Other

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