• Clinical science

Rosacea

Summary

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, telangiectasias, 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, topical agents (e.g., metronidazole, brimonidine) for mild disease, and oral agents (e.g., metronidazole) for more severe disease.

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
    • 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 telangiectasias)
  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]

Treatment

References:[4][6][7][8]

  • 1. Le T, Bhushan V, Bagga HS. First Aid for the USMLE Step 2 CK. McGraw-Hill Medical; 2009.
  • 2. Kupiec Banasikowska A. Rosacea. In: James WD. Rosacea. New York, NY: WebMD. http://emedicine.medscape.com/article/1071429. Updated January 24, 2017. Accessed May 17, 2017.
  • 3. Alinia H, Tuchayi SM, Patel NU, et al. Rosacea triggers. Dermatol Clin. 2018; 36(2): pp. 123–126. doi: 10.1016/j.det.2017.11.007.
  • 4. Goldgar C, Keahey DJ, Houchins J. Treatment options for acne rosacea. Am Fam Physician. 2009; 80(5): pp. 461–468. url: http://www.aafp.org/afp/2009/0901/p461.html.
  • 5. Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a clinical review. Dermatol Reports. 2016; 8(1). doi: 10.4081/dr.2016.6387.
  • 6. Oge LK, Muncie HL, Phillips-Savoy AR. Rosacea: Diagnosis and treatment. Am Fam Physician. 2015; 92(3): pp. 187–196. url: http://www.aafp.org/afp/2015/0801/p187.html.
  • 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.
  • 8. Abokwidir M, Feldman SR. Rosacea Management. Skin Appendage Disord. 2016; 2(1-2): pp. 26–34. doi: 10.1159/000446215.
  • 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 12/06/2019
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