Rosacea

July 17, 2023 Maladywise

5% of adults, often after >30 years of age and more common with fair skin, blue eyes and northern decent

Linked to depression, anxiety, hypertension, CV disease, dyslipidemia, diabetes, migraines, rheumatoid arthritis, ulcerative colitis, dementia and helicobacter infections

Genetics
Impaired skin barrier allowing bacterial colonisation and inflammation
Altered skin and gut microbiome lead to problems with immune response
Skin mechanisms including UV radiation, temperature change, exercise, spicy food, psychological stress, air pollution and smoking

Recurrent facial flushing
Persistent facial redness
Prominent blood vessels over nose and face
Inflammatory papules and pustules
Big nose due to phymatous changes
50% of patient have eye symptoms including dryness, photophobia, conjunctivitis, blepharitis, keratitis

Avoid known triggers
- Symptom diary to identify triggers
- Spicy food
- Hot/cold temperatures
- Exercise
- Sun Exposure
- Cosmetic products
- Medications
- Alcohol
- Fruits and vegetables, dairy, marinated meat
Skin care
- Moisturise frequently
- Gentle cleansers
- Use physical suncreens (zinc oxide, titanium oxide)
- Avoid exfoliants
- Avoid alcohol baesd skin products
- Avoid topical steroids
- Green tinted cosmetics can minimise redness
Psychological
- Important
Flushing
- Can use alpha agonists, beta blockers
Redness
- alpha agonists, laser
inflammatory papules / pustules
- Topical metronidazole, erythromycin
- Oral Doxycycline, Metronidazole
Telangectasia
- Laser
Neurogenic
- TCAs, B blockers
Phyma
- Doxycycline
Ocular
- Increase dietary intake of omega-3 fatty acids
- Warm compresses
- Gentle eyelas / eyelid cleansing to express sebum trapped in the glands
- If mild to moderate then topical azithromycin, pimecrolimus, tacrolimus
- If severe then Doxycycline