as chili peppers.

e. Strictly abide by the doctor’s prescribed medications and follow-up visits.

Method/Step 6:

Pharmaceutical therapy for rosacea

1. Tag: non-surgical

2. Technical principle

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Drug treatment for rosacea mainly focuses on eliminating Helicobacter pylori (HP) and anaerobic bacteria, and reducing leukocyte chemotaxis, granuloma formation and cellular immune response. In addition, it can also inhibit the dissolution of sebum secretion and inhibit scar formation to achieve therapeutic effects. However, simple drug treatment of rosacea has certain limitations. If combined with surgical and physical methods for simultaneous treatment, better results can be achieved.

3. Cost: ranging from tens to hundreds of yuan.

4. Technical methods

1) Oral drugs: oral tinidazole, metronidazole, tetracycline, erythromycin, isotretinoin, etc., for women in menstrual period, It can be combined with oryzanol, diazepam and other drugs for simultaneous treatment.

2) Topical drugs: Retinoic acid topical preparations are effective in correcting rosacea erythema and telangiectasia, reducing sebum secretion, and maintaining normal keratinization of epithelial tissue; compound sulfur lotion, Lincomycin, chloramphenicol salicylic acid tincture, tinidazole gel, metronidazole cream, and appropriate concentration of benzoic acid peroxide gel can all inhibit bacterial activity.

5. Adverse reactions

Different drugs are suitable for different administration routes, otherwise the first-pass effect will greatly affect the efficacy of the drug, and excessive drug dosage and too long course of treatment will cause In case of adverse reactions, please strictly follow the dosage prescribed by your doctor. Long-term application or improper dosage of topical drugs can also have irritating effects on the skin, ranging from drying out the skin to corrosive effects in severe cases.

6. Treatment course and recovery time

Determine the appropriate course of treatment based on the individual's specific circumstances and the selected drugs. Generally, oral medications need to be taken for about 3 courses, and external medications require different courses of treatment according to different situations.

7. Precautions

When using drugs to treat rosacea, you must go to the hospital and follow the doctor’s instructions to determine the specific drugs and course of treatment. You must not blindly use drugs on your own to avoid Cause serious adverse reactions.