Rosacea

• Definition
  
• Clinical Features
  
• Rosacea Variants
  
• Pathogenesis
  
• Diagnosis and Differential Diagnosis (see Table)
  
  

Rosacea

Rosacea

Rosacea

Rosacea

• Definition:  chronic inflammatory facial dermatosis of adults.
  

• Clinical Features (three components):

  The disorder occurs in middle aged persons of either gender, typically in the central area of the face; i.e. chin, forehead and nose, and adjacent malar skin. The morphology can be broken down into vascular, inflammatory and proliferative components.
  
  

  • Vascular Component: Rosacea typically occurs in persons having a history of easy flushing with emotion, alcohol, hot drinks or food, spicy food and temperature. The development of rosacea however is associated with more fixed erythema and the development of telangiectases.
    
    
  • Inflammatory Component: This is centered on follicles and consists of red papules and/or pustules in the absence of comedones.
    
    
  • Proliferative Component: The sebaceous glands become larger and the skin more oily. This may be particularly marked in the nose and accompanied by connective tissue proliferation.

• Each of these three components may be predominant in individual cases. 
  
  
• For the vascular component, the obvious feature may be multiple telangiectases, particularly in the central face and a careful search must be made for papules and pustules to establish the diagnosis.
  
  
• When the inflammatory component is dominant, the diagnosis is usually simpler and the search is then for comedones to make the distinction between rosacea and acne vulgaris.
  
  

Rhinophyma

• When the proliferative component is dominant, the nose becomes very large and pendulous, the so-called "rhinophyma", that is associated in history and literature with excessive alcohol intake.
  There is no truth to this but it is true that those afflicted are likely to flush more easily with alcohol than others, which may have lead to the association.

• Rosacea Variants
• In some cases, there may be ocular involvement which includes most commonly a blepharitis but may also extend to a conjunctivitis and more seriously, a keratitis.
  
• This may be kept in mind for purposes of diagnosis and treatment.