Download 4-Acne Rosacea

Definition

Rosacea is a Latin word meaning (Like-Roses), is
an Acne-like rash, caused by disorder of the PiloSebaceous unit, often affect the central region of
the face (Centro-facial) characterized by:

1-Hyper-reactivity of superficial vessels and
capillaries to external stimuli, thereby reflecting
temporary or persistent redness of the face area,

Central emergence and expansion of capillary vessels
(Telangiectasia) surface and/or accompany an
inflammatory papules or in severe cases there are burst
of pustules,

symptoms vary within a broad spectrum between one
person to another, from different symptoms of
temporary redness of the face to continuous redness,
vascular dilatation, papules and pustules.
Epidemiology

Rosacea often seen in patients from third to sixth
decade, peak incidence in the fourth or fifth decade of
life, affects both genders, but affects women more than
men, rhinophyma type afflicts mostly men.

Acne rosacea affects white people, II-I-type
classification (Fitzpatrick) and is rare in Africans or
Asians.
Incidence

In a study conducted in Sweden to 809 desk officers,
found that 81 either have the disease or had it at some
point, and concluded that the incidence among white is
about 10%, another study believe that nearly 14 million
people are affected in the United States, but the
incidence of this disease is not known yet, due to the
lack of proper studies and to errors in diagnosis.

A-hormonal and B-neurological mechanism, both
mechanisms leading to equal results and may
interact with each other, and often the external
factors (stimuli) play a role in activating those
mechanisms,
particularly
the
increase
in
temperature, the so-called (Heat Stimuli), if the
heat source is oral i.e. (hot drinks),

Chemicals and Food intake: hot spices, alcohol and hot
drinks are considered to be an aggravating factors in
rosacea, and certain medications used to treat
cardiovascular diseases (such as Amiodarone) may
aggravate or cause rosacea, topical steroids for
prolonged period may cause so-called steroid acne or
rosacea-like disease, (Nicotinic acid) may aggravate
rosacea, some reported acne cases similar to Rosacea
after using vitamin (B6, B12).

6-Microbes: many believe that the mite or the
apportunistic microbe of the pilosebacous unit
(Demodex folliculorum, brevis), causes rosacea

supports this belief:




a- The Demodex favours areas affected often by
rosacea, (the central zone of face)
b- The number of Demodex is increased in aging skin
old age, (where rosacea is rare in children).
c- Studies have shown that most patients with rosacea
carry antibodies most probably against Demodex, and
about 22% of patients have confirmed antibodies against
Demodex.
d- Many studies have also shown a colonization of
demodex in Rosacea patients.
Types of Rosacea (4 types)
1. Erythemotelangiectatic Rosacea.
Features include continuous erythema in the central
region of the face, telangactasia is very common but not
essential for diagnosis of this type, and accompanying
symptoms may be a tingling sensation and or burning
sensation in the face, or the Central face, oedema or
roughness or some facial desquamation, patients usually
give history of transient or non-transient erythema.
2. Papulopustaular Rosacea.
Characterized by continuing erythema and the
appearance of transient papules or pustules in the
Central face, papules and pustules may appear
elsewhere, for example, around the mouth or around
the eyes, nose this type of rosacea is very similar to
Acne Vulgaris, this type of rosacea may coexist with
acne and comedones may appear thus it is very
crucial to notice accompanying symptoms i.e.
(tingling and burning sensation)
This type often appears with or after the emergence
of the first type (Erythemotelangiectatic Rosacea) but
telangiectasia might be obscure due to papules and
pustules and continues erythema, but might appear
after good treatment,
3- Phymatous Rosacea
The most common type is Rhinophyma,
This type can appear in other parts of the face (nose, Chin
and cheeks) the affected area often shows pores
enlargement, or may show some telangiectasia too, in the
case of Rhinophyma accompanying symptoms are severe.
This type often appears with or after a period of
Erythemotelangiectatic
Rosacea,
or
type
II
(Papulopustaular Rosacea)
4- Ocular Rosacea
For the diagnosis of this case 1 or more of the
following symptoms should coexist with rosacea
 Continuous or transit Conjunctival reddness
 The sense of foreign body in the eye
 blurry vision, tingling or burning or overly photo
sensitivity
 appearance of telangiectasia within the
conjunctiva or swollen or redness around the eye
 inflammation of eyelids (Blepharitis) or
conjunctivitis (Conjunctivitis) or irregular eyelid
border.
Other Rosacea types
1. Glandular Rosacea
Men are more frequently affected usually around the eyes
and in women around the chin telangactasia is and
erythema is not seen due to thikned skin and severe
seborrhea
2. Granulomatous Rosacea 10% of all rosacea there are
brownish papules and pustules on face, in about 50% eyes
might be involved, some believes its part of what is so
called lupus maliaris disseminatous faciei.
Diagnosis
Full and detailed history (including medications)is
required,
 diagnosis is made clinical
 Other conditions should be rolled out
Acne vulgaris
Folliculitis
Polycythemia vera
Dermatomyocytis
Lupus erythematousus
Carcinoid tumor
Mastocytosis
Mitral stenosis

Treatment
Sunscreen
 Avoidance of chemicacl irritants and habitis that
aggrivate rosacea including alcohol and cosmetic for
those with (Erythemotelangiectatic Rosacea)

Topical medications
Metronidazole
 Sodium sulfacetamide and sulfur
 Azelaic acid
 Benzoyl peroxide
 Tretinoin
 Erythromycin and Clindamycin

Oral medications
Tetracyclines
 Macroloides (e.g Erythromycin)
 Metronidazole
 isotretinoin


Other facial rejuvenation (ablative and non-ablative)
laser show good results in treatment of solar damage
and connective tissue remodelling thus improving
Rosacea.