Rosacea
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Synopsis
The etiology of rosacea is poorly understood. Cutaneous vascular changes, inappropriate activation of the immune system, UV and microbial exposure (ie, Demodex mites), and disruption of the epidermal barrier have all been implicated as playing a role in the pathogenesis in this condition. There have been reports of familial rosacea, so an underlying genetic predisposition has not been ruled out.
Rosacea primarily affects individuals with lighter skin phototypes, and females tend to present at a younger age than males. The disease is reported less commonly in skin types IV-VI, perhaps because darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize.
There are 4 main subtypes of the disease: erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea.
- Erythematotelangiectatic rosacea – Presents with persistent erythema of the central portion of the face with intermittent flushing. Telangiectasias can also occur. Patients often complain of stinging or burning sensations on the skin. This is the most common subtype.
- Papulopustular rosacea – Acneiform papules and pustules predominate; there is also erythema and edema of the central face with relative sparing of the periocular areas. Dramatic swelling can result in lymphedematous changes manifesting as solid facial edema or lead to phymatous changes.
- Phymatous rosacea – Chronic inflammation and edema result in marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin, most commonly on the nose (rhinophyma). Men are more often affected.
- Ocular rosacea – Presents with conjunctivitis, blepharitis, and hyperemia. Patients complain of dry, irritated, itchy eyes. Keratitis, scleritis, and iritis are potential but infrequent complications. Ocular rosacea can occur in patients with or without cutaneous findings.
Rosacea fulminans (pyoderma faciale) refers to the sudden onset of inflammatory facial papules and pustules with possible abscess and sinus tract formation. Systemic signs and symptoms are present.
A rare consequence of chronic rosacea and certain other facial disorders is solid facial edema, sometimes called Morbihan disease.
Since rosacea manifests on the face, it is important to recognize that this disease can have psychosocial consequences, which may affect quality of life.
Codes
ICD10CM:L71.9 – Rosacea, unspecified
SNOMEDCT:
398909004 – Rosacea
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Differential Diagnosis & Pitfalls
Papulopustular rosacea:- Acne vulgaris
- Perioral dermatitis (periorificial dermatitis)
- Lupus miliaris disseminatus faciei
- Bromoderma
- Folliculitis
- Sarcoidosis
- Menopause, "hot flashes"
- Chronic actinic damage / dermatoheliosis
- Lupus erythematosus
- Seborrheic dermatitis
- Photosensitive or photoallergic drug eruption
- Cellulitis (usually unilateral)
- Erysipelas (usually unilateral)
- Carcinoid syndrome
- Pheochromocytoma
- Medullary thyroid carcinoma
- Mastocytosis
- Chronic blepharitis (allergic, bacterial, viral)
- Hordeolum or chalazion
- Chlamydia
- Dry eye syndrome
- Keratitis (bacterial, herpetic, atopic, sicca)
- Corneal ulceration
- Mucous membrane pemphigoid
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Last Updated: 03/29/2017
Rosacea
See also in: External and Internal Eye
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