Rosacea is a chronic rash involving the central face that most commonly starts between the ages of 30 and 60 years. It is most common in those with fair skin. It may be transient, recurrent or persistent and is characterised by its red colour.
The causes are complex and may include genetic, environmental, vascular and inflammatory factors. Chronic sun damage can also be contributory.
The skins innate immune response may also play a role and cause chronic inflammation in the dermis of the skin with dilatation of blood vessels leading the redness and swelling.
Hair follicle mites (demodex folliculorum) are sometimes observed within rosacea papules but their role is unclear.
Rosacea appears as red spots and sometimes pustules. They are dome-shaped rather than pointed and unlike acne there are no blackheads, whiteheads or nodules. Rosacea may also result in red areas, scaling and swelling.
Characteristics of Rosacea
- Frequent blushing or flushing
- Persistent redness associated with blood vessels – telangiectasia
- Red papules and pustules on the nose, forehead, cheeks and chin
- Dry and flaky facial skin
- Aggravated by sun exposure and hot / spicy food or drink (anything that reddens the face)
- Sensitive skin with burning and stinging
- Enlarged, unshapely nose with prominent pores and fibrous thickening (rhinophyma)
- Persistent redness and swelling or solid oedema of the upper face due to lymphatic obstruction (Morbihan disease)
Treatment of Rosacea:
- General measures
- Avoidance of factors that cause facial flushing
- Avoid oil based facial creams
- Do not use topical steroids
- Sunscreen and avoid direct sunlight
- Oral antibiotics
- Tetracycline antibiotics including doxycycline and minocycline are commonly used to treat rosacea
- When antibiotics are ineffective or poorly tolerated isotretinoin may be effective.
- Vascular Laser
- Persistent redness and telangiectasia can be improved with vascular laser and may also help to improve papulopustular rosacea
- Rhinophyma may be effectively treated with re-surfacing with ablative erbium laser