Related Subjects:
|Nikolsky's sign
|Koebner phenomenon
|Erythema Multiforme
|Pyoderma gangrenosum
|Erythema Nodosum
|Dermatitis Herpetiformis
|Lichen Planus
|Acanthosis Nigricans
|Acne Rosacea
|Acne Vulgaris
|Alopecia
|Vitiligo
|Urticaria
|Basal Cell Carcinoma
|Malignant Melanoma
|Squamous Cell Carcinoma
|Mycosis Fungoides (Sezary Syndrome)
|Xeroderma pigmentosum
|Bullous Pemphigoid
|Pemphigus Vulgaris
|Seborrheic Dermatitis
|Pityriasis/Tinea versicolor infections
|Pityriasis rosea
|Scabies
|Dermatomyositis
|Toxic Epidermal Necrolysis
|Stevens-Johnson Syndrome
|Atopic Eczema/Atopic Dermatitis
|Psoriasis
May be triggered or worsened by the use of topical steroids and drugs e.g. Amiodarone
About
- Common chronic inflammatory skin condition - Flushing and burning
- Perifollicular and perivascular inflammation. It is not infectious
Aetiology
- Demodex species (mites that inhabit human hair follicles) may play a role
Epidemiology
- Middle-aged 40 to 60 years old and fair-skinned people.
- Males have worse disease
- Alcohol and spicy food cause flushing
Clinical
- Affects cheeks, forehead, chin and nose, and is characterised by flushing and redness, telangiectasia, small red bumps and pus-filled spots (sometimes these may only be visible with a magnifying glass).
- There may also be uncomfortable inflammation of the surface of the eyes and eyelids.
- Coarseness of skin. Eye involvement even with corneal scarring
- Burning and stinging feeling and can lead to rhinophyma
- Worsens with alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress and natural sunlight
- Psychological and can cause anxiety and depression
Investigations
- Clinical diagnosis and tests not needed
Management
- Sunscreen: Protect skin using a sunblock (with a sun protection factor of at least 30) on the face every day. Do not rub or scrub your face as this can make rosacea worse. Do not use perfumed soap as this can make rosacea worse. Use a soap substitute (emollient) to cleanse your face. Cosmetic camouflage agents. Avoid alcohol and precipitant
- Topical: Useful preparations include Metronidazole and azelaic acid. It takes at least 8 weeks for their effect to become evident.
- Eye symptoms need to be escalated to prevent corneal scarring. These are helpful for the inflammatory element of moderate or severe rosacea.
- Oral Oxytetracycline 500 mg bd in more severe disease. The duration of an antibiotic course depends on your response. Topical and oral treatment may be combined together. Others include Minocycline which can cause bluish-grey skin pigmentation in the legs.
- Severe cases - Isotretinoin tablets are sometimes prescribed for severe rosacea.
- Rhinophyma: A bulbous nose affected by rhinophyma can be reduced surgically.
- Laser therapy for redness and dilated blood vessels
- Topical treatment called Brimonidine gel can help reduce the redness.
Images online