It arises later than acne dose, usually when patients are between the ages of 30 and 50 years. Rosacea occurs most commonly in fair-skinned people of northern European, particularly Celtic, descent; it is unusual among dark-skinned people. Women are reportedly three times more likely to be affected than are men. Clinically, rosacea is a facial eruption that consists of erythematous papules, pustules, and telangiectasias. Lesions are most typically seen on the central third of the face-the forehead, nose, cheeks, and chin (the socalled flush/blush areas).
Rosacea lacks the comedones (“blackheads” or “whiteheads”) that are seen in patients with acne vulgaris. In general, it does not scar or present with nodules or cysts, unless the patient has concomitant acne. Rosacea lesions tend to be bilaterally symmetric, but they may also occur on only one side of the patient’s face.
The appearance of facial erythema and telangiectasias, without the inflammatory lesions of rosacea, is known as pre-rosacea. Many people with a “rosy-cheeked,” ruddy complexion may never develop the full clinical spectrum that is seen in patients with rosacea. (The recent increase in medical and public awareness of rosacea has led to an over diagnosis of pre-rosacea and rosacea by primary care clinicians and dermatologists alike.)
An extreme form of disfiguring sebaceous hyperplasia of the nose, rhinophyma seems to occur only in middle-aged men, many of whom also have typical facial and/or ocular rosacea.
TOPICAL STEROID-INDUCED ROSACEA:
Rosacea induced by topical steroids is often clinically indistinguishable from ordinary rosacea. However, a history of long-term, indiscriminate misuse of potent topical steroids (a well-documented cause of rosacea) on the face helps to confirm the diagnosis. The condition typically worsens when the topical steroids are discontinued (an occurrence known as rebound rosacea). In an unfortunate cycle, the steroid is sometimes reapplied to diminish the erythema, which only worsens the condition.
Pre-rosacea generally does not require treatment, nor do any effective treatments exist. However, patients with pre-rosacea should be observed for signs of rosacea and encouraged to use sun protection.
Patients should be advised to avoid the sun or to apply a sunscreen prior to sun exposure. They may also wish to avoid the environmental triggers discussed above.
POINTS TO REMEMBER:
-Rosacea is a chronic condition with no known cure.
-The use of potent topical steroids on the face should be avoided.