Rosacea

Rosacea is a chronic skin disease that affects the central face and manifests with a variety of cutaneous or ocular symptoms.

Epidemiology:

Rosacea is primarily found among adults over 30 years old, and females are more likely to develop the disorder than males. People with light pigmentation or skin phototypes I and II are thought to be more prone to rosacea than those with darker pigmentation or skin phototypes III and IV.

Pathogenesis:

Rosacea has a poorly understood pathogenesis. Several potential contributing factors have been identified, including abnormalities in the innate immune system, inflammatory reactions to cutaneous microorganisms such as Demodex folliculorum and Staphylococcus epidermidis increased density on the skin , ultraviolet radiation exposure, vascular hyperreactivity, and genetics.

Clinical features:

Rosacea can be divided into four different types:

Type 1 – Erythematotelangiectatic Rosacea: Characterized by flushing and persistent central facial erythema with or without telangiectasia.

Type 2 – Papulopustular Rosacea: Characterized by persistent central facial erythema with transient papules and/or pustules.

Type 3 – Phymatous rosacea: Characterized by thickened skin with irregular surface and nodularities, particularly on the nose, chin or ears.

Type 4 – Ocular rosacea: Characterized by inflammations of the eyes and eyelids causing burning, stinging, dryness, and foreign body sensation of the eye.

Rosacea flares are usually associated with common triggers including sunlight, heat, stress, alcohol, and spicy foods.

Diagnosis:

For most patients, clinical assessment suffices to diagnose rosacea and rule out other disorders that might resemble it. The use of skin biopsies is rarely recommended, but can be beneficial if another disorder with specific histopathologic findings is suspected, or if granulomatous rosacea is suspected.

With highly pigmented skin, centrofacial erythema and telangiectasias can be subtle. A careful examination of other features of rosacea together with techniques such as dermoscopy and diascopy may help diagnose rosacea in patients with highly pigmented skin.

Management:

 Patient with rosacea should be instructed on the avoidance of triggers, gentle skin care routine including frequent moisturizing, avoiding exfoliant, and sunscreen use. 

Persistent erythema could be managed with brimonidine. Additionally, laser therapy or intense pulsed light can be used for facial erythema as well as facial telangiectasia.

Treatment with topical metronidazole, azelaic acid, or ivermectin is recommended for mild papules and pustules. Moderate to severe diseases or mild diseases that do not respond to topical agents should be treated with oral tetracycline, doxycycline, or minocycline. Treatment with oral isotretinoin may benefit patients with papules and pustules that are resistant to other therapies.

Rosacea can damage the ocular tissues when ocular involvement occurs. An ophthalmologist should be consulted if signs or symptoms of ocular involvement are present.

Written by:

Ghaida Altammami, medical student

Revised by:

Maee Barakeh, medical student

References:

UTD

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