ROSACEAROSACEA

INTRODUCTIONINTRODUCTION

Rosacea is well recognized as a Rosacea is well recognized as a chronic cutaneous disorder primarily chronic cutaneous disorder primarily of the convexities of the central face of the convexities of the central face (cheeks, chin, nose, and central (cheeks, chin, nose, and central forehead)forehead)

Cutaneous signs: flushing, erythema, Cutaneous signs: flushing, erythema, telangiectasia, edema, papules, telangiectasia, edema, papules, pustules, ocular lesions, and pustules, ocular lesions, and rhinophyma.rhinophyma.

EPIDEMIOLOGYEPIDEMIOLOGY

Rosacea appears to be quite commonRosacea appears to be quite common It has been most frequently It has been most frequently

patients with fair skin,patients with fair skin, In Asians and African Americans In Asians and African Americans

can occur. can occur. Any sex , any ageAny sex , any age The onset typically begins at any The onset typically begins at any

time after age 30.time after age 30.

Etiology and Etiology and PathogenesisPathogenesis

The etiology of rosacea is The etiology of rosacea is unknownunknown. . Several pathogenesis are:Several pathogenesis are:

VasculatureVasculature Climatic exposuresClimatic exposures Dermal matrix degenerationDermal matrix degeneration Chemicals and ingested agentsChemicals and ingested agents Perivascular versus perifollicular Perivascular versus perifollicular

inflammationinflammation Microbial organismsMicrobial organisms

Clinical PictureClinical Picture

Cardinal Physical sign are as Cardinal Physical sign are as follower:follower: ErhytemaErhytema TelangiectasiaTelangiectasia PapulesPapules SwellingSwelling pustulespustules

STAGE IN ROSACEA

Episodic Erythema :the Rosacea diathesisEpisodic Erythema :the Rosacea diathesis Stage I. Persistent moderate erythema Stage I. Persistent moderate erythema

with scattered telangiectases. with scattered telangiectases. Stage II. Persistent erythema, numerous Stage II. Persistent erythema, numerous

telangiectases, papules and pustulestelangiectases, papules and pustules Stage III. Persistent deep erythema, Stage III. Persistent deep erythema,

dense telangiectases forming sprays dense telangiectases forming sprays (nose) papules, pustules, nodules with (nose) papules, pustules, nodules with variable plaquelike edemavariable plaquelike edema

Subtype of RosaceaSubtype of Rosacea

Subtype 1: erythematotelangiectatic rosacea

Subtype 2: papulopustular rosacea.

Subtype 3: phymatous rosacea. Subtype 4: ocular rosacea.

Subtype 1 Erythematotelangiectatic

rosacea

Subtype 2: papulopustular rosacea

Subtype 3: phymatous rosacea.

Subtype 4: ocular rosacea

Histopathology Histopathology

According to the stageAccording to the stage Often not diagnosticOften not diagnostic Demodex folliculorum Demodex folliculorum often found in often found in

all typeall type

Diagnostic CriteriaDiagnostic Criteria

Deferential DiagnosticDeferential Diagnostic

Acne vulgaris, Acne vulgaris, Seborrheic dermatitis Seborrheic dermatitis Sarcoidosis,Sarcoidosis, Lymorphous light eruption, Lymorphous light eruption, Harber’s syndromeHarber’s syndrome

ComplicationComplication

Rhinophyma Rhinophyma Ocular InflammationOcular Inflammation Rosacea lymphoedemaRosacea lymphoedema

Other complication: Other complication: blepharitis, blepharitis, meibomianitis, trichiasis, episcleritis, meibomianitis, trichiasis, episcleritis, chalazion and hordeolumchalazion and hordeolum

Treatment Treatment

Additional therapyAdditional therapy

Use sunscreenUse sunscreen SPF 15 or higher SPF 15 or higher Massase facialMassase facial Diet cigarette, alcohol, coffee, Diet cigarette, alcohol, coffee,

spicyspicy Surgery Surgery

Surgery Surgery Laser resurfacing. Laser surgery Laser resurfacing. Laser surgery

removes layers of skin. This may help removes layers of skin. This may help with an enlarged nose (rhinophyma); with an enlarged nose (rhinophyma); small, red lines; or lingering redness. small, red lines; or lingering redness.

Dermabrasion. This procedure may Dermabrasion. This procedure may smooth the rough skin and bumps smooth the rough skin and bumps from the nose caused by rhinophyma. from the nose caused by rhinophyma.

Cosmetic surgery. Reconstructive Cosmetic surgery. Reconstructive surgery and plastic surgery may surgery and plastic surgery may reshape or remove bumps from a nose reshape or remove bumps from a nose damaged by rhinophyma. damaged by rhinophyma.