Rosacea

Fig.1 Rosacea showing a red nose with pustules and papules around the nose

Fig.2 Rosacea showing red nose with dilated blood vessels

Fig.3 Rosacea affecting the nose - rhinophyma

• A common disorder affecting facial skin.
• Initially carries both a vascular and an inflammatory component
  - Inflammatory: Papules, pustules
  - Vascular: Erythema, telangiectasia, flushing

• Symmetrical localization on the face; may be asymmetrical
• Nose, cheeks, forehead, chin
• May involve a variety of ocular lesions

• Unknown
• Age - thirty to fifty years at onset (most common);
  may occur from adolescence to late adult life
• Females predominate, but severity is greater in males
• Greater incidence in fair skinned people

• Flushing - periodic reddening of the face (erythema)
• Inflammatory lesions - papules, pustules
• Edema may be present
• Telangiectosia may be added with time
• Ocular rosacea - accompanies vascular cutaneous rosacea
• Comedones are characteristically absent
• Diagnosis is made on a clinical basis
• Rhinophyma is a late finding

• Recurrent flushing, blushing;
  may last several minutes - several hours
• Stinging in the malar areas, forehead, ears
• Facial edema may be present

• Pre-rosasea ===> Flushing and blushing
• Vascular Rosasea ===> Erythema and telangiectasia
• Inflammatory Rosacea ===> Papules and pustules
• Late Rosacea ===> Rhinophyma

• Is a prominent feature of rosacea
• Is usually the initial manifestation of the disease
• Worsens during inflammatory outbreaks
• Patients should avoid activities and aggravating
  factors which induce flushing

• Enlargement of the nose
• More common in males
• Skin thickens
• Enlarged follicles
• Hyperplasia of sebaceous glands, connective tissue

• Demodex folliculorum
• Psychogenic stress
• Endocrine abnormalities
• Focal infection
• Vascular disorder
• Diet

• Leaky vessels
• Insufficient blood flow
• "Pooling effect"
• Connective tissue dystrophy -
  leads to dilation of blood vessels

• Hot liquids
• Sun exposure, wind exposure
• Spicy foods
• Extreme temperatures
• Alcoholic beverages
• Stress and other psychological factors
• Prolonged use of topical fluorinated corticosteroids

• Acne vulgaris
• Seborrheic dermatitis
• Perioral dermatitis
• Lupus erythematosus
• Carcinoid syndrome
• Some may exist

• Chronic, progressive disease
• Periodic exacerbations and remissions common
• May slowly increase in extent
• Inflammatory ocular complications may occur
• Long-term therapy may be required

• Can cause rebound erythema
• Can worsen the condition in long run, although
  may effect impressive short-term improvement
• If used, should be low potency for short time period

• Oral antibiotics - tetracycline and others
• Topical formulations - metronidazol topical gel and others
• Many patients will do well with topical therapy alone.
  For some patients, the addition for oral tetracycline for several weeks
  may accelerate initial response to therapy. Lifestyle changes are also
  an important aspect of the overall treatment plan. Avoidance of situations
  and factors that aggravate rosacea should be emphasized.

Question: I have very sensitive skin due to my rosacea. How can I clean my face without causing additional irritation?

Answer: Only very mild soaps or cleansers should be used on the face. Avoid products containing alcohol or witch hazel. A mild cleanser such as Cetaphil Gentle Cleansing Lotion is recommended.

Question : What about cosmetic use? Can I continue to wear cosmetics?

Answer: Yes, but use of high quality mosturizers and oil-free cosmetic products are recommended. Sunscreens of SPF 15 or higher should be used when prolonged sun exposure is expected. To reduce the redness or a rosacea flare, a green-based concealer may be used.

Question: Can anything make rosacea worse?

Answer: Certain things are known to aggravate rosacea. These include hot liquids, alcohol, spicy foods, extremes of temperature and stress.