Rosacea

Rosacea is a persistent eruption occurring on the forehead and cheeks. It is more common in women than men.

There is erythema with prominent blood vessels. Pustules, papules, and oedema occur. Rhinophyma, with thickened erythematous skin of the nose and enlarged follicles, is a variant. Conjunctivitis and blepharitis may be associated. It is usually made worse by sunlight.

Rosacea should be distinguished from:

• Acne, in which there are blackheads, a wider distribution, and improvement with sunlight. Acne, however, may coexist with rosacea—hence the older term "acne rosacea".

• Seborrhoeic eczema, in which there are no pustules and eczematous changes are present.

Lupus erythematosus, which shows light sensitivity, erythema, and scarring but no pustules.

• Perioral dermatitis, which occurs in women with pustules and erythema around the mouth and on the chin. There is usually a premenstrual exacerbation. Treatment is with oral tetracyclines.

Treatment

The treatment of rosacea is with long term courses of oxytetracycline, which may need to be repeated. Topical treatment along the lines of that for acne is also helpful. Topical steroids should not be used as they have minimal effect and cause a severe rebound erythema, which is difficult to clear. Avoiding hot and spicy foods may help.

Recent reports indicate that synthetic retinoids are also effective.

Lupus erythematosus

Remember the following points

• Avoid topical steroids

• Persevere with one antibiotic not short courses of different types

• Do not prescribe a tetracycline for children and pregnant women

• Oxytetracycline must be taken on an empty stomach half an hour before meals

Further reading

Cunliffe WJ, Cotterill JA. The acnes: clinical features, pathogenesis and treatment. St Louis: Mosby, 1989. Plewig G, Kligman AM. Acne and rosacea, 2nd ed. Berlin: SpringerVerlag, 1992

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