Rosacea is a common facial rash. It is characterised by sterile inflammatory papules, pustules, and nodules that may sometimes be mistaken for acne vulgaris, but do not cause comedones. It is associated with the mite Demodex folliculorum, which is a normal flora of the skin. It is found in higher concentrations in the faces of individuals with rosacea.
It affects patients aged 30 – 50 years, mainly females of Celtic origin.
- Signs and symptoms
- Facial flushing (precedes the rash)
- Hotness or burning of the face
- Red rash (inflammatory papules, pustules, or nodules) affecting the face. Spares peri-orbital and peri-oral areas
- Telangiectasia
- Facial oedema
- Seborrhoeic dermatitis
- Differentials
- Acne vulgaris
- Seborrhoeic dermatitis
- SLE
- Periorifical dermatitis
- Treatment
- Daily high-factor sunscreen
- Camouflage creams to conceal redness
- Topical brimonidine gel (for patients with predominant flushing but limited telangiectasia) to temporarily reduce redness
- Topical ivermectin for papules and pustules
- Topical metronidazole or azelaic acid for papules/pustules
- Topical ivermectin + oral doxycycline for severe papules/pustules
- Laser therapy for patients with prominent telangiectasia
- Complications
- Blepharitis (ocular involvement)
- Conjunctivitis (blepharoconjunctivitis) and corneal ulceration (rare)
- Rhinophyma (large, bulbous nose)
