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).

Sunday, June 29, 2008

what is Rhinophyma?


Rosacea Rhinophyma
It occurs almost exclusively in men. Fortunately, only a few acne rosacea sufferers develop this complication. The bulbous nose develops over many years as a result of progressive increase in connective tissue, sebaceous gland hyperplasia, ectatic veins, and chronic deep inflammation. Rosacea Rhinophyma may accompany stage III rosacea; in other sufferers surprisingly the signs of rosacea in the rest of the face may be rather mild. Four variants of Rosacea Rhinophyma are recognizable.
GLANDULAR FORM
The nose is enlarged mainly because of enormous lobular sebaceous gland hyperplasia. The surface is pitted, with deeply indented and mildly distorted follicular orifices. The tumorous expansions of the nose are often asymmetric and of varying size. Humps and sulci occur. Sebum excretion is increased. Compression by the fingers yields a white pasty substance consisting of an amalgam of corneocytes, sebum, bacteria, and Demodex folliculorum mites.
FIBROUS FORM
Diffuse hyperplasia of the connective tissue dominates this picture. A variable amount of sebaceous gland hyperplasia may be seen.
FIBROANGIOMATOUS FORM
The nose is copper-red to dark red, greatly enlarged, edematous, and covered by a network of large, ectatic veins. Pustules are frequently present.
ACTINIC FORM
Nodular masses of elastic tissue distort the nose. These are rather similar to the elastomas that occur in older individuals who have markedly photodamaged skin as a result of overexposure to sunlight. This variety is mainly observed in subjects of Celtic origin who burn easily and tan poorly.
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