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Ästhetik Krankheiten

Ein brandheißes Thema: Rosazea.

Es brennt. Es ist heiß. Es ist rot.  Deine Wangen. Rosazea?

Was ist eigentlich Rosazea?

Als Rosazea wird eine weit verbreitete und in mehreren Stadien verlaufende Hauterkrankung, welche im Gesicht, und vor allem an den Wangen auftritt, bezeichnet.
Rosazea wurde früher als Akne Rosazea bezeichnet und bedeutet auf deutsch „Kupferrose“.
Die Rosazea äußert sich anfangs vor allem durch gerötete Wangen, die immer wieder auftreten, später jedoch dauerhaft bestehen. Schreitet die Erkrankung voran, so kommen Pickel im Bereich des Mittelgesichtes hinzu.
Bei der Rosazea unterscheidet man vier Subtypen:

  1. Rosacea erythematoteleangiectatica: wow klingt kompliziert – beschreibt aber einfach eine Rosazea mit Rötung (Erythem) des Mittelgesichtes und erweiterten, durch die Haut durchscheinenden Blutgefäßen (Teleangiektasien). Häufige Symptome sind hier ebenso Brennen und Schmerzen der betroffenen Hautareale.
  2. Rosacea papulopustulosa: hier kommen dann noch unterirdische (Papeln) und sich eröffnende Pickel (Pusteln) hinzu.
  3. Rosacea phymatous: durch knotige Wucherungen des Bindegewebes und der Talgdrüsen entstehen hier starke, unter der Haut liegende Knoten und das bekannte „Rhinophym“, welches auch oft als „Säufernase“ fehlinterpretiert wird.
  4. Rosacea ocularis: diese Form der Rosazea betrifft zusätzlich auch die Augen und kommt in bis zu 58% aller Rosazea Fälle vor und wird oft übersehen. Gerötete Augen, Entzündungen des Lidrandes und eine starke Trockenheit bis hin zu Hornhautentzündungen prägen das klinische Bild.


 

Wen betrifft Rosazea?

Häufig tritt diese Hauterkrankung das erste Mal im Alter von 30-40 Jahren auf (>80% der Erkrankten sind >30Jahre), wobei sich die Erkrankung nach dem 40. Lebensjahr oftmals noch einmal verschlimmert. Man denkt oft, Frauen seien häufiger betroffen als Männer, dies ist aber lokal unterschiedlich verteilt.
Was jedoch klar der Fall ist: bei Männern verläuft die Erkrankung oftmals schwerwiegender als bei Frauen. Während Männer oftmals von einem Rhinophym geplagt sind, so tritt dies bei Frauen so gut wie nie auf.
Die Angabe der Häufigkeit schwankt in der Literatur stark. In den USA sind laut aktuellen Studien mehr als 16 Mio. Menschen betroffen, in Deutschland belaufen sich Schätzungen auf 5-7% der Erwachsenen. Eine estländische Studie gibt sogar an, dass 22% der Bevölkerung an Rosazea leiden, womit dies in diesen Regionen die häufigste Hauterkrankung überhaupt wäre. Vermutlich betrifft Rosazea auch eher einen hellen Hauttyp (Südländer sind so gut wie nie betroffen).

Welches sind die Ursachen von Rosazea?

  1. Als die wahrscheinlichste Ursache wird eine Fehlfunktion des angeborenen Immunsystems angesehen. Ein Protein ( für alle die, die es genau wissen wollen: Cathelicidin ) ist in seiner Struktur und Funktion verändert, so dass es zu Störungen der Immunmodulation in der Haut, als auch zu Fehlverteilungen des Mikrobioms in der Haut kommt. ebenso kann dieses Protein die Neubildung von Gefäßen anregen.
  2. Ein ebenso sehr wichtiger Punkt in der Rosazea-Entstehung ist die Fehlfunktion u.a. von diesen Blutgefäßen.
  3. Bereits in frühen Stadien der Rosazea beginnt das eigene Immunsystem diese Erkrankung abzuwehren und schickt Immunzellen in das betroffene Gebiet (Mittelgesicht). Diese führen zu einer lokalen Entzündung, dadurch vermehrter Durchblutung des betroffenen Areals und wiederum Stimulation der Blutgefäßneubildung.
  4. Die Demodex-Milbe: Diese Ursache ist wohl am weitesten verbreitet und bekannt. Die Milbe im Gesicht wird aber heutzutage nur noch als Mitauslöser der Rosazea betrachtet, dennoch sind Demodex-Milben bei Rosazea Patienten vermehrt nachgewiesen.

