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Rosacea, sometimes called "acne rosacea," is an inflammatory disease with unknown etiology. Various facial manifestations occur, and symptoms differ from patient to patient. The four types of rosacea are erythematotelangiectatic, papu-lopustular, phymatous, and ocular. Patients may have overlapping features of more than one type. The predominant manifesting complaints of erythematotelangiectatic rosacea are intermittent central facial flushing and erythema. Itching is often absent; however, many patients complain of a stinging pain associated with flushing episodes. Common triggers include exposure to the sun, cold weather, sudden emotion including laughter or embarrassment, hot beverages, spicy foods, and alcohol consumption.

Papulopustular rosacea presents with acnelike papules and sterile pustules and can occur alone or in combination with the erythema and telangiectasias (Fig. 33-26). Intermittent or chronic facial edema may also occur in all forms. Some patients develop rhinophyma, a coarse hypertrophy of the connective tissue and sebaceous glands of the nose. This can be extremely disfiguring and even cause nasal airway obstruction. Approximately one third of patients with

Richard Usatine
Figure 33-26 Rosacea. © Richard P. Usatine.)

rosacea develop ocular symptoms, including eyes that are itchy, burning, or dry; a gritty or foreign body sensation; and erythema and swelling of the eyelid. The ocular changes can become chronic. Corneal neovascularization and kera-titis can occur, leading to corneal scarring and perforation. Episcleritis and iritis have also been reported to occur in patients with rosacea.

First-line treatment is avoidance of triggering or exacerbating factors. Although patients have different trigger(s), almost all patients benefit from strict sun avoidance and protection. Acnelike lesions respond well to long-term topical treatment using metronidazole, azelaic acid, erythromycin, and clindamycin. Oral tetracyclines used in antimicrobial (high) doses or anti-inflammatory (low) doses are helpful for moderate to severe rosacea. Oral or topical retinoid therapy may also be effective. Laser treatment is an option for progressive telangiectasia, erythema, or rhinophyma. Ocular symptoms generally require oral tetracyclines. Consultation may be required for the management of rhinophyma, ocular complications, or severe disease.

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How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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