Rosacea - Facial dermatoses

Rosacea

Definition

A chronic inflammatory facial dermatosis affecting the central face characterised by vascular dilation, erythema and pustules.

Age

Generally affects patients aged 30–60 years.

Sex

F > M

Aetiology/pathophysiology

There is dilation of dermal blood vessels, hyperplasia of sebaceous glands but normal excretion of sebum. The cause is unknown but it is more common in individuals with fair skin, light hair and light eye colour. Some evidence suggests a role for hair follicle mites.

Clinical features

Symptoms begin with recurrent flushing of the face, which worsens on exposure to hot drinks, alcohol, stress and sunlight. This may precede, by years, erythema of the nose and cheeks. Telangiectasia are seen on the cheeks and sebaceous gland hyperplasia results in the formation of papules and pustules. There may be a sensation of a foreign body in the eye, telangiectasia and inflammation of lid margins (blepharitis), conjunctivitis and keratitis.

Hypertrophy of the sebaceous glands and connective tissue around the nose, most commonly in middle-aged men, causes rhinophyma.

Management

Topical treatments using antibiotic gels, such as metronidazole, are used for at least 4–6 weeks.

Systemic treatments are used in refractory cases and in patients with ocular symptoms. Prolonged courses of metronidazole, tetracycline, oxytetracycline or erythromycin are generally used, which is changed to a retinoid if symptoms remain. See section Acne Vulgaris for details regarding the use and safety of retinoids.

Rhinophyma may require electrosurgical resection.

Prognosis

Rosacea is a chronic condition, and topical metronidazole may be required to maintain remission.