A. A multifactorial vascular skin disorder, acne rosacea is characterized by chronic inflammatory processes in which flushing and dilation of the blood vessels occur on the face. It is manifested in four stages of pathologic events.
Incidence
A. Acne rosacea affects approximately 13 million people in the United
States.
Pathogenesis
A. Rosacea is a functional vascular anomaly with a tendency toward
recurrent dilation and flushing of the face. This results in inflammatory
mediator release, extravasation of inflammatory cells, and the formation of
inflammatory papules and pustules.
Predisposing Factors
A. Tendency to flush frequently
B. Exposure to heat, cold, or sunlight
C. Consumption of hot or spicy foods and alcoholic beverages
D. Some topical medications, astringents, or toners
Common Complaints
A. Papules, pustules, and nodules. Hallmarks for diagnosis are the small papules and papulopustules. Many presenting erythematous papules
have a tiny pustule at the crest. No comedones are present.
B. Periodic reddening or flushing of face
C. Increase in skin temperature of face
D. Face flushing in response to heat stimuli (hot liquids) in mouth
Other Signs and Symptoms
A. Periorbital erythema
B. Telangiectasia, paranasally and on cheeks
C. Rhinophyma
D. Blepharoconjunctivitis with erythematous eyelid margins
E. Conjunctivitis: Diffuse hyperemic type or nodular
F. Keratitis: Lower portion of cornea, associated with pain, photophobia, and
foreign-body sensation
Diagnostic Tests
A. Consider skin biopsy to rule out lupus, sarcoidosis, or other possible
causes if history and physical exam findings warrant further testing.
Differential Diagnoses
A. Acne rosacea
B. Acne vulgaris
C. Steroid-induced acne
D. Perioral dermatitis
E. Seborrheic dermatitis
F. Lupus erythematosus
G. Cutaneous sarcoidosis
Pharmaceutical therapy
1. Drug of choice: Tetracycline 500 to 1,000 mg twice to four times daily
for 2 to 4 weeks.
2. Others: Erythromycin 500 mg twice daily until clear, minocycline
(Minocin), 50 to 200 mg daily divided into two doses, doxycycline
(Vibramycin) 100 mg daily, Amoxil, and metronidazole (Flagyl,
Protostat). Start at a higher dose and taper to the maintenance dose.
a. Topical antibiotics. Apply topical Metrogel twice daily after
cleansing skin.
b. Do not use topical steroids. Topical steroids may worsen irritation.
c. Other topical antibiotics: Clindamycin (Cleocin T), erythromycin
twice daily.
Follow-Up
A. Follow up in 2 weeks to evaluate therapy.
B. See patients monthly for evaluation until maintenance is reached.
C. Relapses are common following discontinuance of antibiotics; repeat
treatment.
