Rosacea (pronounced rose-ay-shah) is a chronic skin disorder, affecting the convexities of the face preferentially, which is characterized by redness and telangiectasia and is punctuated by episodes of inflammation. During the attacks of inflammation the affected skin typically develops papules, pustules and swelling. Rosacea usually starts with redness on the cheeks and slowly worsen, so it may be hard to recognize it in early stages and unfortunately, many poeple mistake it for a sunburn, or acne and do not see a doctor.

Although rosacea is commonest in the third to fourth decades, it not uncommonly occurs in both the elderly and the adolescent. Women are affected three times as frequently as men, but the disease may become more severe in men. It seems that rosacea affects fair-skinned people more often, though it can occur in any skin type.

The cause of rosacea is unknown. The main hypotheses can be grouped as follows: 1.alimmentary, 2.psychological, 3.pharmacological, 4.infective, 5.climatic and 6.immunological.

The most common triggers for rosacea are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold.

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously

Differential Diagnosis

Acne, perioral dermatitis, seborrheic dermatitis, folliculitis, Demodex folliculorum infestation, and SLE are among the main differential diagnoses.

Management

Rosacea can't be cured, but it can be controlled. 

First of all, patients should avoid precipitating factors mentioned above.

Treatment may include diet modification, antibiotics, sulfur and sulphacetamide. The treament of choice for all stages and complications of rosacea, except the persistent and non-swollen red and telangiectatic stage, is tetracycline by mouth. In severe cases, isotretinoin can be highly effective.

Interestingly, Helicobacter pylori therapy often clears rosacea up, but this effect is not really understood.

Related links: 

www.rosacea.org                 www.internationalrosaceafoundation.org 

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