Rosacea

Rosacea:
It is chronic inflammatory disease characterized by erythema and pustules.
Histopathology:
1) Dialated dermal vessels
2) Sebaceous gland hyperplasia
3) Inflammatory cell infiltrate
Age group: 20-50 years ( middle age)
Cause: unknown
Exacerbating factors:
1) Spicy food
2) Angry mood / emotional stress
3) Hot weather
4) Hot shower bath for prolonged time
5) Exposure to sunlight
6) Alcohol
7) Exercise
8) Cosmetics
9) Hot drinks
10) Medications

Disease Association with acne is common.
Clinical features:
Sites affected: cheek, nose,forehead,chin
Earliest symptom: flushing
1)Redness over face :
Diffuse erythema over cheeks and nose
Sometimes accompanied by itching and burning sensation
2) prominent telangiectasia
3) Papule and pustules formation
4) sebaceous gland hyperplasia resulting in swelling.

Types of Rosacea:
1) Erythematotelangiectatic (ET)
2) Papulopustular Rosacea
3) Rosacea fulminans ((pyoderma faciale)
4) Rhinophyma ( nose deformity)




Approach to patient:
History of exacerbating factor
Clinical examination with dermatoscope:
For visualization of tiny capillaries

Treatment:
1) Topical treatment
2) Systemic treatment
3) Lasers



1) Topical treatment:
a) Metronidazole gel 0.75% once or twice daily for 8-12 weeks
b) Azelaic acid cream 15% twice daily
c) Tacrolimus ointment 0.1%
d) Pimecrolimus cream 1%
e) Tretinoin cream 0.25% at night
f) Brimonidine gel

2) Systemic treatment:
a) Tablet doxycycline 100 mg 1 OD for 1-3 months
b) Tab erythromycin 500 mg 1OD for 3 months
c) Tablet isotretinoin 0.5 mg/kg
d) Tablet tranexamic acid 250-500 mg 1OD
e) Capsule vitamin C 200 mg 1OD
f) Tablet carvediol ( in low dosage)for resistant cases

3) Lasers:
a) Pulsed dye laser 585nm
b) Combined pulsed dye and Nd Yag laser
c) Ruby laser( Q-switched)
d) Diode laser
e) Intense pulsed light (IPL)
f) KTP 532 nm

Advice :
1) Avoid strong harsh products ( containing astringent, menthol, camphor, sodium lauryl sulfate)
2) Avoid sun exposure
3) Use sunscreen with spf  30+ and UVA +++
4) Use moisturizer with isotretinoin treatment
5) Use of Soap free cleansers
6) Avoid triggering factor

Patients with Rosacea come in oily sensitive skin type.
Complication:
1) If not treated the nose deformities like rhinophyma
 ( bulbous nose) can develop eventually.
2) Eye involvement:
Blepharitis, conjunctivitis

Rosacea fulminans case can be treated more aggressively with systemic steroids in initial part of treatment to control inflammation.
fig1: papulopustular rosacea                                            
fig2:rhinophyma

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