I will not tire of repeating: the doctor treats what he sees, and sees what he knows. When we see a stagnant erythema of the face – a pathognomonic sign of rosacea or all subsequent morphological elements – papules, papulo-pustules, tubercular infiltration - we need to know what is happening behind the scenes, in the depths of the skin layers.
Under the influence of numerous and various endo - and ecofactor that remains to be seen, there is a clear sequence of pathophysiological events that lead to the dynamics of the process, namely:
- angiographers in the area of innervation of the trigeminal nerve;
- spasm of arterioles and dilation of venules;
- increased permeability of the vessels to the level of ecosense;
- the violation of the trophic and lymphatic drainage in the dermis;
- elastic fibers homogentisate and disintegrate.
These events are the final stage of sterile inflammation. Manifestations of rosacea at this time will be either minimal (transient spontaneous erythema of the face, transient swelling, periodic and weak itching) or invisible at all.
- in the focus of inflammation, by diapedesis come macrophages, exciting dendrite elastic fibers;
- at the same time, inflammatory factors are abundant.
At this point, the doctor's eye opens stagnant erythema spilled character.
- due to the ongoing impact of endo - and ecofactor and increasing inflammation in response (to the level of exocytosis), there is a worsening of the trophic disorders of the skin, decreasing its protective function;
- activated saprophytic microflora;
- there is swelling of the dermis and increases the pressure on the mouth of the follicle;
- increases the concentration of sebum.
These events are manifested by the appearance (of course, against the background of erythema) papules.
- in response to the increase in the concentration of sebum increases the population of D. folliculorum
- at the same time, the population of Bacillus Oleronius increases, complicating the vital activity of D. folliculorum, and due to the processing of surface proteins of the skin, multiplying inflammation.
The inflammation ceases to be sterile. This is accompanied by the appearance of pustules, mainly on the surface of papules (papulo-pustules).
the focus of inflammation is surrounded by the peripheral shaft, there comes a stage of autoagression of local immunity, and after that the systemic one.
The totality of what is happening, along with autoimmune mechanisms leads to the fact that we see the emergence of bugorkova infiltration and granulomatous inflammation (Atofina, rhinophyma, gnathophyma, metafile).
Now, colleagues, when we see this or that morphological element on the face, we not only suspect the diagnosis of rosacea and think about the differential diagnosis, but also understand what processes and events preceded its appearance.
Easy meditation for everyone!