Rosacea

Rosacea
  • It is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema, telangiectasia, coarseness of skin, and an inflammatory papulopustular eruption resembling acne.
Types:
  1. Erythematotelangiectatic type
  2. Papulopustular
  3. Phymatous
  4. Ocular
Common triggering factors include the following
  1. Hot or cold temperatures
  2. Wind
  3. Hot drinks
  4. Caffeine
  5. Exercise
  6. Spicy food
  7. Alcohol
  8. Emotions
  9. Topical products that irritate the skin and decrease the barrier
Clinical Features:
  • It is seen almost exclusively in adults, rarely affecting patients
  • Rosacea is more common in women
  • But those most severely affected are men
  • Rosacea is defined by persistent erythema of the central portion of the face lasting for at least 3 months. Supporting criteria include flushing, papules, pustules, and telangiectasias on the convex surfaces. Secondary characteristics are burning and stinging, edema, plaques, a dry appearance, ocular manifestations, and phymatous changes.
 Management 

Laser treatment
  • Vascular lasers, the mainstay of rosacea therapy, use wavelengths that allow selective absorption by oxyhemoglobin, leading to vessel reduction and causing minimal scarring or damage to surrounding tissue.
Surgery
  • Permanent telangiectasia may be treated by electrosurgery or the 585-nm pulsed dye laser. 
  • Cosmetic improvement of rhinophyma may be produced by mechanical dermabrasion, carbon dioxide laser peel, and surgical shave techniques.
Deterrence
  • Before the initiation of therapy, the triggering factors that exacerbate the patient's rosacea should be identified and avoided if possible.
  • In addition, the use of daily broad-spectrum sunscreen is recommended for all patients with rosacea.
Exam Question
  • An 76 year lady had a history of a red facial rash suffered venous eczema of legs. She was treated for acne rosacea by her GP. On examination, she had bluish pigmentation on both the legs. Minocycline is likely to have caused this.
  • A 40-year-old woman presents with a 2-year history of erythematous papulopustular lesions on the convexities of the face. There is a background of erythema and telangiectasia. The most likely diagnosis in the patient is Rosacea.
  • Rosacea is a chronic disease affecting fair skinned middle aged adults characterised by flushing and telangiectasia in early stage, papules and pustules in inflammatory stage, papules and induction and rhinophyma in chronic stage.
  • ion the skin is erythematous, with dilated blood vessels, nodules and pustules without any comedones. Rosacea is the MOST likely diagnosis in this patient. Rhinophyma is a complication of glandular form of acne rosacea.
  • A 25-year old girl presented with erythematous papules on the face as seen in the figure. The lesions were exacerbated on excessive sweating, sun exposure and emotional disturbance.Acne Rosacea is the diagnosis.
  • Potato nose is seen in acne rosacea.
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