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Updated: Aug 24 2020

Acne Rosacea

  • 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)
    • Cause is unknown
    • Exacerbated by
      • hot foods and drinks
      • spicy foods
      • alcohol
      • heat
      • sun
  • Epidemiology
    • most commonly in adults
    • can occur in children, though rare
  • 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
    • 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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