(Figure 3.4A–C) - Chronic inflammatory condition of facial pilosebaceous units with increased vascular hyperreactivity; common in fair-skinned patients with peak in the third to fifth decade
- Presents with easy flushing and gradual reddening of complexion; exacerbating factors may include particular foods (especially spicy), alcoholic beverages, UV exposure, hot weather, warm beverages, and exercise
| | | | | | | | Type | | Clinical Findings | | | Erythematotelangiectatic
(Type 1) | | Prolonged flushing (>10 min), persistent central facial erythema, ± telangiectasias, ± burning/stinging sensation, easy irritation | | | Papulopustular
(Type 2) | | Persistent central facial erythema with acneiform pustules and papules (no comedones) | | | Phymatous
(Type 3) | | Indurated erythematous to yellow-brown papules/nodules with persistent edema; almost exclusively in men; rhinophyma (subtype) over distal half of nose; less common sites include forehead, chin, philtrum, ears and eyelids | | | Ocular
(Type 4) | | Xerophthalmia, tearing, pain, blurry vision, blepharitis, conjunctivitis, recurrent chalazion, keratitis, iritis, scleritis |
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| | | | | | Treatment of choice for ocular rosacea: oral antibiotic | | | | | |
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- Steroid rosacea : use of oral/topical corticosteroid results in exacerbation of disease after initial improvement
- Granulomatous rosacea : red-brown papules/nodules with underlying granulomatous inflammation
- Histology: early lesions with dilated blood and lymphatic vessels; later lesions show lymphectasia, perivascular and perifollicular lymphohistiocytic infiltrate, ± poorly organized granulomas, dermal fibrosis, sebaceous gland hyperplasia, ± Demodex folliculorum mites within infundibula
- Treatment:
- Sun protection and avoidance of triggers, green-tinted makeup (conceals redness)
- Topical therapy: metronidazole or azelaic acid best for inflammatory lesions, sodium sulfacetamide/sulfur
- Oral therapy: tetracyclines, macrolides, isotretinoin
- Other: pulsed-dye laser or intense pulsed light
| | Figure 3.4
A: Rosacea, papulopustular
(Courtesy of Dr. Paul Getz)
B: Rosacea, granulomatous
(Courtesy of Dr. Iris K. Aronson)
C: Rhinophyma |
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