• Clinical science

Rosacea

Abstract

Rosacea is a chronic inflammatory skin disease that may be triggered by a number of factors (e.g., alcohol, stress). The etiology is unclear; however, the disease is more common in females and middle-aged individuals with fair skin. The disease presents with central facial erythema, telangiectasia, and papules/pustules. In severe cases, the nose develops a large, bulbous shape (rhinophyma). In contrast to acne, comedones are not present. Treatment options include the avoidance of triggers and the application of topical metronidazole. In more severe cases, systemic tetracycline or isotretinoin may be added.

Epidemiology

  • Sex: >
  • Age range: 30–60 years

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

The cause of rosacea is not entirely understood, but is especially associated with triggers that increase body temperature.

  • Trigger factors
    • Hot weather, hot drinks, spicy food
    • Stress, alcohol, nicotine, caffeine
    • Demodex mites

References:[2][3]

Clinical features

There are four different clinical subtypes of rosacea:

  1. Erythematotelangiectatic rosacea
    • Facial flushing
    • Persistent erythema of the face (together with telangiectasia)
  2. Papulopustular rosacea
  3. Phymatous rosacea
    • Skin and sebaceous glands thicken
    • Inflammatory, widespread nodules
    • Rhinophyma: enlarged, bulbous nose (almost exclusively in males)
    • Similar changes may occur on the chin, forehead, cheeks, and ears
  4. Ocular rosacea

In contrast to acne, comedones are NOT present!

References:[4][5]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

References:[4][6][7]

Complications

  • Eye involvement (common)
  • Granulomatous lesions
    • Small brown papules, especially around the mouth and eyes
    • Granulomatous lesions may occur on their own, without other symptoms of rosacea
    • Histology: tuberculoid granulomas

All patients with rosacea and concurrent eye problems should have their eyes examined by an ophthalmologist!

We list the most important complications. The selection is not exhaustive.

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  • 7. Weinkle AP, Doktor V, Emer J. Update on the management of rosacea. Clin Cosmet Investig Dermatol. 2015; 8: pp. 159–177. doi: 10.2147/CCID.S58940.
  • Bron A, Dahl MV, Trobe J, Ofori AO. Ocular Rosacea. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/ocular-rosacea. Last updated May 25, 2017. Accessed September 1, 2017.
last updated 09/07/2018
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