What is Acne Rosacea?
Acne Rosacea is a common pustular eruption with flushing and telangiectasias of the butterfly area of the face may occur in adults especially in the 40- to 60-year-old age group.
What are the primary Acne Rosacea lesions?
Diffuse redness, papules, pustules, and, later, dilated venules, mainly of the nose, cheeks, and forehead, are seen.
What are the secondary Acne Rosacea lesions?
Severe, longstanding cases eventuate in the bulbous, greasy, hypertrophic nose characteristic of rhinophyma.
What about the course of Acne Rosacea?
The pustules are recurrent and difficult to heal. Rosacea keratitis of the eye may occur.
What are the causes of Acne Rosacea?
Several factors influence the disease:
heredity (oily skin);
excess ingestion of alcoholic beverages, hot drinks, and spicy foods;
Demodex mites (may be causative);
increased exercise;
increased exposure to hot or cold environment; and
topical or systemic corticosteroids.
Excess sun exposure and emotional stress can aggravate some cases of Acne Rosacea.
What are the conditions that have some similarities to Acne Rosacea?
Systemic lupus erythematosus: No papules or pustules; positive ANA blood test.
Boils: Usually only one large lesion; can be recurrent but may occur sporadically; an early case of Acne Rosacea may look like small boils. Bacterial culture shows Staphylococcus aureus or group A hemolytic streptococci. Responds to anti-Staphylococcus antibiotics.
Iodide or bromide drug eruption: Clinically similar, but drug eruption usually is more widespread; history positive for drug.
Seborrheic dermatitis: Pustules uncommon; red and scaly; also in scalp.
Acne Rosacea-like tuberculid of Lewandowsky: Mimics small papular Acne Rosacea clinically and tuberculids histologically, rare; biopsy helpful.
Outline Acne Rosacea treatment?
* Prescribe avoidance of these foods: chocolate, nuts, cheese, cola drinks, iodized salt, seafood, alcohol, spices, and very hot drinks.
* Metronidazole gel (MetroGel, Metrocream, Metrolotion or Noritate cream)
Apply thin coat b.i.d. Response to therapy is slow, taking 4 to 6 weeks to benefit.
* Sulfur, ppt. 6%
Resorcinol 4%
Colored alcoholic shake lotion q.s. 60.0
Apply to face h.s.
Similar proprietary lotions are Sulfacet-R lotion Rosac Cream (contains a sunscreen), Rosula (contains urea to decrease irritation), sodium sulfacetamide topical preparations, Plexion topical preparations, Novacet lotion, Avar Green (contains green tint to hide redness).
* Tetracycline, 250-mg capsules
Take 1 capsule q.i.d. for 3 days, then 1 capsule b.i.d. for weeks, as necessary for benefit. Other antibiotics that can be used, as for acne, include doxycycline, minocycline, and erythromycin.
* Therapy for Helicobacter pylori in the same treatment regimens as for peptic ulcer disease has been tried with some benefit in severe cases.
* Azeleic acid (Azelex, Finacea) in thin coat b.i.d.
* Crotamiton (Eurax) lotion in thin coat b.i.d.
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).
