Rosacea is a common condition that presents with facial flushing and a spectrum of clinical manifestations including erythema, capillary dilatation, skin roughness, and inflammatory papules pustules, similar to acne.
Based on the specific clinical manifestations, it is divided into four subtypes as follows.
Erythematous capillary dilatation type; papulopustular type; nasal flaccid type; periocular type; clinical manifestations.
Erythematous capillary dilatation type.
Central facial flushing with burning or tingling sensation.
The redness does not usually involve the skin around the eyes.
The skin is usually fine, unlike other subtypes of rosacea.
The erythematous areas sometimes appear rough and scaly and may be associated with chronic, low-grade dermatitis.
Common irritants that cause facial redness include acute emotional stress, hot drinks, alcohol, spicy foods, exercise, cold or hot days, and hot baths.
Burning or stinging sensations may be exacerbated by topical medications.
Papulopustular rosacea.
Classic rosacea with the following characteristic presentation.
It is usually seen in middle-aged women.
Central facial erythema, in which red papules with pinpoint pustules are visible.
There is a previous history of facial flushing.
Capillary dilation may be present but may be indistinguishable from erythema.
Nasal flaccid rosacea.
Significant skin thickening and nodules on the surface of the nose, chin, forehead, or eyelids.
Periocular rosacea.
Blepharitis; conjunctivitis; inflammation of the eyelids and lid glands; conjunctival congestion within the eyelids; dilated conjunctival capillaries.
Although periocular manifestations can precede cutaneous manifestations, most patients develop them simultaneously with cutaneous manifestations.
Granulomatous variants.
A rare granulomatous variant of rosacea (clustered acne/ facial milia) presents as inflammatory erythema or dermatophytic papules symmetrically distributed over the face, especially around the eyes and nose. The skin color is often isolated and the peripheral erythema is present but may be inconspicuous. These patients usually have no history of facial flushing.
Diagnosis.
Diagnosis is primarily a clinical judgment, and skin biopsy can sometimes exclude other skin conditions such as lupus erythematosus or nodular disease. Histopathologic manifestations are as follows.
Nonpustular lesions show a nonspecific perivascular and perifollicular lymphohistiocytic infiltrate with occasional multinucleated giant cells, plasma cells, neutrophils, and eosinophils.
Papulopustular lesions present as more prominent granulomatous inflammation, sometimes with perifollicular abscesses.
Accessory hair follicles are sometimes seen in excess of follicular worms.
The pathology of granulomatous rosacea is prominent, showing caseous and non-caseous granulomas with negative staining for mycobacteria and fungi.
Treatment.
Laser treatment.
Vascular lasers, the primary treatment for rosacea, use oxidized hemoglobin to absorb the pulse width, causing vascular degradation and causing mild scarring or damage to the surrounding tissue.
Surgery.
Persistent capillary dilation can be treated with electrocautery or a 585-nm pulsed dye laser. However, facial erythema does not improve and new capillary dilation reappears with time.
Nasal flaccid rosacea can be improved by techniques such as skin grinding, CO2 laser peeling, and surgical debridement.
Avoidance of predisposing factors.
Before starting treatment, one should find and avoid the irritants that cause rosacea to be more severe, such as.
Hot or cold days; wind; hot drinks; caffeine; exercise; spicy foods; alcohol; emotions; topical products that irritate and disrupt the skin barrier; and medications that cause facial redness.
In addition, apply a broad-spectrum sunscreen topically daily.