Updated: 8/24/2020

Acne Rosacea

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Snapshot
  • A 30-year-old woman presents with complaints of redness in her face, especially in her cheeks. She notes that it is worse after sun exposure. She has a history of unspecified joint pains but no other symptoms. Physical exam shows some pustules and papules on her cheeks.
Introduction
  • Common facial dermatosis
    • vascular (flushing, blushing, telangiectasias)
    • inflammatory (papules, pustules)
  • Epidemiology
    • most commonly in adults
    • can occur in children, though rare
  • Cause is unknown
  • Exacerbated by 
    • hot foods and drinks
    • spicy foods
    • alcohol
    • heat
    • sun
Presentation
  • Skin findings 
    • facial eruption
      • forehead
      • cheeks
      • nose
      • around the eyes
    • erythema with telangiectasias
    • flushing
    • papules and pustules may appear
  • Non-skin findings
    • ocular symptoms (> 50% of patients)
      • conjunctivitis with lacrimation
      • telangiectasias of eyelid
      • blepharitis
      • meibomian gland dysfunction
Evaluation
  • Diagnosis is usually based on clinical exam and history
  • Biopsy to rule out lupus if indicated
Differential Diagnosis
  • Acne vulgaris
  • Pustular tinea
  • Folliculitis 
  • Lupus erythematosus
Treatment
  • Lifestyle modifications
    • avoid spicy foods
    • avoid hot food/drinks
    • avoid sun exposure and use sunscreen
  • Pharmacologic
    • topical metronidazole
    • topical sulfacetamide
    • brimonidine
      • the best treatment for persistent flushing
      • alpha-2 agonist, causes vasoconstriction
    • systemic antibiotics like tetracycline for resistant or ocular symptoms
    • isotretinoin for chronic or relapsing cases
Prognosis, Prevention, and Complications
  • Disease course varies
    • chronic condition
  • Complications
    • recurrence of disease or resistant disease
 

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Questions (3)
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(M2.DM.14.48) A 39-year-old female presents with complaints of redness and "acne" over her cheeks, nose and chin. A representative photo is shown in Figure A. She states that the redness worsens with emotional stresses, heat, and hot beverages. Which of the following is an appropriate treatment for this condition?

QID: 104259
FIGURES:
1

Oral terbinafine

3%

(1/29)

2

Topical steroids

17%

(5/29)

3

Topical metronidazole

62%

(18/29)

4

Topical tetracycline

7%

(2/29)

5

UV light

7%

(2/29)

M 7 E

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