Chapter 29-14: Rosacea

TEXTBOOK PRESENTATION

Commonly presents in adults with a facial rash. There is a gradual development of telangiectasias and persistent centrofacial erythema occasionally with inflammatory red papules and papulopustules. Comedones are absent. There is often a history of easy flushing. The rash may worsen with sun exposure, ingestion of spicy foods and thermally hot foods/liquids, emotional stress, and exercise.

DISEASE HIGHLIGHTS

1. Description of lesion: centrofacial persistent facial erythema, telangiectasias, and, occasionally, inflammatory papules and papulopustules (Figure 29-3).

2. Rosacea is most common in fair-skinned individuals of northern European descent but can be seen in people with darker skin as well.

3. Women are more commonly affected than men.

4. However, complicated disease with sebaceous gland hyperplasia and rhinophyma (sebaceous overgrowth causing deformity of the nose) develops more often in men.

5. Rosacea typically begins later than acne and reaches a peak in middle age. That said, the 2 can overlap.

6. Sun exposure is thought to be a trigger and sun-damaged skin is frequently seen in patients with rosacea.

7. Ocular rosacea is common, perhaps affecting more than half of patients with rosacea, and includes conjunctival hyperemia, anterior blepharitis, and keratitis.

EVIDENCE-BASED DIAGNOSIS

1. Diagnosis is by clinical presentation.

2. Histopathology, which is rarely necessary, varies according to the stage and variant of the disease and is often nonspecific.

TREATMENT

1. Sun protection

2. Avoidance of triggers of flushing

   1. Sun exposure

   2. Ingestion of spicy and thermally hot foods and liquids

   3. Emotional stressors

   4. Physical exertion: encourage frequent cool-downs

3. Topical agents

   1. Metronidazole (treats papules and papulopustules, modest effect on erythema)

   2. Brimonidine (treats erythema)

   3. Ivermectin (treats papules and papulopustules)

4. Systemic agents: oral antibiotics of the tetracycline class control severe eruptions of inflammatory lesions.

5. Laser treatment

   1. Used to ablate telangiectasias and improve background erythema.

   2. May be helpful to reduce rhinophyma.