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).

Wednesday, June 25, 2008

Rosacea symptoms


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.
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