Acne rosacea

Question 1

Define rosacea.

Answer 1

Rosacea is a common chronic disorder of the skin characterised by redness, flushing, and other cutaneous findings that often include telangiectases, roughened skin, rhinophyma, and general inflammation that can resemble acne.

Question 2

What are the risk factors for rosacea?

Answer 2

Unknown aetilogy but associations include:

• Age 30-60yrs
• F=M
• FH
• Fair skin, blue eyes
• Hot baths/showers
• Temperature extremes
• Sunlight
• Stress

Question 3

What are the clinical features of rosacea?

Answer 3

• Transient recurrent erythema i.e. flushing
• Persistent facial erythema
• Telangiectasias - anywhere other than in nasal alar region
• Inflammatory papules and pustules
• Phymatous changes e.g. thickening of the skin due to hyperplasia/fibrosis of sebaceous glands, rhinophyma is most common especially in men.

Ocular features - dryness, foreign body sensation, photophobia, conjunctivitis, blepharitis, keratitis.

Rarely - Morbihan disease -> redness and swelling of the face and lids.

Question 4

What is shown?

Answer 4

Rhinophyma with swelling and sebacous gland openings

Question 5

What is shown?

Answer 5

Swelling and papulopustules in steroid induced rosacea

Question 6

How is rosacea diagnosed?

Answer 6

Clinical - using the ROSCO panel criteria

Question 7

What is the management of rosacea?

Answer 7

No cure
Conservative:

• Symptom diary to identify triggers + avoidance
• Moisturise frequently
• Gentle cleansers
• Sunscreen with SPF >30
• Avoid exfoliants
• Avoid alcohol based products
• Avoid topical steroids
• Cometics with green tint to minimise redness

Medical:

• Alpha adrenergic agonists e.g. topical brimonidine
• Oral beta blockers (carvedilol)
• Topical azelaic acid/ ivermectin /metronidazole - for inflammatory papules/pustules
• Isotretinoin - for phymatous changes

Other:

• Laser treatment - Nd:YAG or intense pulsed light
• Surgery - for fully developed phymatous changes e.g. ablative laser or radiofrequency surgical shaving

Question 8

What are some common triggers for rosacea?

Answer 8

Common triggers include:

• sun/ultraviolet exposure;
• hot, cold, or windy weather; humidity, indoor heating, hot baths, hot beverages; heavy exercise;
• alcohol consumption;
• spicy foods;
• emotional stress;
• some skincare and toiletry products (e.g., those that contain menthol, camphor, or sodium lauryl sulfate);
• some medicines (e.g., amiodarone; nasal corticosteroids; and, paradoxically, topical corticosteroids);
• some fruits and vegetables, or certain dairy products.

Question 9

What are the complications/prognosis of rosacea?

Answer 9

Chronic and relapsing-remitting.

Many able to keep symptoms under control by avoiding triggers while others find no treatment.