202201171008酒糟鼻-玫瑰斑-酒渣鼻 rosacea

參考資料: Mayoclinic 美國梅奧診所
酒糟鼻治療目標是減輕症狀. 需要良好的皮膚護理與藥物治療, 治療時間因不同症狀表現有差異, 而且容易復發. 除了藥物治療, 雷射治療可讓擴張的血管比較看不到, 雷射的目標主要是看得到的靜脈. 對曬黑的皮膚或深色皮膚治療效果較不明顯. 
藥物治療 Prescription drugs for rosacea include:
藥物局部治療可減輕潮紅, 對於輕度至中度酒糟鼻, 可使用的藥物包括外用血管收縮劑, 外用痤瘡藥物, 口服抗生素, 口服痤瘡藥物等等
血管收縮劑可改善皮膚潮紅, 擦藥之後 12 小時內可改善症狀. 但效果是暫時性的, 因此需每天擦藥
1. Brimonidine (mirvaso 敏立紓凝膠)血管收縮, 降低潮紅
2. Oxymetazoline (Rhofade) 血管收縮, 降低潮紅

外用痤瘡藥物可改善輕微酒糟鼻合併的痤瘡
1. azelaic acid 壬二酸(Azelex 雅潔麗酸 杏輝使痘消乳膏, Finacea), 剛開始擦的前 2-6 周並不會馬上改善病灶 
2. metronidazole 甲硝唑抗生素 (Metrogel, Noritate, others), 剛開始擦的前 2-6 周並不會馬上改善病灶  
3. ivermectin 伊維菌素 (Soolantra舒利達), 效果比甲硝唑抗生素更慢出現, 但好處是能讓酒糟鼻緩解時間拉長(療效慢但效果持久)
伊維菌素是前陣子很夯的抗生素, 有新聞說能治療新冠肺炎, 目前認為這是假消息
* azelaic acid 因為名稱與杜鵑花 Azalea 相似, 因此又被翻譯為杜鵑花酸, 但兩者除了名稱相近並無其他關聯.

口服抗生素 doxycycline 可治療中度至重度酒糟鼻合併痤瘡

口服痤瘡藥物, 當嚴重酒糟鼻無法以上述治療緩解, 可考慮使用口服 isotretinoin (口服A酸,也稱異維A酸)(例如:羅氏Roaccutane®羅可坦®). 可治療酒糟鼻病灶類似痤瘡的部分. (孕婦禁用)

其他治療方式還包括雷射, 使用不同波長雷射照射皮膚下的靜脈血管, 使血管萎縮來改善外觀, 雷射治療的前幾周可能還看不出治療效果, 需治療一段時間才看得出改善, 但當新的靜脈血管再次生成, 酒糟鼻又會再發. 

Oral antibiotics. Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples.
Oral acne drug. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (台灣商品名, 羅氏Roaccutane®羅可坦, 其他商品名 Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.
Topical drugs that reduce flushing. For mild to moderate rosacea, your doctor may prescribe a cream or gel that you apply to the affected skin. Brimonidine (Mirvaso) and oxymetazoline (Rhofade) reduce flushing by constricting blood vessels. You may see results within 12 hours after use. The effect on the blood vessels is temporary, so the medication needs to be applied regularly to maintain improvements.

    
Other topical products help control the pimples of mild rosacea. These drugs include azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others) and ivermectin (Soolantra). With azelaic acid and metronidazole, noticeable improvements generally don't appear for two to six weeks. Ivermectin may take even longer to improve skin, but it results in a longer remission than does metronidazole.
Finacea Gel: 含 15% azelaic acid 壬二酸
2022-01-17 Finacea.png - 2021藥物 

下圖來自萬芳醫院, 兩種同成分藥物. 

Oral antibiotics. Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples.
Oral acne drug. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.

