Rosácea: revisión y nuevas alternativas terapéuticas / Rosacea: a review and new treatment alternatives

La rosácea es una dermatosis crónica que afecta a un 10% de la población. No es una enfermedad con graves repercusiones en la salud del paciente pero tiene un componente estético que puede suponer una importante carga emocional. Por todo ello el médico de familia debe estar familiarizado con esta entidad y con los diferentes tratamientos disponibles, así como conocer la posibilidad de derivar a los pacientes con determinadas características al dermatólogo para beneficiarse de la aplicación de técnicas con láser (AU)

Rosacea is a chronic skin disease that affects 10% of the population. It is a disease with serious implications for patient's health but has an aesthetic component that can cause significant emotional damage. Therefore the practitioner should be familiar with this entity and the different treatments available, as well as the possibility of referring patients with certain characteristics to the dermatologist to benefit from the application of laser techniques (AU)

Treatment of cutaneous and mucosal telangiectases in hereditary hemorrhagic telangiectasia: Report of three cases.

INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomal dominant disorder characterized by epistaxis, mucocutaneous telangiectases and visceral arteriovenous malformations. Cutaneous telangiectases are the most obvious sign of this disorder and are not a merely cosmetic problem owing to their risk for bleeding, which may constitute an authentic matter of concern to these patients. METHODS: Three patients with type-II HHT disease who presented cutaneous and labial lesions were treated with an intense pulsed light (IPL) system associated with a long-pulsed Nd:YAG laser (Photoderm-Vasculight, Lumenis). Labial lesions were treated with the IPL system and cutaneous lesions were treated with the IPL system and the long-pulsed Nd:YAG laser. All treatments were accomplished on an outpatient basis, without anesthesia. RESULTS: All three patients experienced a reduction in the frequency and severity of bleeding episodes and a great cosmetic improvement, with total lesion clearance. Side effects, such as purpura, hypopigmentation, hyperpigmentation or textural changes, were not observed. Recurrences were not detected after a maximum period of 24 months of follow-up. CONCLUSION: The combination of an IPL system and a long-pulsed Nd:YAG laser is efficient and safe for the treatment of cutaneous and labial telangiectases in patients with HHT disease and constitutes an important tool in improving their quality of life.

External beam radiotherapy for severe epistaxis from Osler-Weber-Rendu disease.

Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder of blood vessels, which affects about 1 in 10,000 people. The disorder is also sometimes referred to as Osler-Weber-Rendu Disease after the doctors who studied HHT. The disorder affects males and females from all racial and ethnic groups, and the most commonly affected organs are the nose, lungs, gastrointestinal tract, and brain--in that order. Radiation therapy should be considered for intractable bleeding from the upper airway or alimentary tract.

Management of epistaxis in Rendu-Osler disease: is brachytherapy effective?

PURPOSE: This paper reviews the results of intranasal brachytherapy for epistaxis in 43 patients with Rendu-Osler disease treated between 1971-1991 at Henri Mondor Hospital. METHODS AND MATERIALS: 2-3 intranasal catheters were afterloaded with 192Ir sources. Computer dosimetry was performed and then the dose was prescribed to an isodose thought to cover the nasal mucosa. The dose rate ranged from 0.16 Gy/h-0.63 Gy/h with a median of 0.34 Gy/h. Dose at one application ranged from 15-35 Gy with a median of 30 Gy. The severity of epistaxis was graded 1 to 5. RESULTS: The time to recurrence of significant epistaxis ranged from 6-178 months with a median of 24 months. The dose prescribed did not correlate with control rate. The only brachytherapy complication was septal perforation in 4 patients; in one this was a result of repeated nasal coagulation. CONCLUSION: We suggest that intranasal brachytherapy is a useful modality in the management of epistaxis in Rendu-Osler disease.

Gastric radiotherapy as treatment of hereditary hemorrhagic telangiectasia.

A patient with hereditary hemorrhagic telangiectasia and von Willebrand's disease is described. He suffered recurrent episodes of gastrointestinal bleeding endoscopically localized to the cardia and body of the stomach. A cobalt 60 source was used to deliver 1600 rad to the patient's stomach. The effect of the radiation was remarkable in that he remained free of bleeding for more than 11 months. Radiotherapy should be considered for control of gastric bleeding in hereditary hemorrhagic telangiectasia.

[Rendu-Osler disease treated by endonasal radiotherapy (evaluation of 62 cases)]. / Maladie de Rendu-Osler traitée par plésiocuriethérapie endo-nasale. (Bilan de 62 cas)

Two groups of patients were treated by plesiocurietherapy. The first group of 17 patients received only one exposure to radium (between 1949 and 1960). The second group received one or more doses of irridium 192 (between 1960 and 1973). The average period for stabilization of the disease was 13,2 months with radium and 20,4 months with irridium. Unfortunately, this does not give a permanent cure and, for irridium 192, the percentage of successes is only 30 p. 100 after 5 years. Logically, radiotherapy with irridium 192 should only be used when other methods have failed. The progressive accumulation of radio-lesions may, in fact, make the use of other techniques impossible.