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Introduction

Rosacea is a common facial rash, of unknown aetiology. It is typically chronic and persistent.

It causes sterile inflammatory papules, pustule and nodes and it may sometimes be mistaken for acne.

Epidemiology and Aetiology

  • Typically affects patients aged 30-50
  • Mainly females
  • “Celtic” ethnic origin
    • Fair skin
    • Blue eyes

Presentation

  • Red rash, often with inflammatory papules
    • May often begin as a increasing tendency for fascial flushing, before progressing to papules, pustules and nodules
  • Typically rash on the cheeks, forehead, nose and chin
  • Worse when flushed or blushing
  • Usually peri-orbital and peri-oral areas are spared
  • May also be associated with increased skin sensitivity, and stinging sensations
  • May be accompanied by:
    • Telangectasia
    • Facial oedema
    • Seborrheic dermatitis
    • Sensitive skin – burning sensation to creams and other agents applied to face
Rosacea

Rosacea. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Complications

  • Blepharitis
  • Conjunctivitis
    • Rarely – corneal ulceration
  • Rhinohpyma
    • Development of a large, bulbous nose

Differential diagnosis

Management

  • Stringent sun protection
  • Use gentle soap-free cleanser (e.g. emollient)
  • Avoid oil based creams – use water-based make-up and sunscreen
  • Avoidance of factors that cause facial flushing:
    • Heat, wind, sudden changes in environmental temperature
    • Alcohol
    • Excessive exercise
    • Hot baths
    • Spicy food
    • Hot drinks
  • Cool packs
  • Medication
    • Topical metronidazole cream 0.75% OD or BD
      • Use for 6-12 weeks
      • Long term maintenance therapy is often required
    • Oral Antibiotics – used when topical agents have not been successful – e.g. Doxycycline 100mg OD or erythromycin 250-500mg BD for 4-8 weeks
  • Laser treatment for telangectasia
  • Surgical correction of rhinophyma
  • Avoid topical steroids

Flashcard

References

  • Rosacea - Dermnet NZ
  • Murtagh‚Äôs General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

Read more about our sources

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