Follicular skin diseases
- Be able to recognise and manage a straightforward case of rosacea.
- 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.
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
Unlike acne vulgaris, there are no comedones, cysts, or nodules.
Rosacea is often accompanied by:
- Blepharitis or meibomianitis (erythematous papules on eyelid margins)
- Facial oedema
- “Sensitive” skin i.e. face creams sting and burn
- Seborrhoeic dermatitis
- Irritant dermatitis
Symptoms are often aggravated by:
- Sun exposure
- Hot and spicy food or drink
- Rapid change in environmental temperature
- Topical steroids
- Reduce facial flushing: avoid extremes of temperature, minimize exposure to hot or spicy foods and alcohol, protect from sun exposure;
- Avoid oil-based facial creams -use water-based make-up and sunscreen;
- Oral anti-inflammatory antibiotics such as tetracycline 250-500 mg, doxycycline 50–100 mg or minocycline 50–100 mg daily for 4-8 weeks. Repeat as necessary;
- Topical metronidazole cream or gel or azelaic acid cream or lotion can be used intermittently or long term alone for mild cases and in combination with oral antibiotics for more severe cases;
- Brimonidine gel to reduce erythema (may cause rebound)
- Low-dose isotretinoin if antibiotics fail
- Vascular laser or intense pulsed light treatment of telangiectasia;
- Surgical correction of rhinophyma.
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