Rosacea

Case Two

Case Two: History

• HPI: Mr. M is a 47-year-old man who presented to clinic with “red cheeks” for the last 3 years. He reports it is more noticeable with exercise or heat. He stops alcohol because he thinks it makes it worse.
• PMH: no major illnesses or hospitalizations
• Allergies: none
• Medications: multivitamins
• Family history: noncontributory
• Social history: lives with wife
• ROS: negative

Case Two: Skin Exam

• Facial erythema on the nose and cheeks as well as a few small telangiectasias within the erythema.
• No comedones, papules, or pustules are noted.
• There is no scale.

Case Two, Question 1

• What is the most likely diagnosis? a. Allergic contact dermatitis (no itching) b. Atopic dermatitis (no itching, ho past history, wrong age) c. Rosacea d. Seborrheic dermatitis (erythematous patches with greasy scale on the central face) e. Systemic lupus erythematosus (negative review of systems; SLE is not triggered by alcohol)

Case Two, Question 2

• Which of the following might trigger Mr. M’s rosacea?
  1. Alcohol
  2. Heat/hot beverages
  3. Hot, spicy foods
  4. Sunlight
  5. All of the above

Clinical Features of Rosacea

• Rosacea is typically located on the mid face including the nose and cheeks with occasional involvement of the brow, chin, eyelids, and eyes
• Patients have erythema and telangiectasias
• Patients can have papules and pustules
• The absence of comedones helps to distinguish acne vulgaris from rosacea
• May also present with rhinophyma (dermal and sebaceous gland hyperplasia of the nose)
• Patients can have ocular rosacea: keratitis, blepharitis, conjunctivitis

The Following Photos Illustrate Different Types of Rosacea

Erythematotelangietatic Rosacea

• Erythema and telangiectasias scattered on the nose and cheeks.
• There are no papules, pustules, or comedones present.

Papulopustular Rosacea

• Erythema with papules and pustules on the nose and chin.
• Patient also has erythematous patches on the cheeks bilaterally.

Phymatous Rosacea

• Facial erythema, scattered papules, pustules on the nose, forehead, cheeks and chin. Thickened, highly sebaceous skin.
• This patient also has severe rhinophyma.

Rosacea Treatment

• Therapy is often long-term
• Most treatments are directed at specific findings manifested by rosacea patients
• Types of treatment include:
  • Topical products: metronidazole, sodium sulfacetamide, azelaic acid, sulfur cleansers
  • Oral antibiotics for pustular and papular lesions
• All patients should use sunscreen daily