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Skin manifestations.
Acne Rosacea occurs after the age of 30 and is most common in people of Celtic origin. The resemblance to acne is at times striking. The cardinal features are erythema and edema, papules and pustules, and telangiectasia. One or all of these features may be present. The disease is chronic, lasting for years, with episodes of activity followed by quiescent periods of variable length. Eruptions appear on the forehead, cheeks, nose, and occasionally about the eyes. Most sufferers have some erythema, with less than 10 papules and pustules at any one time. At the other end of the spectrum are those with numerous pustules, telangiectasia, diffuse erythema, oily skin, and edema, particularly of the cheeks and nose. Granuloma formation occurs in some sufferers (granulomatous Acne Rosacea). Chronic, deep inflammation of the nose leads to an irreversible hypertrophy called rhinophyma.
Ocular Acne Rosacea.
Manifestations of this disease range from mild to severe. Symptoms frequently go undiagnosed because they are too nonspecific. The prevalence in sufferers with Acne Rosacea is as high as 58%, with approximately 20% of those sufferers developing ocular symptoms before the skin lesions. A common presentation is a sufferer with mild conjunctivitis with soreness, grittiness, and lacrimation. sufferers with ocular Acne Rosacea have been reported to have subnormal tear production (dry eyes), and they frequently have complaints of burning that are out of proportion to the clinical signs of disease. These signs include conjunctival hyperemia, telangiectasia of the lid, blepharitis, superficial punctate keratopathy, chalazion, corneal vascularization and infiltrate, and corneal vascularization and thinning. The conjunctival epithelium is infiltrated by chronic inflammatory cells.