2nd July 2023

Acne Rosacea

Introduction

A chronic inflammatory skin condition that typically affects the central face and eyes. It presents with centrofacial erythema, inflammatory papules and pustules, flushing, telangiectasia and phymatous skin changes, e.g. rhinophyma.

It occurs in approximately 5% of adults worldwide and tends to affect both genders equally. It typically presents after 30 years of age and is more prevalent with age.

The pathogenesis is multifactorial and is thought to include a combination of genetic susceptibility, altered microbiome of the skin and gut, and neurocutaneous mechanisms – alcohol, UV light, exercise, temperature changes and spicy food.

Investigation and Management

Rosacea is primarily a clinical diagnosis. Differential diagnoses include acne vulgaris, skin damage, seborrhoeic dermatitis, dermatomyositis, drug reactions and eczema, to name a few.

The main treatment is through lifestyle change – patients are encouraged to record a symptom diary to identify their triggers and subsequently avoid them. Patients should moisturise frequently and use daily SPF. Exfoliants, topical steroids and alcohol-based topical products should be avoided.

Medical treatment includes topical metronidazole in mild to moderate cases. In severe cases brimonidine is used (to reduce erythema). Systemic treatment options include a 2-month course of tetracyclines (or erythromycin) and should be used if symptoms have not resolved for a year with topical therapies. In cases of telangiectasia, laser treatments can be trialled. Complications include blepharitis, keratitis and conjunctivitis. Oral antibiotics are indicated in cases of ocular involvement.