Rosacea: An Introduction

Clinical Dermatological Features of Acne Rosacea

Skin involvement in rosacea is characterized by symptoms of blotchy or diffuse erythema, telangiectasias (broken capillaries), papules, pustules, and sebaceous gland hypertrophy in rhinophyma.

The lesions are distributed across the blush areas of the face, involving the nose, cheeks, chin, and central area of the forehead, and may include the neck and chest.

Initially, the hyperemia may be episodic, but within months or years it becomes chronic with the eventual development of telangiectasias (broken capillaries) which may be fine or coarse.

Telangiectasias, papules, and pustules in an axial facial distribution (forehead, cheeks, nose, chin). There is an overall oily appearance to the skin.

Certain persons flush and develop rosaceous lesions in other areas such as the epigastrium.

The skin frequently has an oily appearance.

In most patients, asymptomatic papular, and less frequently, pustular lesions resembling acne vulgaris, may occur.

Rosacea is distinguished from acne vulgaris by the absence of comedones and the associated bacteria and by its confinement to flush areas.

Acne vulgaris commonly involves the back and the chest as well as the face, while rosacea is usually limited to the face.

In addition, the hypertrophic changes seen in rosacea are not features of acne vulgaris.

Rhinophyma, an irregular lobulated thickening of the skin of the nose with follicular dilatation and a purplish-red discoloration, may be a complication of inadequate treatment and long-standing involvement.

Chronic, more advanced disease is characterized by increasing broken capillaries. In this patient there is also early sebaceous gland hypertrophy and rhinophyma.

Although the nose, particularly its lower portion, is the most common site of involvement, the cheeks, forehead, chin or ears may also develop tissue hypertrophy.

Subjective manifestations of rosacea are minimal, although a bothersome, burning sensation may be experienced during hyperemic episodes.

Like the initial hyperemic episodes, the burning may initially be transient, but within months or years may become permanent or disappear.

Rosacea runs a chronic course punctuated by episodes of acute inflammation.

The mean duration of the disease is between 9 and 13 years.

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