Acne Rosacea is a relatively common disease, especially in fair-skinned people of Celtic or northern European heritage, hence the term curse of the Celts. It is rarer in dark-skinned people, particularly so with American and African blacks. The disease is estimated to affect at least 5 percent of Americans, or some 13 million people. Although it is said that women are more often affected than men in earlier stages (3:1 ratio), men develop the tissue and sebaceous gland hyperplasia leading to rhinophyma much more frequently. Although Acne Rosacea tends to be milder in women, it can lead to severe emotional distress owing to its chronic course.
The importance of sun-damaged skin in Acne Rosacea cannot be stressed enough. Acne Rosacea is always associated with solar elastosis and often with heliodermatosis. This is a consistent background on which Acne Rosacea is superimposed. However, an increase in ultraviolet sensitivity has not been demonstrated in Acne Rosacea sufferers, nor is the disease more common in outdoor workers.
There is also a wide spectrum of Acne Rosacea manifestations. Especially in young sufferers there may be a history of acne giving rise to variants of two independent facial diseases that are difficult to recognize and treat. It is important to realize that Acne Rosacea and acne can coexist, though normally Acne Rosacea begins and reaches its peak incidence decades after acne declines.
Although the precise cause of Acne Rosacea remains a mystery, various factors have been suspected to contribute to this condition. None of them, however, has been definitely confirmed. Acne Rosacea sufferers are constitutionally predisposed to flushing and blushing. Migraine headaches have been shown to be two or three times more common in Acne Rosacea sufferers than among age- and gender-matched control subjects, suggesting the possibility of a more generalized vascular pathogenesis. The fact that vasomotor lability is especially pronounced during menopause and that a significant number of Acne Rosacea sufferers are perimenopausal women supports this hypothesis. Experimental studies show that the involved skin responds normally to various vasoactive chemicals, with facial blood vessels maintaining their capacity for dilatation and constriction. The basic abnormality seems to be a microcirculatory disturbance of the function of the facial angular veins directly involved in the brain-cooling vascular mechanism.
what is Rosacea
Rosacea is a common chronic inflammatory disorder of the hair follicles, sebaceous glands and vasculature of the face. The role of Demodex mite in the pathogenesis of Rosacea is controversial.
Rosacea sufferers have recurrent flushing, exacerbated by heat (shower, hot drinks), spicy foods, sunlight, cold, alcohol, and stress. They have sensitive skin, and may complain of dry and gritty eyes.
The peak incidence of Rosacea is 30—50 yr; Females being more affected than Males.
Rosacea sufferers may develop erythema, telangiectases, papules, and pustules of central face; there are no comedones in contrast to acne. Sebaceous hyperplasia, seborrheic dermatitis and facial lymphedema are also more common.
There are 4 Major Subtypes of Rosacea:
Erythematotelangiectatic, papulopustular, ocular, and phymatous.
Chronic inflammation may progress to rhinophyma (enlarged nose; in males). Ocular involvement is also common (e.g., gritty, conjunctival injection, styes, photophobia).
Investigations include clinical diagnosis; uncommonly, skin biopsy is indicated to rule out lupus or sarcoidosis.
Similar conditions that needs to be differentiated from Rosacea are: Acne, lupus erythematosus, perioral dermatitis, sarcoidosis, seborrheic dermatitis.
Treatment of Rosacea is based on severity and subtype.
Lifestyle modification:
Avoid triggers; sun protection and avoidance; facial massage for lymphedema.
Topical antibiotics:
Metronidazole 0.75% gel or 1% cream bid.
Sodium sulfacetamide lotion 10% bid.
Oral antibiotics (moderate to severe cases with inflammatory papulopustular component):
Tetracycline 500 mg po bid
Minocycline 100 mg po od—bid.
Doxycycline 20 mg po bid (subantimicrobial dose therapy) or 100 mg po qd–bid.
Isotretinoin (low dose); less commonly, topical retinoids may be used.
Laser therapy (e.g., PDL, IPL) for telangiectases and ablative laser (e.g., CO2) for rhinophyma.
Camouflage makeup (e.g., Dermablend, Covermark) for erythema.
Ophthalmologist to assess for ocular Rosacea (blepharitis, conjunctivitis, episcleritis).
