Definition

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Definition

• Rosacea is a Latin word meaning (Like-Roses), is
  an Acne-like rash, caused by disorder of the
  Pilo-Sebaceous unit, often affect the central
  region of the face (Centro-facial) characterized
  by
• 1-Hyper-reactivity of superficial vessels and
  capillaries to external stimuli, thereby
  reflecting temporary or persistent redness of the
  face area,

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• Central emergence and expansion of capillary
  vessels (Telangiectasia) surface and/or accompany
  an inflammatory papules or in severe cases there
  are burst of pustules,
• symptoms vary within a broad spectrum between one
  person to another, from different symptoms of
  temporary redness of the face to continuous
  redness, vascular dilatation, papules and
  pustules.

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Epidemiology

• Rosacea often seen in patients from third to
  sixth decade, peak incidence in the fourth or
  fifth decade of life, affects both genders, but
  affects women more than men, rhinophyma type
  afflicts mostly men.
• Acne rosacea affects white people, II-I-type
  classification (Fitzpatrick) and is rare in
  Africans or Asians.

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Incidence

• In a study conducted in Sweden to 809 desk
  officers, found that 81 either have the disease
  or had it at some point, and concluded that the
  incidence among white is about 10, another study
  believe that nearly 14 million people are
  affected in the United States, but the incidence
  of this disease is not known yet, due to the lack
  of proper studies and to errors in diagnosis.

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• A-hormonal and B-neurological mechanism, both
  mechanisms leading to equal results and may
  interact with each other, and often the external
  factors (stimuli) play a role in activating those
  mechanisms, particularly the increase in
  temperature, the so-called (Heat Stimuli), if the
  heat source is oral i.e. (hot drinks),

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• Chemicals and Food intake hot spices, alcohol
  and hot drinks are considered to be an
  aggravating factors in rosacea, and certain
  medications used to treat cardiovascular diseases
  (such as Amiodarone) may aggravate or cause
  rosacea, topical steroids for prolonged period
  may cause so-called steroid acne or rosacea-like
  disease, (Nicotinic acid) may aggravate rosacea,
  some reported acne cases similar to Rosacea after
  using vitamin (B6, B12).

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• 6-Microbes many believe that the mite or the
  apportunistic microbe of the pilosebacous unit
  (Demodex folliculorum, brevis), causes rosacea
• supports this belief

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• a- The Demodex favours areas affected often by
  rosacea, (the central zone of face)
• b- The number of Demodex is increased in aging
  skin old age, (where rosacea is rare in
  children).
• c- Studies have shown that most patients with
  rosacea carry antibodies most probably against
  Demodex, and about 22 of patients have confirmed
  antibodies against Demodex.
• d- Many studies have also shown a colonization of
  demodex in Rosacea patients.

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Types of Rosacea (4 types)

• 1. Erythemotelangiectatic Rosacea.
• Features include continuous erythema in the
  central region of the face, telangactasia is very
  common but not essential for diagnosis of this
  type, and accompanying symptoms may be a tingling
  sensation and or burning sensation in the face,
  or the Central face, oedema or roughness or some
  facial desquamation, patients usually give
  history of transient or non-transient erythema.

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• 2. Papulopustaular Rosacea.
• Characterized by continuing erythema and the
  appearance of transient papules or pustules in
  the Central face, papules and pustules may appear
  elsewhere, for example, around the mouth or
  around the eyes, nose this type of rosacea is
  very similar to Acne Vulgaris, this type of
  rosacea may coexist with acne and comedones may
  appear thus it is very crucial to notice
  accompanying symptoms i.e. (tingling and burning
  sensation)
• This type often appears with or after the
  emergence of the first type (Erythemotelangiectati
  c Rosacea) but telangiectasia might be obscure
  due to papules and pustules and continues
  erythema, but might appear after good treatment,

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• 3- Phymatous Rosacea
• The most common type is Rhinophyma,

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• This type can appear in other parts of the face
  (nose, Chin and cheeks) the affected area often
  shows pores enlargement, or may show some
  telangiectasia too, in the case of Rhinophyma
  accompanying symptoms are severe.
• This type often appears with or after a period of
  Erythemotelangiectatic Rosacea, or type II
  (Papulopustaular Rosacea)

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• 4- Ocular Rosacea
• For the diagnosis of this case 1 or more of the
  following symptoms should coexist with rosacea
• Continuous or transit Conjunctival reddness
• The sense of foreign body in the eye
• blurry vision, tingling or burning or overly
  photo sensitivity
• appearance of telangiectasia within the
  conjunctiva or swollen or redness around the eye
• inflammation of eyelids (Blepharitis) or
  conjunctivitis (Conjunctivitis) or irregular
  eyelid border.

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Other Rosacea types

• 1. Glandular Rosacea
• Men are more frequently affected usually around
  the eyes and in women around the chin
  telangactasia is and erythema is not seen due to
  thikned skin and severe seborrhea
• 2. Granulomatous Rosacea 10 of all rosacea
  there are brownish papules and pustules on face,
  in about 50 eyes might be involved, some
  believes its part of what is so called lupus
  maliaris disseminatous faciei.

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Diagnosis

• Full and detailed history (including
  medications)is required,
• diagnosis is made clinical
• Other conditions should be rolled out
• Acne vulgaris
• Folliculitis
• Polycythemia vera
• Dermatomyocytis
• Lupus erythematousus
• Carcinoid tumor
• Mastocytosis
• Mitral stenosis

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Treatment

• Sunscreen
• Avoidance of chemicacl irritants and habitis that
  aggrivate rosacea including alcohol and cosmetic
  for those with (Erythemotelangiectatic Rosacea)

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Topical medications

• Metronidazole
• Sodium sulfacetamide and sulfur
• Azelaic acid
• Benzoyl peroxide
• Tretinoin
• Erythromycin and Clindamycin

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Oral medications

• Tetracyclines
• Macroloides (e.g Erythromycin)
• Metronidazole
• isotretinoin

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• Other facial rejuvenation (ablative and
  non-ablative) laser show good results in
  treatment of solar damage and connective tissue
  remodelling thus improving Rosacea.