Makindo Medical Notes

strong>Note: May be triggered or worsened by the use of topical steroids and drugs such as Amiodarone.

About Acne Rosacea

• Acne Rosacea is a common chronic inflammatory skin condition that presents with frequent episodes of flushing and burning sensations.
• Inflammation is perifollicular and perivascular, but it is not an infectious condition.

Aetiology

• The Demodex species (mites that inhabit human hair follicles) are believed to play a role in the development of Acne Rosacea.

Epidemiology

• Commonly affects middle-aged individuals (40 to 60 years old), particularly those with fair skin.
• Males tend to experience more severe forms of the disease.
• Factors such as alcohol consumption, spicy food, and sun exposure can cause flushing and exacerbate symptoms.

Clinical Presentation

• Typically affects the cheeks, forehead, chin, and nose. Characterized by flushing, persistent redness, telangiectasia, and small red bumps or pustules.
• Eye involvement is possible, leading to discomfort or even corneal scarring.
• The condition can worsen with triggers such as alcohol, temperature extremes, spicy foods, and stress.
• May lead to psychological effects like anxiety and depression due to visible facial changes.

Physical Examination

• The affected areas may exhibit flushing, and visible blood vessels (telangiectasia), as well as the development of small bumps and pus-filled spots. These features may be noticeable even with the aid of a magnifying glass.
• Some patients experience a burning or stinging sensation in the affected areas.
• Advanced cases may lead to rhinophyma (a bulbous, red nose).

Triggers

• Alcohol, hot drinks, spicy foods, exercise, sunlight, stress, and extreme temperatures can trigger or worsen the symptoms of Acne Rosacea.

Images

Management

• Sun protection: Daily use of a broad-spectrum sunscreen with a minimum SPF of 30 is recommended. Patients should avoid scrubbing the skin and use gentle emollients instead of perfumed soaps.
• Topical treatments: Include Metronidazole and Azelaic acid, which typically show results after at least 8 weeks of consistent use. Brimonidine gel can help reduce redness.
• Oral antibiotics: Oxytetracycline (500 mg twice daily) is often used in more severe cases. Minocycline may be considered, though it can cause bluish-grey pigmentation on the skin.
• Severe cases: Isotretinoin tablets are prescribed for refractory cases. Surgical interventions may be necessary to address rhinophyma, and laser treatments can help reduce redness and dilated blood vessels.

Ocular Rosacea

• Ocular symptoms such as eyelid inflammation and discomfort should be addressed promptly to prevent complications like corneal scarring.

Investigations

• The diagnosis of Acne Rosacea is usually clinical, and further tests are rarely required unless there are concerns about differential diagnoses.

Related Images

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