MANAGEMENT STRATEGY FOR A PATIENT WITH THE PHYMATOUS ROSACEA

Background. Patient N., 43 years old, complained of facial redness, rashes, swelling, burning of the face, hot flashes, pronounced skin hypersensitivity to stress, sun exposure, the pre-ovulation phase of her menstrual cycle. The redness was constant, intensifying in hot environments and during emotional stress. Rashes appeared periodically, the main trigger was hormonal changes, the beginning of the cycle. On examination: there was total lesion of the entire face, diffuse erythema over the forehead, cheeks, nose, chin; multiple papular, pustular, infiltrative elements; soft tissues edema of the face with an emphasis in the middle third of the face; xerosis, pronounced hyperkeratosis, signs of inflammation of the outer eye; multiple cicatricial atrophic deformities in the lateral cheeks; positive the symptom of white glasses (white foci around the eyes), a positive symptom of a leaf (a rustling sound of dry foliage when stroking the skin of the face) which is characteristic of severe skin dehydration. The more pronounced the skin xerosis is, the more pronounced the test is. On palpation, the patient was diagnosed with a sharply positive palpation test (a sharp increase in erythema at the site of palpation). Examination of the outer surface of the thighs reveals pronounced fibrosis of subcutaneous fat tissue, lymphostasis of tissues, cyanosis; on palpation, these areas were firm, fainful and cold to the touch. The therapy was performed in accordance with Invention Patent No. 2814360, as well as No. 2810361 in combination with home care. The presented clinical case of Patient N. with the phymatous rosacea is complex, demonstrates the unpredictability of the course of the disease and its variability in clinical manifestations. In case of torpid skin angioedema, it is important to enhance home care therapy for the body to achieve lymphatic drainage effect and for the face to restore the lipid mantle and relieve skin xerosis. Purpose. To analyze a patient with the phymatous subtype of rosacea, to analyze the complexities of the clinical course of the disease, to develop a strategy for managing the patient in the clinic and at home, to determine the tactics of correcting home care products based on the dynamics of the skin condition. Materials and methods. To analyze the treatment strategy for the phymatous subtype of rosacea, Patient N., 43 years old, was observed and managed. The patient provided information about treatment with cosmetologists, dermatologists, gastroenterologists, gynecologists before the initial medical treatment at the Dermatology and Cosmetology Clinic “MDElena”. Anti-inflammatory, seborrheic, and regenerating therapy was performed in accordance with Patent No. 2814360, as well as No. 2810361. A protocol was conducted for ophthalmorosacea to restore the eyes. The tactics of prescribing home care products were determined based on the links in the pathogenesis of the phymatous subtype of rosacea. Results. The patient was observed regularly for 3 months at short intervals: every or two weeks, then the interval was increased to 2, 3, 6, 8 and 12 months. For the first 3 months, an active inflammatory process was observed, resolution of deep inflammatory elements was noted 5 months after the start of pathogenetic treatment (torpid clinical form), by 8 months the skin's resource and the state of the lipid mantle were fully restored, skin sensitivity to external and internal environmental factors was normalized, including hormonal changes in the body (the main trigger of the patient). Conclusions. After anti-inflammatory, seborrheic, regenerating therapy in accordance with Patents No. 2814360 and No. 2810361, dynamic in the clinical picture of home care, all signs of a deep inflammatory process in the skin of the face and in the eye area were stopped, the lipid mantle was restored, the skin became intact.