Acne Rosacea ✅
Related Subjects:
| Nikolsky's sign
| Koebner phenomenon
| Erythema Multiforme
| Pyoderma gangrenosum
| Erythema Nodosum
| Dermatitis Herpetiformis
| Lichen Planus
| Acanthosis Nigricans
| Acne Rosacea
| Acne Vulgaris
| Alopecia
| Vitiligo
| Urticaria
| Basal Cell Carcinoma
| Malignant Melanoma
| Squamous Cell Carcinoma
| Mycosis Fungoides (Sezary Syndrome)
| Xeroderma pigmentosum
| Bullous Pemphigoid
| Pemphigus Vulgaris
| Seborrheic Dermatitis
| Pityriasis/Tinea versicolor infections
| Pityriasis rosea
| Scabies
| Dermatomyositis
| Toxic Epidermal Necrolysis
| Stevens-Johnson Syndrome
| Atopic Eczema/Atopic Dermatitis
| Psoriasis
🌹 Acne Rosacea is a chronic inflammatory disorder of the central face.
It is non-infectious and often worsened by triggers such as topical steroids or systemic drugs (e.g., amiodarone, vasodilators).
💡 Early recognition and trigger avoidance are key to preventing progression and complications.
📖 Overview
- 🔥 Characterised by recurrent flushing, persistent erythema, papules, pustules, telangiectasia, and phymatous changes.
- 🧬 Inflammatory changes are perifollicular and perivascular; no microbial pathogen is primary.
- ⚖️ Often misdiagnosed as acne vulgaris – key distinction: no comedones and later age of onset.
🧪 Aetiology & Pathophysiology
- 🕷 Demodex folliculorum mites: may trigger innate immune response and inflammation.
- 💓 Vascular dysregulation: abnormal vasomotor response → flushing, persistent erythema.
- 🧠 Neurovascular factors: TRPV1 receptor hyperreactivity contributes to burning/stinging.
- 🌍 Environmental factors: UV light, temperature extremes, wind, humidity.
- 🧬 Genetic predisposition: family clustering suggests heritable susceptibility.
- 💊 Exacerbating medications: corticosteroids, vasodilators, niacin, amiodarone, topical irritants.
- 🔥 Chronic inflammation: cytokine-mediated perivascular and perifollicular infiltrates → papules/pustules, phymatous changes in sebaceous glands.
📊 Epidemiology
- 👩 Typically adults 40–60 years; rare in children.
- 👨 Males: more severe phymatous changes; females: more frequent erythematotelangiectatic subtype.
- 🚩 Triggers: alcohol, spicy foods, hot beverages, sunlight, heat, stress, exercise, topical steroids.
🩺 Clinical Subtypes (NICE / ROSACEA Grading)
- 🌡 Erythematotelangiectatic: flushing, persistent erythema, visible telangiectasia.
- 🔴 Papulopustular: central facial papules/pustules, no comedones.
- 👃 Phymatous: sebaceous gland hypertrophy → rhinophyma, mostly in men.
- 👁 Ocular rosacea: blepharitis, conjunctivitis, keratitis, corneal involvement.
🚩 Triggers to Avoid
- 🍷 Alcohol, hot drinks
- 🌶 Spicy foods
- ☀️ Sunlight (SPF ≥30 advised), 💨 wind, ❄️ cold, high temperature
- 🏃 Exercise or heat exposure
- 😰 Stress
- 💊 Topical steroids or irritating cosmetics
🔍 Diagnosis & Examination
- ✅ Clinical diagnosis: central facial erythema, papules/pustules, telangiectasia, phymatous changes, ocular involvement.
- 🚫 Key differentiator from acne vulgaris: absence of comedones.
- 👁 Examine for ocular involvement: lid margin inflammation, conjunctival injection, corneal changes.
- 🧾 Consider dermoscopy for telangiectasia and inflammatory changes.
- 🧪 Investigations only if atypical presentation: exclude lupus, seborrhoeic dermatitis, or drug-induced eruptions.
💊 Management (NICE-Aligned)
- General care & lifestyle:
- SPF ≥30 daily, gentle cleansers, avoid irritants.
- Identify and avoid triggers (diet, alcohol, heat, stress, topical steroids).
- Topical therapy:
- Metronidazole 0.75–1% gel/cream OD–BD
- Azelaic acid 15–20% gel/cream BD
- Brimonidine 0.33% gel: vasoconstrictor for persistent erythema (short-term effect)
- Oral therapy:
- Doxycycline 40–100 mg/day (anti-inflammatory dose) – typically 4–12 weeks
- Lymecycline as alternative
- Oxytetracycline or minocycline less preferred (pigmentation, side effects)
- Refractory/severe cases: low-dose isotretinoin or specialist dermatology input
- Procedures: Pulsed dye laser or IPL for telangiectasia/erythema; surgical/laser rhinophyma reduction
- Ocular rosacea: eyelid hygiene, lubricating drops, topical/oral antibiotics if keratitis or blepharitis; urgent ophthalmology referral if corneal involvement
🖼 Images
📝 Exam Pearls
- 🚫 No comedones → key differentiator from acne vulgaris
- 👃 Rhinophyma → severe, late complication, mostly in men
- 👁 Ocular involvement → sight-threatening if untreated, urgent referral
- 💡 Flushing precedes persistent erythema; papules/pustules appear later
- 🧪 Topical steroids worsen rosacea → teach patients to avoid
📚 References & NICE Resources
