Rosacea: An Introduction

Acne Rosacea? Why We Were Wrong for Thirty Years

The disease rosacea was originally called acne rosacea.

That name is no longer considered correct.

Even though many aspects of Rosacea may closely mimic the description and characteristics of acne, it is a separate entity.

Unlike acne, rosacea is not driven by Propionibacterium, and subsequently should not be treated using acne medications.

Acne itself has been well researched and is no longer a necessarily devastating skin disease.

Arguably if we had remained with the original misnomer of "acne rosacea" more research would had taken place, and a significantly more effective rosacea treatment may have already resulted.

The prior information on "acne rosacea" remains below as an archive. While the terminology has changed, the information remains fundamentally sound for the present day.

About Acne Rosacea — Disease Entity

Acne rosacea is a chronic acneiform disorder affecting both the skin and the eye.

It is a syndrome of undetermined etiology characterized by both vascular and papulopustular components involving the face and occasionally the neck and upper trunk.

Clinical findings are usually limited to the sun exposed areas of the face and chest and include mid-facial erythema, telangiectasias, papules and pustules, and sebaceous gland hypertrophy.

Acne rosacea symptoms are characterized by episodic flushing of affected areas, which may be associated with consumption of alcohol, hot drinks, spicy foods and other triggers.

During inflammatory episodes, affected areas of the skin, primarily the convexities of the face, develop swelling, papules and pustules.

The skin lesions are notable for the absence of comedones, which distinguishes this disorder from acne vulgaris.

Rhinophyma is a late finding in advanced cases which may conceal skin cancer.

Ocular rosacea is a term used to describe the spectrum of eye findings associated with the skin involvement.

Ocular involvement may include meibomian gland dysfunction and/or chronic staphylococcal lid disease, recurrent chalazia, chronic conjunctivitis, peripheral corneal neovascularization, marginal corneal infiltrates with or without ulceration, episcleritis and iritis.

Occasionally, the ocular manifestations may precede skin involvement, delaying the diagnosis.

Rosacea occurs most commonly in adult life, between the ages of 30 and 60 years.

It may also be found in children, although rarely.

In a series of 47 patients with ocular rosacea, the decade of prevalence was 51-60 years. Ocular involvement occurs in more than 50% of patients.

Women have been traditionally considered to be affected with twice the frequency of men, although some data suggests that the distribution between men and women is equal.

Cases with ocular manifestations are about evenly divided between the sexes or show only a small female preponderance.

The distribution of cases by age in the two sexes is similar.

Both acne rosacea and ocular rosacea have been documented in African-Americans.

Increased pigmentation in the black population may mask the early lesions of rosacea, accounting for previous failure to recognize the disease in the population.

There is a wide-spread clinical impression that rosacea mainly affects fair-skinned people of northern European descent or Celtic origin. However, studies have not substantiated this assumption.

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