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
- -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
- -Telangiectasia 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
Early Clues To Rosacea
- -Recurrent flushing, blushing; may last several minutes – several hours
- -Stinging in the malar areas, forehead, ears
- -Facial edema may be present
Rosacea Often Progresses In The Following Steps
- -Pre-rosacea ===> Flushing and blushing
- -Vascular Rosacea ===> 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
Pathogenesis: Theories Proposed
- -Demodex folliculorum
- -Psychogenic stress
- -Endocrine abnormalities
- -Focal infection
- -Vascular disorder
- -Leaky vessels
- -Insufficient blood flow
- -“Pooling effect”
- -Connective tissue dystrophy – leads to dilation of blood vessels
Rosacea – Aggravating Factors
- -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
Course Of Rosacea
- -Chronic, progressive disease
- -Periodic exacerbations and remissions common
- -May slowly increase in extent
- -Inflammatory ocular complications may occur
- -Long-term therapy may be required
Topical Steroids – Are Best Avoided
- -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
Methods Of Treatment
- -Oral antibiotics – tetracycline and others
- -Topical formulations – metronidazole topical gel and others (brominidine…)
- -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.
- -Low dose isotretinoin has been shown to be useful
- -Erythema can respond to lasers.
- -Lifestyle changes are also an important aspect of the overall treatment plan.
- .Avoidance of situations and factors that aggravate rosacea should be emphasized.
Answers To Common Patient Questions
1. 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 mild cleansers should be used on the face. Avoid products containing alcohol or witch hazel.
2. 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.
3. 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.