Rosacea is a common inflammatory skin disease. In general, the eruption is confined to the face, mainly affecting the cheeks, forehead, nose, and chin. In some cases lesions may extend onto the scalp, and occasionally also onto the neck and the upper part of the body.
Flushing is a common early characteristic of rosacea is, which is often accompanied by a burning sensation. Inflammatory lesions (development of papules and pustules) are another characteristic feature and may become florid. Vascular changes (telangiectasia and erythema) are also frequently observed. These are initially mild, but later they may become very conspicuous.
Other features that develop as the disease progresses are the development of lymphedema, thickening, and induration. On the nose and, less often the ears, forehead or chin, hypertrophy and lymphedema of subcutaneous tissue may develop into distinct swellings known as phymas, of which rhinophyma is most familiar. Quite often there is also ocular involvement. It manifests as a sensation of grittiness, which may be accompanied by conjunctivitis, blepharitis, episcleritis, chalazion, hordeolum, iritis, and occasionally severe keratitis.
The etiology and pathogenesis of rosacea remain poorly understood. Hopefully, improvements in our understanding of the etiology will one day facilitate a more rational approach to treatment, which has so far developed rather empirically.
Management Strategy for Rosacea
People with rosacea may find it beneficial to avoid alcohol, spicy food, hot drinks, etc. as they may induce flushing and promote the development of telangiectasia. Moreover, it is important to avoid exposure to irritants, while emollients can be helpful. Cosmetic camouflage of the erythema and telangiectasia can be helpful.
Facial massage may promote lymphatic drainage and reduce the development of lymphedema. Papulation, pustulation, and erythema can be effectively suppressed using a variety of topical and systemic antibiotics, retinoids, and other agents described below. Unfortunately, these modalities are usually not very effective for suppressing flushing and have little effect on established telangiectasia.
Telangiectasia and erythema can be effectively treated by physical measures to ablate the vessels, such as intense pulsed light or vascular lasers. Flushing is usually the most difficult feature to treat, but sometimes improves during treatment of telangiectasia.
Ocular rosacea is often treated symptomatically with a range of ‘artificial tears’ – the ophthalmic equivalent of emollients. Systemic tetracyclines, used as for cutaneous rosacea, and topical ophthalmic formulations of fusidic acid are also helpful. The use of retinoids for rosacea requires special care in patients with eye involvement and may be poorly tolerated.