Laser therapy
Laser therapy can make enlarged blood vessels less visible. Because the laser targets visible veining, it's most effective on skin that isn't tanned, brown or black.
Talk with your doctor about the risks and benefits of laser therapy. Side effects of laser therapy for rosacea include swelling and bruising that might last for several days. Icing and gentle skin care will be needed during the recovery period. On brown or black skin, laser treatment might cause long-term or permanent discoloration of the treated skin.
The full effect of the treatment might not be noticeable for weeks. Repeat treatments may be needed periodically to maintain the improved appearance of your skin.
Laser treatment for rosacea is usually considered a cosmetic procedure, which insurance typically doesn't cover.
改善生活型態
Lifestyle and home remedies
These self-care practices may help you control the signs and symptoms of rosacea and prevent flare-ups:
避免誘發因素
Identify and avoid triggers. Pay attention to what tends to cause flare-ups for you and avoid those triggers.
保護臉部, 出外前使用防曬產品, 最好能同時防護 UVA UVB, 防曬係數 SPF 宜選擇 30以上, 擦藥之後記得補擦防曬
Protect your face. Apply sunscreen liberally daily before going outdoors. Use a broad-spectrum sunscreen — which blocks both ultraviolet A and ultraviolet B rays — with an SPF of 30 or higher. Apply sunscreen after you apply any topical medication you are using for your face, and before applying any cosmetics.
使用各種不同防曬方式, 包括戴帽子. 避免正午曬太陽, 冬天或風大的時候戴圍巾或全罩式頭套
Take other steps to protect your skin, such as wearing a hat and avoiding midday sun. In cold, windy weather, wear a scarf or ski mask.
避免過多的摩擦臉部,
使用無皂清潔用品一天兩次, 以及保濕產品,
使用無香精產品.
避免使用含有皮膚刺激物的產品. 例如酒精, 樟腦油. 尿素. 薄荷醇
Treat your skin gently. Don't rub or touch your face too much. Use a nonsoap cleanser twice a day and moisturize. Choose fragrance-free products, and avoid those that contain other skin irritants, such as alcohol, camphor, urea and menthol.
使用化妝品遮蓋臉部的潮紅, 
Reduce visible flushing with makeup. Some makeup products and techniques may help reduce the appearance of skin flushing.
Alternative medicine
Gentle daily facial massage may help reduce swelling and inflammation. Use a circular motion with your fingers starting on the central part of the face and work toward the ears.

A recent study suggests that caffeine may reduce the risk of developing rosacea. Even so, hot beverages are a common trigger.
Many other alternative therapies — including emu oil, laurelwood and oregano oil — have been touted as possible ways to treat rosacea. But no conclusive evidence supports the idea that any of these substances are effective.
Talk with your doctor about the pros and cons of specific alternative therapies.
Coping and support
Rosacea can be distressing. You might feel embarrassed or anxious about your appearance and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions. Consider talking with a counselor about these feelings.
A rosacea support group, either in person or online, can connect you with others facing the same types of problems — which can be comforting.
Preparing for your appointment
You're likely to start by seeing your family doctor. Or when you call to set up an appointment, you may be referred to a skin disease specialist (dermatologist). If your condition affects your eyes, you may be referred to an eye specialist (ophthalmologist).
It's a good idea to prepare for your appointment. Here's some information to help you.
What you can do
Preparing a list of questions will help you make the most of your appointment time. For rosacea, some basic questions to ask your doctor include:
What might be causing the signs and symptoms?
Do I need tests to confirm the diagnosis?
What is the best treatment?
Is this condition temporary or chronic?
Is there a generic alternative to the medicine you're prescribing?
I have other medical problems; how can I manage them together?
Can I wait to see if the condition resolves on its own?
What are the alternatives to the approach that you're suggesting?
What skin care routines do you recommend I use?
Don't hesitate to ask any other questions that come up during your appointment.
What to expect from your doctor
Your doctor is likely to ask you several questions, including:
When did you begin experiencing symptoms?
How often do you experience these symptoms?
Have your symptoms been continuous or occasional?
What, if anything, seems to improve your symptoms?
What, if anything, appears to trigger or worsen your symptoms?
參考資料: Mayoclinic 美國梅奧診所
杏輝 AZEIC-A Cream(Azelaic Acid) 使痘消 仿單

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