Contents
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, however it does not cause comedones.
There is an association between rosacea and a mite called demodex folliculorum. This mite usually lives on the skin of healthy individuals in hair follicles, and is not considered pathogenic. However it is found sin higher concentrations on the face of those with rosacea. It is not know if higher concentrations cause rosacea, or if the conditions created by rosacea lead to higher concentrations of the mite.
Epidemiology and Aetiology
- Typically affects patients aged 30-50
- Mainly females
- “Celtic” ethnic origin (Irish / Scottish)
- 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
- Patients often reports that their face feels hot or burns
- 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
Complications
- Blepharitis
- Conjunctivitis
- About 50% of patients with suffer from belpharoconjunctivitis which typically causes dry and itchy eyes
- Rarely – corneal ulceration
- Rhinohpyma
- Development of a large, bulbous nose
Differential diagnosis
- Acne
- Seborrheic dermatitis
- SLE
- Periorifical dermatitis
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
- In women of menopausal age – consider menopausal related flushing as the cause which may respond to HRT
- Topical metronidazole cream 0.75% OD or BD
- Laser treatment for telangectasia
- Surgical correction of rhinophyma
- Avoid topical steroids
Flashcard
References
- Rosacea – Dermnet NZ
- Murtagh’s 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