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    Rosacea

    • Skin condition affecting primarily the face, proposed theory is that skin mites plug pores. 
    • Initially: Intermittent redness or blushing. Over time, redness may become persistent and more visible.
    • Most common sites are cheeks, nose, chin, and forehead.
      • In over half of patients, can affect eyes (blood shot eyes that feel gritty)
    • Bumps, tiny pus-filled pimples, and enlarged blood vessels can also appear, giving skin a rough, uneven appearance. ​
    • No known cure for rosacea, although it can be managed with appropriate treatment and lifestyle changes.
      • Avoid hot/cold changes
    • Rarely, can be severe enough (esp if untreated) that the skin tissue of the nose becomes thick, swollen, and bumpy (rhinophyma) - occurs when oil-producing glands and surrounding connective tissues becoming enlarged
      • Rhinophyma develops in some men , and very rarely in women with rosacea.
      • Can be mistaken for acne (but worsens with benzoyl peroxide etc..)
    • Epi: usually age 30-50y, F>M but more severe in M; tendency for fair skin and eastern European
    • RF:
      • Fair skin (Irish, Scottish, English or Eastern/Northern European descent)
      • Family history
      • Chronic sun exposure
      • Skin mite (?blocks glands)
      • H Pylori
    • S/S:
      • Frequent flushing or blushing on cheeks, nose, chin, forehead
      • Persistent redness
      • Red lines, due to enlarged blood vessels becoming visible
      • Dry skin
      • Burning, stinging, or itching
      • Pimple-like bumps without blackheads or whiteheads
    • Graded based on severity
      • Mild - facial flushing/redness intermittently. Can also have swelling, burning/stinging, roughness and visible blood vessels
      • Moderate - persistent redness and pimple like bumps with burning and stinging
      • Severe - thickening of skin with bumpy and enlarged appearance
      • Ocular - eyes and eyelid involvement; can cause redness to surrounding skin tissue and also burning or stinging, dryness, light sensitivity, blurred vision and watery bloodshot eyes
    • Triggers
      • Hot/cool weather, sun (UV exposure)
      • Stress
      • Hot/spicy food/drinks
      • Intense exercise
      • Medications: vasodilatory, ACEI
    • Treatment - not self-resolving --> NEED TREATMENT​
      • NEEDS TREATMENT - can thicken skin permanently
      • 1st Line -> Metronidazole CREAM- gold standard; gel, cream or lotion form
        • Antibiotics - topical or oral (tetracycline, minocycline, erythromycin, clindamycin
        • Steroid creams - mild topical; short term use only
      • Isotretinoin - for severe
      • Tretinoin - mild rosacea
      • Sodium sulfacetamide and sulphur - treat redness and inflammation
      • Laser therapy - later
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