A number of clinical symptoms and signs are included under the broad group Rosacea. Facial flushing, the appearance of broken blood vessels and persistent redness of the face, eruption of inflamed spots & pimples, on the face and thickening of the sebaceous glands of the nose, with swelling & congestion in that area. Changes in the eyes are present in more than 50 percent of patients and range from mild dryness and irritation with inflammation of the eyelid and & conjunctivitis (common symptoms), to a sight-threatening, but rare, disease of the cornea.
Patients with Rosacea may experience increased sensitivity of the facial skin and may have dry, flaking facial dermatitis, swelling of the upper face, or persistent spots & pimples. Clinical features can overlap, but in the majority of patients, a particular manifestation of Rosacea dominates the clinical picture.
The disease can be classified into four subtypes: -
- Erythematotelangiectatic - rash,
- Papulopustular - skin eruptions,
- Phymatous - swelling,
- Ocular - eye infections.
Each subtype is graded according to the severity of the condition; 1 (mild), 2 (moderate), or 3 (severe). The disease can have serious psychological, social, and occupational effects on the patient and these factors should be considered when treatment decisions are being made.
The onset of Rosacea usually occurs between the ages of 30 and 50 years. The course of the disease is typically chronic, with remissions and relapses. Some patients can identify exacerbating factors such as heat, alcohol, sunlight, hot beverages, stress, menstruation, certain medications, and certain foods. Rosacea is more common in women than in men, but men with Rosacea are more prone to the development of thickening and distorting skin changes. Rosacea has been reported to be associated with an oily, greasy skin condition-Seborrheic Dermatitis, with migraine headaches in women, and with an infectious gastric disease -Helicobacter pylori. A Rosacea-like eruption can sometimes occur when fluorinated Corticosteroids and Tacrolimus ointments are used on the facial skin. Two European population studies illustrating the prevalence of Rosacea reported a 1.5 percent and 10 percent incidence, but estimates are complicated by the difficulty of distinguishing between sun damaged skin and genuine cases of Rosacea.
Rosacea can occur in all racial and ethnic groups, but is more common in white, Anglo Saxon groups; it is rarely seen in dark complexions. There is evidence that Rosacea is an hereditary condition.
Unfortunately the common misconception generally held that both the facial redness and the thickening of the nose area are a direct result of excessive alcohol consumption makes Rosacea a socially embarrassing and stigmatizing condition for many patient.
The diagnosis of Rosacea is a clinical one. There is no reliable laboratory test, and biopsy is only justified in ruling out alternative diagnoses;
Diagnosis and therapy varies according to subtype.
1. Erythematotelangiectatic - rash
Flushing, one of the most common presentation of rosacea, is difficult to treat, but the condition may improve with the management of other manifestations, [ psychosocial factors, anxiety or menopause], and the avoidance of provoking or triggering factors,[ certain foods, alcohol or drugs]. Skin inflammations are usually responsive to medical therapies and heal without scarring, whereas damaged blood vessels and swollen areas often require laser or surgical intervention. Prolonged episodes of severe flushing accompanied by sweating, flushing that is not limited to the face, and, especially, symptoms such as diarrhea, wheezing, headache, palpitations, or weakness need further investigations to rule out rare conditions .
Abnormal blood vessels are usually prominent on the cheeks and nose in grades 2 and 3 of this subtype 1, and cause the facial rash. This form of Rosacea is difficult to distinguish from the effects of sun damage sensitive, easily irritated skin, which may be another factor. It is poorly responsive to treatment . The two conditions require similar treatment. Similarities to facial contact dermatitis, & other conditions suggest further investigations may be needed. Studies of the effectiveness of medical treatments offer little evidence to support the effectiveness of treatments.
2. Papulopustular – skin eruptions
Small, eruptions, some of which have tiny pustules, on the central portion of the face, with a background rash distinguish this form of Rosacea. In grade 3 of the disease, inflammed lesions, abnormal blood vessels, swelling, eye inflammation, flushing are all common. Acne and forms of dermatitis are included in this group.