Acne Rosacea FAQ

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.

Acne Rosacea

Acne Rosacea is a chronic inflammatory skin condition of unknown cause. It occurs in persons whose skin is prone to flushing therefore it has been postulated that the underlying defect is vascular in nature. Acne Rosacea affects 1–10% of the population, it is more predominant in the middle aged and females.

Paler skin types, such as celts, northern European and the fair skinned are more prone to developing Acne Rosacea. It is characterised by the development of a red rash on the cheeks. The nose, forehead, scalp and eyes can become affected. The facial redness becomes persistent often with the presence of dilated blood vessels over cheeks. Acute attacks of papules,

pustules and edema can occur in response to various triggers. These attacks can persist for weeks.

Three distinct phases are recognised in the development of Acne Rosacea:

* phase 1

– Persistent facial redness

– Telangiectasia on cheeks, nose, forehead

– Sensitive, irritable skin

– Stinging and burning sensation on application of cosmetics and treatment creams

* phase 2

– Development of papules, pustules and lymphedema

– Skin follicles affected and sebaceous glands enlarged

– Prominent facial pores

– Extension of rash over face and scalp

* phase 3

– Persistent edematous, inflamed facial skin

– Facial contours become thickened, coarse and irregular

– Tissue overgrowth especially nose, chin, eyelids, ears and forehead

– Eye involvement with inflammation, irritation, redness, discomfort,

photosensitivity

– Inflamation of the cornea with disturbed vision

Triggers to acute flares

Certain substances and conditions are thought to trigger acute attacks of Acne Rosacea:

* Foods triggers

– Coffee, tea, chocolate, cold drinks, alcohol, soy sauce, cheese, citrus fruits,

curries, vinegar, tomatoes, red meat, yogurt

– Large meals

– Thermal heat

– Highly spiced foods, pickled foods, smoked foods, fermented foods

* Chemical triggers

– Caffeine, vasodilators, perfumes, aftershaves, astringents, cosmetics

* Environmental triggers

– Resident Demodex skin mite in follicles and sebaceous glands

– Gastrointestinal upset (e.g. diarrhoea, cholecystitis, gastritis)

– Weather conditions (e.g. Sunlight, wind)

– Heat and cold

* Other triggers

– Topical corticosteroids