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Ästhetik Krankheiten Vorbeugung und Prävention Wissenschaft

Rosazea Ihr fragt, Wir antworten

Flushs bei Rosazea nach dem Sport- Hilft es, das Gesicht zu kühlen?

Unserer Meinung nach ja- Werden Immunzellen aktiv, schütten diese Stoffe aus, die die Blutgefäße erweitern und das ganze Areal erweitern. Ähnlich wie bei Sportverletzungen hilft es, das Areal zu kühlen. Dadurch bleiben die Gefäße eng und weniger Blut fließt- ergo auch weniger Rötung.

Welchen Einfluss hat die Ernährung?

Die Ernährung hat einen großen Einfluss- manche Stoffe (Alkohol) führen zu einer Verschlimmerung von Rosazea und sind  verstärkende Faktoren. Lies gern hier Teil 1.

Bringt es etwas auf Weizen, Zucker und Milch zu verzichten?

Alkohol wird in Studien als stärkster Faktor, der eine Rosazea begünstigen kann, beschrieben. Außerdem sollte man Gewürze und Kaffee meiden.
Leider fehlen zur Ernährungsweise mit Weizen, Zucker und Milch aussagekräftige Studien, so dass man sich hier auch in Empfehlungen nur auf überliefertes Wissen und Erfahrungen bezieht. Wie bei Akne auch, ist es ratsam, den Konsum von Einfachzucker, Milch und Weizenprodukten einzuschränken. 

Wäre Lasern eine gute Alternative?

Lasern ist für bestimmte Rosazea-Formen eine gute Alternative und hilft gegen Rötung und Teleangiektasien. Je nachdem welche Form der Rosazea vorliegt, kommen verschiedene Laser zum Einsatz. Einige sind nicht-ablativ (tragen kein Gewebe ab), sondern zerstören durch ihre Wellenlänge nur gezielt Stoffe in der Haut. Dadurch können z.B. Farbstoffe neutralisiert, oder Blutgefäße durch Hitze verödet werden. 
Im Gegensatz dazu stehen CO-2 Laser, als ablative Laser, zur Verfügung. Diese tragen gezielt Gewebe ab (bei Knötchen und beim Rhinophym). 

Ich werde immer total schnell rot, wenn ich lache und habe ein paar geplatzte Äderchen-bezeichnet man das schon als Rosazea?

Eine schnelle Errötung und geplatzt Äderigen im Bereich des Mittelgesichtes können erste Anzeichen für eine Rosazea sein. Um diese zu diagnostizieren, sollte man immer einen Dermatologen aufsuchen. 

Benötigt man wirklich eine spezielle Sonnencreme?

Bei Rosazea spielt der Sonnenschutz eine große Rolle, da Sonnenlicht die Blutgefäße erweitert und dadurch den sogenannten Flush auslösen kann. Eine spezielle Sonnencreme ist nicht von Nöten, jedoch sollte ein hoher Lichtschutzfaktor gewählt werden. Einige Anbieter bringen vermehrt neutralisierende Cremes (mit Grün-Anteil) auf den Markt. Grüne Farbe neutralisiert das rot und so gibt es auch beim Auftragen solcher Sonnencremes gleich einen etwas mattierenden Effekt.

Hilft das Lasern auch gegen Papeln und Pusteln?

Bei Papeln und Pusteln sind vor allem topische (lokale) Therapien angebracht. Diese beinhalten entweder anti-entzündliche oder anti-bakterielle Substanzen. Zusätzlich hemmen manche Produkte die Proliferation (Neubildung) der obersten Hautzellen (Keratinozyten). Dadurch wird die Entstehung von Papeln und Pusteln effektiv gehemmt. Metronidazol und Azelainsäure sind die am öftesten angewandten Produkte.
Bisher gibt es noch keine aussagekräftigen Studien, dass ein Farbstofflaser auch gegen die Rosazea-Pickel wirkt. Ein abtragender Laser ist im akut entzündlichen Stadium nicht zu empfehlen.

Was kann ich gegen Papeln tun?

Bei Papeln ist eine topische Therapie die erste Wahl. Lies hierzu gern den ersten Teil unserer Rosazea Artikel.

Wie kann ich die tägliche Pflege bei Rosazea optimieren?

