皮膚科 劉權毅醫師

   
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【人間福報】 2014年8月21日  文/ 劉權毅醫師

FDA Approves Rosacea Treatment.
MedPage Today (8/26, Petrochko) reports that the Food and Drug Administration has approved Galderma’s brimonidine alpha-2 adrenergic agonist, “the first topical treatment specifically indicated for the persistent facial erythema of rosacea.” The treatment works by constricting dilated facial blood vessels, and is effective for 12 hours.
Medscape (8/26, Brooks) reports that the 16 million Americans afflicted with rosacea will have access to brimonidine starting in September.
The FDA has approved the alpha-2 adrenergic agonist brimonidine (Mirvaso) to treat facial redness in adult rosacea patients, the drug's manufacturer announced.
The new indication makes Mirvaso 0.33% topical gel the first topical treatment specifically indicated for the persistent facial erythema of rosacea, according to a statement from Galderma.
The gel is applied once a day to the forehead, chin, nose, and cheeks, and remains effective for up to 12 hours. The drug is thought to constrict dilated facial blood vessels, which reduces the redness in rosacea.
Approval for the new indication was based on phase III trial data from 550 patients in two month-long studies, which found that adult participants who used brimonidine gel had significant improvement of facial redness compared with those who used a placebo preparation.
Common adverse reactions during the trials included erythema, flushing, a burning sensation, and contact dermatitis.
Patients with depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, thromboangiitis obliterans, scleroderma, or Sjogren's syndrome, as well as those with severe, unstable, or uncontrolled cardiovascular disease should use the drug with caution, the agency said.
The gel should be kept out of reach of children as accidental ingestion has resulted in serious adverse events.
The agent should not be taken orally, ophthalmically, or intravaginally.
Mirvaso is marketed by Galderma.
http://www.medpagetoday.com/Dermatology/GeneralDermatology/41183

臉為什麼會紅？主要是因為表皮下面的血管異常地增生或擴張，染料雷射就是利用血管內的血液，因為帶有會吸收特殊波長(595nm)的含氧血紅素，以此為目標用雷射去攻擊，便能有效讓血管吸收熱能，且盡量減少不必要的週邊組織傷害，接著血管凝集收縮、慢慢壞死，最後血管病變就消失了。
有了這樣的概念，染料雷射便應用在很多疾病的治療，譬如酒糟、紅色痘斑、微血管絲、靜脈曲張、葡萄酒色斑、血管瘤、櫻桃血管瘤、蜘蛛狀血管絲、甚至蟹足腫或牛皮癬。近年來，染料雷射甚至擴大應用到回春治療，這麼多年來始終是個歷久不衰的明星雷射。
因為染料雷射主要用來治療紅紅的病兆，所以又得到一個美麗的名字，叫作『櫻花雷射』。隨著技術的進步，櫻花雷射的機器也越做越精良，新一代的機器具備了一些改良的特色，可避免瘀青的發生，也更能去除較深的血管病變，除此之595nm的波長比起585nm更適合膚色較深的東方人使用。此外，讓治療更安全、舒適。再者，櫻花雷射使用長脈衝及八個次脈衝技術，讓病患在治療後大幅減少傳統染料雷射容易出現的瘀青負作用。

 
酒糟簡單講就是一種異常敏感的皮膚，風吹草動下 (譬如曬太陽、喝酒、吃辣等)就會讓臉潮紅，原因是皮膚血管反覆發炎並擴張。那麼為什麼有些人的血管反覆發炎，有些人卻不會呢。過去醫生可能會告訴你這是體質，但隨著科學的進步，更有學問的答案可能一一被找到。
( 閱讀本文前請先參考這篇介紹酒糟的文章 http://yanjiskin.pixnet.net/blog/post/229205858 )
我們都知道大部份的皮膚科醫師會按照標準程序治療酒糟。至於藥物則會遵循美國食品衛生管理局(FDA)已經核准的藥物，也就是四環黴素類抗生素(40mg緩釋型劑型 doxycycline)、外用metronidazole，和外用杜鵑花酸。如果血管擴張仍然明顯，有時會合併雷射治療，譬如染料雷射或脈衝光。其他還常使用的治療包括口服抗生素Tetracycline、Minocycline、Clindamycin及Macrolide、口服Ａ酸Isotretinoin、外用第三代類Ａ酸Adapalene、外用過氧化苯benzoyl peroxide、calcineurin抑制劑等。

  
連美國前總統克林頓、英國黛安娜王妃、英國威廉王子、電影明星卡麥隆迪亞、影后芮妮齊薇格、歌手瑪莉亞凱莉都會得的酒糟，一個廣泛藏於民間的病。

食物如果富含組織胺, 就容易造成血管擴張,導致臉部潮紅, 所以有酒糟體質的人應盡量不要食用以下這些食物以免惡化。
這些食物包括: