​Dermatology - Rosacea

​Dermatology - Rosacea
Rosacea is a prevalent condition affecting around 10% of those with fair skin. It is characterized by persistent inflammation resembling acne, along with heightened sensitivity of the small blood vessels, resulting in redness and the appearance of visible blood vessels.
The age at which symptoms first appear is typically between 30 and 50 years, with a higher prevalence among women. The progression of the condition can be divided into three stages, each characterized by specific symptoms. In Stage I, there is a persistent redness of the skin and the appearance of small dilated blood vessels. In Stage II, in addition to the redness and blood vessels, there are also the presence of small raised bumps and pus-filled pimples. Stage III is characterized by a deeper redness, more prominent blood vessels, and the development of larger bumps, pimples, and nodules. In rare cases, there may also be persistent swelling in the central part of the face. Transition between stages is not always sequential, as there might be overlapping stages, and the course may commence with Stage II.

Typically, individuals with this condition experience a previous occurrence of reddening of the skin in reaction to heat stimulation in the oral cavity (such as hot beverages), spicy cuisine, alcoholic beverages, and exposure to sunlight. Patients frequently express apprehensions with their physical appearance, which can occasionally be misconstrued as indicative of alcoholism.
Abnormalities
A distinctive flushing of the face, characterized by a red coloration, may occur, either with or without the presence of small raised bumps known as papules and papulopustules, measuring 2-3 mm in diameter. The pustules typically measure less than or equal to 1 mm and are located on the top of the papules. There is an absence of comedones.
The individual has dispersed, separate lesions with telangiectases, characterized by red facies and dusky-red papules and nodules. Long-term cases of this condition result in the nose, forehead, eyes, ears, and chin being deformed due to an excessive growth of sebaceous glands and swelling of the lymphatic vessels. The lesions are symmetrically situated on the face and, infrequently, on the neck, chest (in a V-shaped region), back, and scalp.

The diagnosis is made based on clinical examination, and the possible conditions to consider are acne, perioral dermatitis, S. aureus infection, folliculitis, seborrheic dermatitis, excessive use of topical glucocorticoids, lupus, and dermatomyositis.


Apply metronidazole gel or cream, with a concentration of 0.75% or 1%, once or twice a day. Alternatively, use sodium sulfacetamide or sulfur lotions with concentrations of 10% or 5%. Topical antibiotics, such as erythromycin gel, are not as effective as oral antibiotics like minocycline or doxycycline, taken at a dose of 50-100 mg once or twice a day, or metronidazole at a dose of 500 mg twice a day. Tetracycline, although less potent, can still be beneficial. It is recommended to take 1-1.5 grams per day in many doses until symptoms improve. Once the symptoms have cleared, the dosage can be gradually reduced to a once-daily intake of 250-500 milligrams. Following the completion of the initial treatment, a regular dosage of 50 mg of minocycline or doxycycline per day, or 50 mg every other day, or 250-500 g of tetracycline, has proven to be helpful. In individuals with refractory disease, a low-dose treatment with isotretinoin, ranging from 0.1 to 0.5 mg/kg of body weight per day taken orally, is often successful for most people. However, in certain cases, a higher dosage of 1 mg/kg may be necessary. Rhinophyma and telangiectasia associated with chronic disease exhibit favorable response to surgical intervention or laser surgery.