![]() ![]() ![]() Moisturisers should be used if the skin is dryĪvoid use of abrasive materials and pat dry for better absorption of moisturisersĬosmetics with green or yellow tint applied to the central face may conceal redness Identify factors that trigger patient’s signs and symptomsĮncourage patient to keep a journal documenting exposures, diet and activities that cause flare-upsĭaily use of broad-spectrum sunscreen, avoidance of midday sun, shade, protective clothing Inform patient of chronic, intermittent and inflammatory nature of rosacea ![]() Medications (eg topical steroids, niacin, beta blockers)īox 2. ![]() Triggers associated with worsening rosacea symptoms 1 10 Common triggers of flushing are listed in Box 1.īox 1. Usually, the central area of the face is most affected, 9 although, the ears, neck or upper chest can also be affected. Erythrotelangiectatic (vascular) rosaceaĮTR is characterised by flushing and vasodilation and, over time, this leads to the development of permanent erythema, then telangiectasia on the affected areas. Determining the subtype enables the clinician to choose the correct therapy. There are also rarer variants, such as granulomatous rosacea, pyoderma faciale and oedematous rosacea. There are four primary subtypes – erythrotelangiectatic (ETR also known as vascular), inflammatory (also known as papulopustular), phymatous and ocular. The clinical presentation for rosacea is varied. The level of serine proteases normalises when the skin barrier is restored. Abnormal skin barriers often show elevation of serine proteases. Patients with rosacea have elevated epidermal serine protease activity, which causes the deposition of cathelicidin-derived peptides in the skin. 7 Studies have shown that treatment of Demodex mites with topical ivermectin improves inflammatory rosacea. 5 Patients with rosacea have more mites in the follicles around the nose and cheek, compared with other patients, 5,6 and these often have a surrounding inflammatory response. follicularum has antigens that react with sera from patients with rosacea, and are capable of stimulating mononuclear cells to proliferate. In vitro investigations have found that D. follicularum is a mite that lives in sebaceous follicles. 13 Demodex mitesĪn association between Demodex follicularum and rosacea has been reported. There are a number of factors that may trigger flushing in rosacea, including harsh climate, extreme temperature, solar radiation, emotion, spicy food, alcohol and hot beverages (Box 1). This is controlled by vasodilatory mechanisms. Increased blood flow to the facial vasculature then leads to flushing or transient erythema. Genetic vascular reactivity results in increased blood vessel density near the skin surface. Rosacea is thought to have a genetic component, with a higher incidence found in fair-skinned individuals of Celtic or northern European descent. The aetiology of rosacea comprises a number of factors, which are detailed below. 1–3 A Swedish study reported the incidence of rosacea to be 10%, 1 while a UK study reported an incidence ranging from 0.09% to 22%. Rosacea is more common in females than males however, males develop phymatous rosacea more frequently. While flushing may start as early as in childhood, 5–7 symptoms of rosacea typically peak from ages 30 to 50 years. 1 However, patients of any ethnic group may be affected. Rosacea most commonly affects those with fair skin, blue eyes, and those of European or Celtic origin. Although rosacea is largely a cosmetic issue, it can significantly affect a patient’s self-esteem. 1–3 These findings help determine the subtype of rosacea. 1 Other characteristic findings that are often present, but not needed for diagnosis, include flushing, telangiectasia, oedema, inflammatory papules, pustules, ocular symptoms and rhinophyma or hyperplasia of the connective tissue. Persistent erythema in the central portion of the face lasting for at least three months is the primary feature of rosacea. Rosacea is a chronic cutaneous condition characterised mainly by facial flushing and erythema. ![]()
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