Resolution of rosacea-associated persistent facial edema with osteopathic manipulative treatment

Participants

• Number: 1

• Description: a 72-year-old woman with a history of severe asthma in her childhood, atopic dermatitis, hypothyroid goiter treated with radiation, and connective tissue disease following inadequate rosacea treatments. The latter condition took the appearance of a recalcitrant facial edema around the age of 55: initially developed as major redness, over the past 4 years it had become a progressive and chronic swelling, especially on the left side and showing particularly in the morning upon awakening.
  The therapies administered to cure her rosacea (amoxicillin and sulfacetamide, azelaic acid, ivermectin, metronidazole, aluminum acetate cream) were only partially effective, as symptoms continued to persist. A patch test revealed an allergy to acrylates, but this was not considered a pathogenic cause for the edema. She had also undergone a face-lift surgery at the age of 70.
  A biopsy of the left cheek was performed, but revealed relatively normal skin with signs of chronic  exposure.
  Physical evaluation showed nonpitting edema and erythema on the left cheek, while palpation showed significant restrictions in the submandibular fascia and left cervical fascia overlying the upper thoracic inlet. Enlarged lymph nodes were also present at the mandibular and upper cervical levels.
  The analysis of these findings together with the woman’s clinical history led to the hypothesis that the persistent edema condition derived from a problem in lymphatic drainage. Therefore, it was chosen to proceed with OMT.

Interventions and evaluations

• Assessment of symptoms and tissue state
• weekly 10-minute sessions of OMT
• OMT: techniques performed in proximal-distal order to promote lymphatic drainage
  • techniques used (in order): thoracic inlet release; cervical chain drainage; suboccipital decompression and venous sinus release; submandibular release; facial effleurage and trigeminal stimulation.

Results

Already after the first session, the patient showed a significant decrease in swelling, an improvement that progressed over the following month.
After one month a new evaluation showed relaxation in the cervical tissues overlying the upper thoracic inlet as well as the resolution of the enlargement of the lymph nodes.
Having seen such results, the patient decided to schedule monthly osteopathic visits.

Discussion

OMT has been shown to bring immediate relief in a condition delicate, complex and persistent as rosacea-associated facial edema.

In this regard, the literature shows that in this type of situation only 2 out of 3 people respond to treatments and only 1 out of 3 have a major, albeit partial, response. Many therapies are implemented, but they often take time to act and have side effects that are not always tolerable. Moreover, as in the case presented, they may fail to counteract important factors that contribute to the worsening of the disease such as, as in this case, difficulties in lymphatic drainage.

Therefor more studies are needed on the importance of assessing and acting manually through osteopathy or other body techniques on the lymphatic system in cases of facial edema due to rosacea or other similar conditions.