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Follicular skin diseases

Rosacea

Objectives

  • Be able to recognise and manage a straightforward case of rosacea.

Key points

  • Rosacea results in mid-facial flushing, erythema, papules, pustules and telangiectasia.
  • Rhinophyma refers to an enlarged nose.
  • Rosacea is treated with topical metronidazole or azelaic acid and oral antibiotics.
  • Rhinophyma may require surgical management.

Introduction

Rosacea is a common transient, recurrent or persistent facial rash of unknown cause. It affects the cheeks, nose, chin and forehead of those in their 30s or older, especially those with fair-skin, blue eyes and of Celtic origin.

It is characterized by mid-facial erythema, asymptomatic dome-shaped inflammatory papules and superficial pustules. The fleshy part of the nose may slowly enlarge with prominent pores and fibrous thickening (rhinophyma). Persistent swelling may also affect cheeks, earlobes, forehead and eyelids.

Rosacea: erythema and inflammatory papules

Rosacea: erythema and telangiectasia

Rosacea: papules and pustules

Inflammatory rosacea and early rhinophyma

Rhinophyma

Telangiectasia


Unlike acne vulgaris, there are no comedones, cysts, or nodules.

Rosacea is often accompanied by:

Symptoms are often aggravated by:

Treatment

Rhinophyma that should be treated surgically

Inflamed rosacea resulting in sensitive skin

Telangiectasia prior to vascular laser treatment

Six weeks after single treatment with vascular laser