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ED90
4.1.2 Rosacea
Grading & Level of Importance: B
ICD-11
Synonyms
Couperose.
Epidemiology
Incidence: 165/100 000 per year, prevalence: 1 - 22% (great variation).
Individuals with fair skin type have an increased risk.
Age of onset 30 to 50 years.
Definition
Centrofacial, chronic, inflammatory disease.
Aetiology & Pathogenesis
Multifactorial etiology: Environmental trigger factors, demodex, nutritional factors (alcohol, histamine releaser), exercise, acute psychological stress, menstruation, medications.
Pathogenesis: Impaired permeability barrier in the stratum corneum, antimicrobial peptides, overexpression of Toll-like receptors, inflammatory cells, reactive oxygen species, neoangiogenesis, sensory nerve activation.
Signs & Symptoms
Centrofacial transient erythema (flushing), teleangiectatic erythema, papules and pustules without comedones, phymas (rhinophyma, gnathophyma, metophyma), bilateral conjuctivitis, stinging and burning sensations.
Localisation
Mid-face, forehead, nose, conjuctiva, V-area of chest.
Classification
Type I (teleangiectatic)
Type II (papulopustular)
Type III (phymatous)
Ocular rosacea
Morbihan’s disease
Laboratory & other workups
Skin biopsy for ruling out other facial dermatoses. Cyanoacrylate tapestrip for demodex detection.
Dermatopathology
All subtypes show dilated lymph and blood vessels in the upper and mid-dermis and a superficial perivascular and perifollicular mononuclear lympho-histiocytic infiltrate. Widened follicles. Oedema and thickened elastic fibres may be seen. Type III: hyperplastic sebaceous glands, granuloma formation.
Course
Progressive and chronic.
Complications
Proliferation of connective tissue and sebaceous follicles: rhinophyma (enlarged nose), otophyma (ears), metophyma (forehead), gnathophyma (chin). Rosacea fulminans and rosacea conglobata = maximal variants of rosacea. Keratitis in ocular rosacea.
Diagnosis
Clinical findings.
Differential diagnosis
Major: Late-onset acne, corticosteroid-induced acne, periorificial dermatitis. In stage I also lupus erythematosus. If lupoid: sarcoidosis (lupus pernio), erysipelas.
Prevention & Therapy
Elimination of triggers.
Type I: Topical: Brimonidine tartrate
Procedures: Nd:YAG LASER, pulsed dye LASER, intense pulsed light (IPL).
Type II: Topical: Metronidazole, azelaic acid, ivermectin 1%, permethrin 5% pimecrolimus, retinoids - Systemic: Low dose doxycycline, low dose isotretinoin.
Type III: Systemic: Isotretinoin - Procedures: Dermabrasion, ablative LASERS (for phymas).
Ocular rosacea: Systemic doxycycline.
Differential Diagnosis
Podcasts
Tests
- Which efflorescenses appear in rosacea?
- Acne vulgaris is a differtential diagnosis to rosacea
- Rosacea can be treated with topical metronidazole
- Effective treatment for rosacea includes:
- One of the complication in rosacea is
- Which of these diseases belong to the differential diagnosis of rosacea?
- Effective treatment for rosacea includes:
- Which of these lesions are seen in rosacea?
- Statement 1 Acne vulgaris is a differential diagnostic consideration for rosacea
- Statement 1 Rosacea can be treated with topical metronidazole
- Which of these agents is appropriate for treating rosacea?
- Typical locations for rosacea:
- Which of these does not trigger flushing in rosacea?
- A complication of rosacea is:
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