Basis sollte hier immer eine feuchtigkeitsspende Creme mit Lichtschutzfaktor sein, diese gibt es wie eben schon erwähnt auch oft extra für Rosazea-Patienten mit Grünanteil. Anschließend kann man sich wie gewohnt schminken, sollte jedoch darauf achten, nur Produkte zu nutzen welche gut vertragen werden.
Ein regelmäßiges Nachcremen mit LSF ist das A und O bei Rosazea und sollte sowohl im Sommer, als auch im Winter nicht vergessen werden. Die tägliche Anwendung eines Vitamin-C-Serums kann die Rötung durch antioxidative Eigenschaften ebenso verbessern.
Die abendliche Reinigung findet mit gut verträglichen, Rosazea-geeigneten Hautpflegeprodukten statt. Die namhaften Vertreter dermatologischer Kosmetik bieten nahezu alle mittlerweile eine eigene Rosazea-Reihe an, sodass man sich hier gut durchprobieren kann.
Bei Unsicherheit empfehlen wir jeweils eine Reihe mit Pröbchen für 3 Tage zu testen und dann ggf. auf eine andere Marke umzustellen. So findet man relativ gut und schnell heraus was für einen selbst gut passt. Der Dermatologe berät hier zusätzlich gern.

Kann dies ein Hinweis auf andere Krankheiten sein?

Ja, Rosacea steht im Zusammenhang mit zahlreichen anderen Krankheiten, die auftreten können, aber nicht müssen.
Bei Rosazea-Patienten findet man in absteigender Reihenfolge am meisten folgende Krankheiten: Depression, Bluthochdruck, Herz-Kreislauf-Erkrankungen, Angststörungen, Fettstoffwechselstörungen, Diabetes, Migräne, Rheumatoide Arthritis, Helicobacter-pylori-Infektionen, Colitis ulcerosa, Demenz.

Warum tritt es bei älteren Menschen auf und nicht bei jüngeren?

Man vermutet, dass hier vor allem Hautalterung und die veränderten Eigenschaften der Haut-Strukturen im Alter eine Rolle spielen. Das Bindegewebe wird schwächer und Blutgefäße nehmen im Laufe des Lebens Schaden, wodurch es zu kleinen Öffnungen in diesen kommt und sie vermehrt sichtbar werden und Rötungen hervorrufen.

Ist es behandelbar?

Rosazea ist gut behandelbar- grundsätzlich gilt, je früher desto besser.
Der erste und wichtigste Therapieschritt ist immer die Vermeidung der Trigger. Trigger sind sowohl auslösende Substanzen, als auch auslösende Situationen. Zusätzlich dazu gibt es zahlreiche Therapieoptionen, welche zu einem langsameren Fortschreiten der Erkrankung und zu weniger Symptomen beitragen können.

Ist es vererblich?

Bei Rosazea gibt es genetische Faktoren, welche das Auftreten begünstigen können. Es ist allerdings nicht so, dass man als Kind auch eine Rosazea bekommen muss, wenn die Mutter Rosazea hat.

Ist es das gleiche wie Couperose?

Ja- Couperose ist Rosazea im Stadium I.

Wenn es Behandlungen gibt’s ? Gibt es darunter auch „schwarze Schafe“?

Ja- sowohl bei Salben als auch bei Tabletten gibt es wenige, die wirklich als effektiv erprobt worden sind -diese sind in Teil 1 aufgeführt.
Hier lässt sich sagen, dass viele Produkte zwar höchstwahrscheinlich effektiv sind, jedoch sind viele Studien dazu mangelhaft durchgeführt worden, oder die Produkte sind so neu, dass es noch keine Studien dazu gibt. Lediglich bei Metamizol und Azelainsäure liegen hochwertige Studienergebnisse vor. Ivermectin konnte allerdings in den letzten Jahren klinisch auch überzeugen.

Ist es möglich langfristig eine Besserung durch Vermeidung von Kaffee, Alkohol, Gewürzen etc. zu erzielen?

Ja, die Vermeidung von auslösenden Substanzen ist oberstes Therapiegebot.
Quellen:
siehe Teil 1
zusätzlich:

  1. https://doi.org/10.1016/j.jaad.2017.09.016
  2. http://www.jabfm.org/content/15/3/214.full.pdf

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