Malady Wise

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Rosacea

Fact Sheet

Overview

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

Associations

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

Cause

  • 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

Features

  • 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

Treatment

  • 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

Images

References

See this gallery in the original post