- Epidemiology
- 2-3% of general population
- Rosacea tends to occur in adults over the age of 30 years.
- In groups aged younger than 35 years or older than 50 years, men and women are affected equally, however, there is a predominance in women in the 36-50 year age group.
- Most common in fair skinned, anglo-celts
- Cause
- multifactorial and exact mechanisms are not well understood
- Genetics may play a role
- Neurovascular dysregulation and augmented immune detection and response
- infection: the face mite demuxed folliculorum, an obligatory parasite of human pilosebaceous follicles, has been identified in elevated numbers in patients with rosacea
- Clinical features
- commonly affects the central convex areas of the face(cheers, nose, chin and forehead)
- Diagnosis can be made using the following features
- flushing
- erythema
- inflammatory lesions
- telangiectasia
- Differential diagnoses of rosacea
- Acne vulgaris
- Seborrhoeic dermatitis
- Perioral dermatitis
- steroid induced acneiform eruption
- lupus erythematousus-discoid, systemic or subacute cutaneous
- Cutaneous sarcoidosis of the nose
- Tinea faciei
- Essential telangiectasia
- Carcinoid syndrome
- Drug reaction
- polymorphous light eruption
- atypical infections
- contact dermatitis
- Lupus vulgaris (cutaneous tuberculosis)
- Acne agminata
- Dermatomyositis
- Polycythaemia rubra vera
- Superior vena cava obstruction
- Treatment:
- Education
- Avoid precipitants
- sun screen and hats
- Oral agents
- tetracycline 500 mg bd
- doxycycline 50 mg - 100 mg / day (intermittent use is preferable)
- erythromycin 500 mg bd
- erythromycin ethyl succinate 800 mg bd
- Topical agents
- metronidazole
- erythromycin
- brimonidine 0.33% gel
- azelaic acid (available as a 20% lotion or 15% gel)
- other agents
- diclofenac
- isotretinoin for refractory cases
- clonidine, spironolactone, beta blockers, naloxone and ondansetron
- ivermectin
- Recurrence is routine
- Complications
- depression
- ocular rosacea (symptoms include tearing, conjunctival hyperaemia, foreign body sensation, burning, stinging, dryness, itching, light sensitivity and blurred vision)
- lymphoedema
- salivary gland involvement --> reduce in salivary secretions and dry mouth
References:
http://medicinetoday.com.au/system/files/pdf/medicine_today/article/MT2015-01-034-CHEE.pdf
No comments:
Post a Comment