Sind Alkohol und Kaffee wirklich so schlimm?

Alkohol, Kaffee, Hitze, Sonnenstrahlen, Kälte, Röntgenstrahlung, Erregung, Temperaturschwankungen, hormonelle Umstellungen (Menstruation, Schwangerschaft) und auch scharfe Gewürze gelten als Auslöser der Rosazea und werden oft mit schubartigen Auftreten der Rötung in Verbindung gebracht. Man sieht diese Faktoren nicht als Ursache, aber eben als Auslöser und Triggerfaktoren an.

Ist eine Couperose das gleiche wie eine Rosazea?

Die Couperose wird oft Synonym mit der Rosazea verwendet, beschreibt aber „nur“ das erste Stadium dieser. Die Rötung tritt hierbei v.a. im Mittelgesichtsbereich auf.

Wer diagnostiziert eine Rosazea?

Die Rosazea und ihr korrektes Schema wird typischerweise vom Hautarzt diagnostiziert und entsprechend therapiert. Solltest du also das Gefühl haben, dass du an einer Rosazea leidest, so scheue es nicht einen guten Hautarzt aufzusuchen und dich individuell über die Behandlung sowie Therapieoptionen aufklären zu lassen. Früherkennung ist der beste Weg für eine effektive Therapie.

Die Therapie der Rosazea

Die Therapie der Rosazea ist schwierig und oft für beide, sowohl Patient und auch Arzt, ein Geduldsspiel.
Grundsätzlich kann man bei Rosazea Cremes, Tabletten und Laser- Therapien anwenden.

  • Externe Therapie: Cremes:

    • beinhalten meistens Metronidazol oder Azelainsäure (Handelsname Skinoren).

    • Metronidazol:  zielt hauptsächlich darauf ab, die körpereigene Immunabwehr zu schwächen und mildert dadurch die Rötung, die durch die Überaktivierung von Immunzellen hervorgerufen wird, nachweislich.
    • Azelainsäure: hat eine antibakterielle und antientzündliche Wirkung. Zusätzlich bewirkt es eine Hemmung der Bildung der obersten Hautzellen (Keratinozyten). Sowohl bei Akne als auch bei Rosazea konnte dieses Medikament sehr gute Ergebnisse erzielen
    • Ivermectin: wirkt ebenso antientzündlich und antimikrobiell und zeigt einen positiven Effekt vor allem bei der papulopustulösen Rosazea. In Studien zeigte es einen Vorteil gegenüber Metronidazol.
    • Andere topische Therapien (andere Antibiotika sowie Retinol) sind oft zu finden, jedoch konnte die derzeitige Studienlage keine überzeugenden positiven Effekte zeigen.

 
Wichtig: Alle topischen Therapien zielen ausschließlich auf Rötungen, sowie im Verlauf auf Papeln und Pusteln ab. Die Gefäßerweiterungen können hiermit nicht behandelt werden.

  • Interne Therapie: Tabletten

    • Als Orale Therapien werden hauptsächlich Antibiotika eingesetzt. Doxycyclin konnte ebenso die Rötung abschwächen, hatte jedoch ebenfalls keinen Einfluss auf Teleangiektasien. Ähnliche Wirkungen hatte Tetrazyklin, ein anderes Antibiotikum.
    • Retinoide zeigen bei Patienten mit papulopustilöser Rosazea ebenso diskrete Effekte.
    • Blutdrucksenker: einen kleinen Effekt zeigten ebenso Atenolol und Clonidin. Diese wirken gefäßverengend und können somit die Rötung einschränken.

