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ESSENTIALS OF DIAGNOSIS
A chronic disorder affecting the face.
Neurovascular component: erythema and telangiectasis and a tendency to flush easily.
Acneiform component: papules and pustules may be present.
Glandular component: sebaceous hyperplasia and fibrosis of affected areas (eg, rhinophyma).
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GENERAL CONSIDERATIONS
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Rosacea is a common condition that presents in adulthood. The pathogenesis of this chronic disorder is not known. Topical corticosteroids applied to the face can induce rosacea-like conditions (eFigure 6–67).
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Patients frequently report flushing or exacerbation of their rosacea due to heat, hot drinks, spicy food, sunlight, exercise, alcohol, emotions, or menopausal flushing. The cheeks, nose, chin, and ears—at times the entire face—may be affected. No comedones are seen. In its mildest form, erythema and telangiectasias are seen on the cheeks (eFigure 6–68). Inflammatory papules may be superimposed on this background and may evolve to pustules (Figure 6–20) (eFigure 6–69). Associated seborrhea may be found. The patient often complains of burning or stinging with episodes of flushing and extremely cosmetic-intolerant skin. Patients may have associated ophthalmic disease, including blepharitis, keratitis, and chalazion, which often requires topical or systemic antibiotic or immunosuppressive therapy.
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DIFFERENTIAL DIAGNOSIS
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Rosacea is distinguished from acne by the presence of the neurovascular component and the absence of comedones (eFigure 6–64). Lupus is often misdiagnosed, but the presence of pustules excludes that diagnosis.
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Educating patients to avoid the factors they know to produce exacerbations is important. Patients should wear a broad-spectrum mineral-based sunscreen; zinc- or titanium-based sunscreens are tolerated best. Medical management is most effective for the ...