Experience of using topical beta-blockers in combination therapy of rosacea

Background. Neurovascular disorders and an imbalance of immune regulation are the leading links in the pathogenesis of rosacea. However, the basic therapeutic goal underlying the formation of clinical manifestations of rosacea has not been determined, so most treatment methods do not give the desired result. One of the “sniper” drugs is a highly selective α2-adrenergic receptor agonist with powerful vasoconstrictive activity brimonidine tartrate. Promising topical drugs are β-blockers. The mechanism of their action consists not only in vasoconstriction, but also in slowing the growth of vascular epithelial cells and reducing their ability to divide and reduce erythema. Hardware methods of cosmetic correction, such as laser therapy, help to significantly improve skin color and the quality of fibrous tissue.

Aim. To determine the diagnostic value of interleukin-17 (IL-17) and human β-defensin-2 (HBD-2) in the pathogenesis of rosacea and to study the clinical efficacy of the β-adrenoblocker Propranolol in the form of 10% ointment in mono- and combination therapy of rosacea.

Materials and methods. The study included patients aged 20 to 72 years with a diagnosis of Rosacea. The concentration of IL-17 in blood serum was measured by enzyme immunoassay using ELISA (Enzyme-Linked Immunosorbent Assay) Kit for Interleukin 17 (IL17) Cloud Clone Corp. Sensitivity: 5.5 pg/ml. Detection range: 15.6–1000 pg/ml. The patients were divided into two experimental groups. In the first group, monotherapy with 10% Propranolol ointment was performed. The patients of the second group underwent combination therapy: 10% Propranolol ointment, as well as Nd:Yag/Ktp-Qsw laser scanning.

Results. The levels of HBD-2 and IL-17 were significantly increased in patients with rosacea compared with controls. The level of HBD-2 had no significant differences depending on gender, subtype, severity of rosacea and duration of the pathological process, the level of cytokine IL-17 had no significant differences depending on gender, subtype, severity of rosacea, but it significantly increased depending on the duration of the pathological process. In both groups, there was a statistically significant decrease in erythema intensity after treatment. Increased skin vascularization decreased more significantly in the second group 2 weeks after the last visit. The number of inflammatory elements regressed 2 weeks after the start of treatment and was completely resolved by the end of therapy in both groups.

Conclusion. The use of laser therapy in combination with local rosacea treatments provides a comprehensive, personalized approach.