 

  • Externe Therapie: Laser

    • Laser stellen die einzige Möglichkeit dar, die vorhandenen Gefäßerweiterungen zu behandeln. Das Licht eines Farbstofflasers durchdringt die obersten Hautschichten und verödet die Blutgefäße durch Hitze. Dauerhaft. Man braucht meistens mehrere Sitzungen, um die Rötung ganz weg zu bekommen.
    • Zur Hautbildverfeinerung und zur Behandlung der Talgdrüsenhyperplasien, sowie des Rhinophyms, kann ebenso eine Behandlung mit einem abtragenden (ablativen) CO2-Laser in Frage kommen.

 

  • Externe Therapie: Operation

    • Vor allem das Rhinophym bei Rosazea kann operativ behandelt werden. Dies erfolgt entweder durch eine Abtragung mittels Laser oder als Dermashave mit Skalpell.

 

  • Externe Therapie: Botox

    • Botox bei Rosazea? Ja. Kleinste Botoxinjektionen in die obersten Hautschichten hemmt die Übertragung von Botenstoffen und somit das schubartigen Auftreten von Rötungen (Flush).
    • Auch hier sehen wir wieder einen interessanten Nebeneffekt von Botox (neben der Faltenbehandlung, haben wir ja ebenso schon über die Knirsch-Therapie mit Botox berichtet). Bei der Rosazea stellt Botox somit also auch eine Alternative dar, wenn andere Therapieoptionen versagt haben.

 

  • Ernährung

    • Eine spezielle Rosazea-Diät gibt es nicht. Wie bereits oben erwähnt, sollten vor allem auslösende Faktoren wie scharfe Gewürze, Kaffee und Alkohol gemieden werden. All diese Nahrungsmittel haben die Gemeinsamkeit, dass sie eine mögliche Erweiterung der Blutgefäße nach sich ziehen.
    • Einen absolut hohen Stellenwert, nicht nur in der Rosazea-Prävention und -Therapie, hat ein ausreichend hoher Lichtschutzfaktor. UV-Strahlung, als Auslösefaktor, wird so geblockt.

 
Teil II – übermorgen online: Eure Rosazea-Fragen – Unsere Antworten. Nutze jetzt noch die Chance und stelle deine Frage auf Instagram.
 

DISCLAIMER

Dieser Artikel erhebt keinen Anspruch auf Vollständigkeit und liefert lediglich einen Anhaltspunkt. Bitte frage deinen betreuenden Arzt um eine belastbare Diagnose und die entsprechende Therapie zu erhalten.
Quellen:

  1. Ahn, Christine S., and William W. Huang. „Rosacea Pathogenesis.“ Dermatologic clinics 36.2 (2018): 81-86.
  2. Wu, Wiggin, Richard L. Gallo, and Tissa R. Hata. „Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors.“ Journal of the American Academy of Dermatology 72.5 (2015): 749-758.
  3. Rivero, Alexis Lara, and Margot Whitfeld. „An update on the treatment of rosacea.“ Australian prescriber 41.1 (2018): 20.
  4. Gupta A.K., Gover M.D. Azelaic acid (15% gel) in the treatment of acne rosacea. Int J Dermatol, 2007, 46(5), 533-8
  5. Taieb, A., et al. „Superiority of ivermectin 1% cream over metronidazole 0· 75% cream in treating inflammatory lesions of rosacea: a randomized, investigator‐blinded trial.“ British Journal of Dermatology 172.4 (2015): 1103-1110.
  6. Van Zuuren, E. J., et al. „Effective and evidence‐based management strategies for rosacea: summary of a Cochrane systematic review.“ British Journal of Dermatology 165.4 (2011): 760-781.
  7. van Zuuren, Esther J., et al. „Interventions for rosacea.“ Cochrane Database Syst Rev 3 (2011).

Titelbild: M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara: Cutaneous lesions of the nose. In: Head & face medicine Band 6, 2010, S. 7, ISSN 1746-160X. doi:10.1186/1746-160X-6-7. PMID 20525327.. (Review). Open Access

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