Acne Rosacea
Acne Rosacea is a chronic inflammatory facial eruption characterized by papules and pustules on a background of erythema and telangiectasia.
Epidemiology
Acne Rosacea is common. peak age at presentation is the third or fourth decade and the condition has been more frequently observed in patients with fair skin. It has an equal sex incidence but men often have more severe disease.
Pathology
The pathogenesis of Acne Rosacea is unknown. Histologically there is a non-specific perifollicular and perivascular inflammatory infiltrate with dilated capillaries in the superficial dermis.
Clinical features
Acne Rosacea is a persistent disease with episodic inflammatory flares. Patients usually have a long history of episodic facial flushing, which may be exacerbated by heat, emotional upset, hot drinks, spicy foods and alcohol. During these episodes, there is intense erythema symmetrically over the cheeks, nose, forehead and chin. There are three stages in the evolution of this disease.
Chronic Acne Rosacea can be associated with marked sebaceous hyperplasia, most commonly on the nose giving a bulbous craggy appearance. This is known as rhinophyma. There may also be lymphoedema resulting in swelling of the central part of the face. Approximately 50% of patients have minor degrees of ocular involvement, most commonly conjunctivitis, blepharitis and keratitis leading to corneal scarring.
Investigations
Acne Rosacea can be diagnosed clinically; investigations are not usually required.
Skin biopsy
If the diagnosis is in doubt a skin biopsy may be required for histopathology.
Stages in the evolution of Acne Rosacea
Stage Clinical features
I Persistent erythema with telangiectasia
II Persistent erythema, telangiectasia, papules and tiny pustules
III Persistent deep erythema, dense telangiectasia, papules, pustules and nodules
Management
Identify and address precipitating factors
Patients are advised to avoid factors that provoke facial flushing. Reduction of alcoholic and hot beverages is helpful in some cases.
Concealing agents
Camouflages can be used for the erythema, and laser treatment is helpful in the treatment of telangiectasia.
Antibiotic therapy
Papules and pustules of Acne Rosacea respond well to topical metronidazole or to oral oxytetracycline or tetracycline 500 mg twice daily. Courses usually last 6-12 weeks and are repeated intermittently. Alternatively doxycycline or minocycline 100 mg daily can be given.
Oral retinoids
Isotretinoin is occasionally given in refractory or severe cases. Despite topical and systemic treatment the redness and telangiectasia may not improve.
Surgery
Rhinophyma is treated by surgery or laser surgery, shaving the hypertrophic tissue from the nose. Unfortunately regrowth of this tissue frequently occurs.
Prognosis
Despite optimal treatment, recurrences are common.
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).
Showing posts with label WHAT IS ROSACEA. Show all posts
Showing posts with label WHAT IS ROSACEA. Show all posts
Saturday, June 28, 2008
Monday, June 23, 2008
what is Rosacea ?
Acne Rosacea is a chronic inflammatory disease affecting the blood vessels and pilosebaceous units of the face in middle-aged individuals. sufferers with Acne Rosacea have papules and pustules superimposed on diffuse erythema and telangiectasia over the central portion of the face. An important component is easy flushing and blushing of the face often accentuated when alcohol, caffeine, or hot spicy foods are ingested. Hyperplasia of the sebaceous glands, connective tissue, and vascular bed of the nose sometimes causes rhinophyma, which is a large, red, bulbous nose. Ocular complications, which occur in a significant number of Acne Rosacea sufferers, include blepharitis, chalazion, conjunctivitis, and progressive keratitis that can lead to scarring and blindness.
Acne Rosacea can usually be differentiated from adult acne by the lack of comedones and the prominent vascular (flushing/telangectasia) component. Other causes of a red face in adults such as the malar eruption of acute systemic lupus erythematosus and the heliotrope rash of dermatomyositis, seborrheic dermatitis, and perioral dermatitis must be considered. Acne Rosacea and the eye complications usually respond well to tetracycline and/or oral metronidazole, but the antibiotic must be continued for life (at the lowest dose that suppresses the condition) because Acne Rosacea recurs when therapy stops. Topical antibiotics (metronidazole [MetroGel] or Noritate) can be helpful alone or in combination with low-potency topical steroids (e.g., hydrocortisone 1% lotion) once or twice a day; higher-potency steroids can actually worsen the disease.
Acne Rosacea can usually be differentiated from adult acne by the lack of comedones and the prominent vascular (flushing/telangectasia) component. Other causes of a red face in adults such as the malar eruption of acute systemic lupus erythematosus and the heliotrope rash of dermatomyositis, seborrheic dermatitis, and perioral dermatitis must be considered. Acne Rosacea and the eye complications usually respond well to tetracycline and/or oral metronidazole, but the antibiotic must be continued for life (at the lowest dose that suppresses the condition) because Acne Rosacea recurs when therapy stops. Topical antibiotics (metronidazole [MetroGel] or Noritate) can be helpful alone or in combination with low-potency topical steroids (e.g., hydrocortisone 1% lotion) once or twice a day; higher-potency steroids can actually worsen the disease.
Saturday, June 21, 2008
Friday, June 20, 2008
WHAT IS ROSACEA?
Acne Rosacea is a chronic disease involving the central face including the cheeks, chin, nose, and central forehead. There are various combinations of flushing, redness, apparent vessels under the skin surface, edema, papules, pustules, ocular changes, and deep inflammation of the nose.
These symptoms may be temporary and each may occur independently. One or more of the features may be present. There are remissions and exacerbations. The causes and mechanism of development are unknown and there are no tissue or serum markers.
Acne Rosacea is common with a prevalence as high as 10% in some populations. It appears to be more common in people with fair skin. Acne Rosacea may occur at any age but most patients are over 30.
Acne Rosacea has been divided into four types. Progression from one subtype to another may occur. It is important to treat Acne Rosacea to prevent development of disease.
These symptoms may be temporary and each may occur independently. One or more of the features may be present. There are remissions and exacerbations. The causes and mechanism of development are unknown and there are no tissue or serum markers.
Acne Rosacea is common with a prevalence as high as 10% in some populations. It appears to be more common in people with fair skin. Acne Rosacea may occur at any age but most patients are over 30.
Acne Rosacea has been divided into four types. Progression from one subtype to another may occur. It is important to treat Acne Rosacea to prevent development of disease.
Thursday, June 19, 2008
WHAT IS ROSACEA?
The disease was originally called acne rosacea. Papules and pustules occur in the central region of the face against a livid erythematous background with telangiectases. Later, there may occur diffuse hyperplasia of connective tissue with enlarged sebaceous glands. The disease evolves in stages. The early signs are recurrent episodes of blushing that finally become persistent dark red erythema, particularly on the nose and cheeks, often before the age of 20 years. These persons are the so-called flushers and blushers. Rosacea is common in the third and fourth decades and peaks between the ages of 40 and 50 years. In the worst cases, nonpitting edema (fibrosis), particularly of the nose (rhinophyma), may develop after many years. Early diagnosis and appropriate management are required to minimize patient discomfort and psychological distress.
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