Rosacea

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Rosacea

Rosacea

A common disorder affecting facial skin.

Initially carries both a vascular and an inflammatory component

– Inflammatory: Papules, pustules

– Vascular: Erythema, telangiectasia, flushing

Distribution

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

Etiology

• 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

Clinical Picture

• 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

Facial Flushing

• 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

Rhinophyma

• 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
• Diet

Vascular Disorders

• 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

Differential Diagnosis

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

Perioral Dermatitis

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, azelaic acid and others (Brimonidine…)
• 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.

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.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore

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