rosacea
ROSACEA
Rosacea is a chronic cutaneous disease of the convexities of the central face (cheeks, chin, nose and central forehead) w/ periorbital and perioral skin sparing. This condition is attributed to chronic vasodilation.
Remissions and exacerbations are common.
It typically appears after 30 years of age but may occur at any age.  It commonly affects fair-skinned individuals.
The common presenting symptoms are facial flushing, stinging/burning erythema, telangiectasia, edema, papules, pustules, ocular lesions, and hypertrophy of the sebaceous glands of the nose with fibrosis.
A history of episodic flushing often heralds onset of rosacea.

Diagnosis

  • There are no specific lab tests to confirm diagnosis; hence, the diagnosis is based on clinical characteristics

Presence of ≥1 of the primary features:

  • Transient erythema (flushing)
  • Nontransient erythema
  • Papules & pustules
  • Telangiectasia

One or more of the following secondary features may also be present:

  • Dry appearance
  • Burning or stinging sensation
  • Edema
  • Plaque
  • Ocular manifestations
  • Phymatous features (eg rhinophyma)
  • Peripheral location of lesions

Grading of Rosacea

  • Rosacea clinical scorecard is used to determine the severity of rosacea
    • Primary signs & symptoms may be graded as absent, mild, moderate or severe (scores of 0-3)
    • Secondary features may be graded as absent or present 
  • Physicians give global assessment for each subtype based on severity of signs & symptoms; duration & extent of disease at the time of examination may also be considered in the evaluation
  • Patient participates in the grading by giving global assessment of his/her condition considering the physical manifestations & its impact on quality of life (psychological, occupational & social effects)

Classification

  • Primary & secondary features often occur together
  • In most patients, a particular manifestation of rosacea is more predominant
  • Patient may have characteristics of >1 subtype

Erythematotelangiectatic

  • Flushing & persistent central facial erythema w/ or w/o telangiectasia
  • Central facial edema, rough or scaly skin, stinging & burning sensation may be present

Papulopustular

  • Persistent central facial erythema w/ transient central facial papules, pustules, or both
  • Burning or stinging sensation & telangiectasias may be present

Phymatous

  • Irregular surface nodularities, enlargement & thickening of the skin
  • Typically occurs on the nose, chin, forehead, cheeks, or ears

Ocular

  • Conjunctival hyperemia, burning or stinging sensation, foreign body sensation in the eye, dryness, pruritus, photosensitivity, blurred vision, telangiectasia of the sclera or other parts of the eye, periorbital edema
  • Blepharitis, conjunctivitis, irregular eyelid margins, meibomian gland dysfunction may also occur w/ keratitis as serious complications

Variant

Granulomatous

  • Noninflammatory
  • Hard, brown, yellow or red cutaneous papules or nodules of similar size
  • May be severe & eventually lead to scarring
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