Acne Rosacea

BASICS

DESCRIPTION

  • Rosacea is a chronic condition characterized by recurrent and sometimes fixed episodes of facial flushing, erythema (due to dilatation of small blood vessels in the face), papules, pustules, and telangiectasia (due to increased reactivity of capillaries) in a symmetric, central facial distribution; sometimes associated with ocular symptoms (ocular rosacea)
  • Four subtypes:
    • Erythematotelangiectatic rosacea (ETR)
    • Papulopustular rosacea (PPR)
    • Phymatous rosacea
    • Ocular rosacea
  • System(s) affected: skin/exocrine
  • Synonym(s): rosacea

Geriatric Considerations

  • Chronic inflammatory dermatosis with middle-age onset
  • Effects of aging might increase the side effects associated with oral used for treatment (at present, data are insufficient due to lack of clinical studies in elderly patients aged ≥65 years).

EPIDEMIOLOGY

Prevalence

  • Predominant age of onset: 30 to 50 years
  • Predominant sex: female > male. However, males are at greater risk for progression to later stages.
  • More common in Fitzpatrick skin types I and II, however, it may be underreported in other skin types due to background pigmentation. This may lead to a delay in diagnosis for patients with darker skin types (1).

ETIOLOGY AND PATHOPHYSIOLOGY

  • No proven cause
  • Possibilities include the following:
    • Thyroid and sex hormone disturbance
    • Immune system and neurocutaneous dysregulation (2)
    • Alcohol, coffee, tea, spiced food overindulgence (unproven)
    • Demodex follicular parasite (suspected)
    • Exposure to cold, heat
    • Emotional stress
    • Dysfunction of the GI tract (possible association with Helicobacter pylori)

Genetics

  • People of Northern European and Celtic background commonly afflicted
  • Associated with three human leukocyte antigen (HLA) alleles: HLA-DRB1, HLA-DQB1, and HLA-DQA1 (MHC class II)

RISK FACTORS

  • Exposure to spicy foods, hot drinks
  • Environmental factors: sun, wind, cold, heat

GENERAL PREVENTION

No preventive measures known however avoidance of patient specific triggers can minimize severity of flare ups (3).

COMMONLY ASSOCIATED CONDITIONS

  • Seborrheic dermatitis of scalp and eyelids
  • Keratitis with photophobia, lacrimation, visual disturbance
  • Corneal lesions
  • Blepharitis
  • Uveitis

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