Rosacea is a common inflammatory rash predominantly affecting the face. The onset is usually in middle age and it is commoner in women. It often causes significant psychological distress.
The cause is unknown. Theories have suggested an underlying problem in vasomotor stability of blood vessels or a role for the skin mite Demodex but there is little evidence to confirm these speculations.
The cardinal features are of facial flushing, inflammatory papules and pustules affecting the nose, forehead and cheeks. The flushing may precede the other signs by some years. There are no comedones. Additional features may include dilated blood vessels (telangiectasia), inflammation of the eyelid margins (blepharitis), keratitis and sebaceous gland hypertrophy especially of the nose. The latter is commoner in men and can cause a disfiguring enlargement of the nose called rhinophyma. The flushing may be exacerbated by alcohol, hot drinks, sunlight and changes in ambient temperature. Prolonged use of topical steroids can exacerbate or trigger the condition. As the disease progresses, the flushing may be replaced by a permanent erythema.
This is suppressive rather than curative. Long-term use of topical 0.075% metronidazole may help. Avoid topical steroids. A 3-month course of oral tetracycline (500 mg twice daily) is also helpful. Oral metronidazole (400 mg twice daily) or oral isotretinoin (0.5-1 mg/kg/day) is occasionally given in resistant cases. The papules and pustules tend to respond best to therapy but repeat courses may be necessary. The flushing and erythema are often resistant to treatment; cosmetic camouflage can be helpful. Rhinophyma can be treated with plastic surgery or by carbon dioxide laser.
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