Makindo Medical Notes

🌹 Acne Rosacea is a chronic inflammatory skin condition of the face. It is not infectious, but it may be worsened by topical steroids and systemic drugs such as Amiodarone. 💡 Recognising and avoiding triggers is central to management.

📖 About Acne Rosacea

• 🔥 Characterised by recurrent flushing, burning, and inflammation.
• 🧬 Perifollicular and perivascular inflammation; no microbial pathogen identified.
• ⚖️ Frequently misdiagnosed as acne vulgaris — important distinction as treatments differ.

🧪 Aetiology

• 🕷 Demodex folliculorum mites: implicated in pathogenesis via immune response.
• 💓 Vascular dysregulation plays a role in flushing and persistent erythema.
• 🌍 Environmental and genetic predisposition also contribute.

📊 Epidemiology

• 👩 Fair-skinned adults aged 40–60 most affected.
• 👨‍🦱 More severe in men, though women are more commonly affected.
• 🚩 Triggers: alcohol, spicy food, sunlight, temperature extremes, stress.

🩺 Clinical Presentation

• 🌡 Flushing and persistent redness (erythema) over the cheeks, chin, nose, and forehead.
• 🔴 Telangiectasia, papules, and pustules (but no comedones, unlike acne vulgaris).
• 🔥 Burning or stinging sensations may be present.
• 👁 Ocular involvement: blepharitis, conjunctivitis, keratitis → can progress to corneal scarring.
• 👃 Severe: rhinophyma (bulbous nose) due to sebaceous gland hypertrophy, more common in men.
• 🧠 Psychological impact is significant: anxiety, social withdrawal, depression.

🚩 Triggers

• 🍷 Alcohol and hot drinks
• 🌶 Spicy foods
• ☀️ Sunlight, 💨 wind, ❄️ temperature extremes
• 🏃 Exercise
• 😰 Stress
• 💊 Topical steroids

🔍 Physical Examination

• 🔴 Flushing and visible telangiectasia on the central face.
• 🧴 Papules/pustules may resemble acne but without comedones.
• 👃 In chronic cases: phymatous changes (rhinophyma).
• 👁 Ocular findings: lid margin inflammation, conjunctival injection.

🖼 Images

💊 Management

• 🧴 General care: Broad-spectrum SPF ≥30 daily, avoid irritant soaps, use gentle emollients.
• 🧪 Topical: Metronidazole or azelaic acid (response in ≥8 weeks). Brimonidine gel can reduce erythema.
• 💊 Oral antibiotics: Oxytetracycline 500 mg BD; doxycycline or lymecycline alternatives. Minocycline less favoured due to pigmentation risk.
• ⚠️ Refractory cases: Isotretinoin under specialist supervision.
• 💡 Procedures: Laser therapy (for telangiectasia/erythema), surgical/laser reshaping for rhinophyma.

👁 Ocular Rosacea

• Presents with blepharitis, conjunctivitis, gritty eyes, and lid inflammation.
• ❗ Untreated, may lead to keratitis and corneal scarring → sight-threatening.
• ➡️ Requires prompt ophthalmology referral.

🧾 Investigations

• ✅ Usually a clinical diagnosis.
• 🧪 Tests only if atypical features or to exclude differential diagnoses (e.g. lupus, acne vulgaris, seborrhoeic dermatitis).

📝 Exam Pearls

• 🚫 No comedones → not acne vulgaris.
• 👃 Rhinophyma → severe, late complication, more common in men.
• 👁 Ocular involvement → risk of vision loss, needs urgent ophthalmology input.

📚 References

• NICE CKS: Acne Rosacea
• DermNet NZ: Rosacea