Rosacea or acne rosacea is a common skin disease and is also referred to as adult acne. This skin disease is characterized by redness and hyperemia of facial skin vessels, and ocular rosacea is associated with eye involvement. Rosacea has many differences with acne and lupus rash, which we will discuss below. This disease is not contagious. Stay with us to know the symptoms, diagnosis and treatment of rosacea.
What is skin rosacea?
Acne rosacea is a common skin rash on the face characterized by redness, telangiectasia (prominence of blood vessels in the skin), redness, and papules and pustules. Therefore, it can be said that this disease has two main parts:
Inflammatory part: This part causes papules and pustules on the skin of the face.
Vascular part: This part causes redness, inflammation and reddening of the facial skin.
What is the cause of rosacea?
Patients with this skin disorder are usually more than 30 years old, that's why it is also called adult acne, of course, you should know that rosacea can also occur in children. The cause of rosacea is unknown.
Signs and symptoms of acne rosacea facial skin
Skin symptoms include rashes and lesions on the forehead, cheeks, nose and around the eyes (ocular rosacea). In this disease, there is redness or erythema of the facial skin and vascular hyperemia in the form of telangiectasia. The number of papules and pustules is usually less than 10. However, in severe cases, patients have a large number of pustules, telangiectasia, diffuse erythema, oily skin, and edema or swelling of the nose and cheeks.
Chronic and deep inflammation of the nose leads to irreversible thickening of the nasal skin and its enlargement, which is called rhinophyma and is more common in men.
In rare cases, papules can also involve the scalp, back, and upper and lower limbs.
What is ocular rosacea?
Rosacea may involve the eyes and cause ocular symptoms. These symptoms include:
Slight swelling of the eye conjunctiva with pain and discomfort.
Feeling of a foreign body in the eye and tearing.
conjunctival hyperemia
Eyelid involvement in the form of telangiectasia, blepharitis, punctate superficial keratopathy and chalazion.
Infiltration, thinning and vascularization of the cornea.
How is rosacea diagnosed?
The diagnosis of the disease is registered based on clinical examination and usually there is no need to perform tests. But if the lesions are unusual and do not cause the usual symptoms of the disease, a bacterial culture is done to rule out folliculitis.
Also, if there is flaking of the lesions, a potassium hydroxide test is performed to check tinea (fungal infections of the skin).
What is the difference between rosacea and lupus and acne?
A biopsy can be done to check lupus and differentiate it from rosacea. Also, lupus is a systemic disease and usually has non-cutaneous symptoms as well. ANA antibodies are positive in lupus but not usually positive in rosacea.
Regarding the difference between rosacea and acne, it should be said that comedones (small whiteheads) do not exist in rosacea, but are found in abundance in acne. Also, the patient's history and age help a lot to distinguish between these two diseases.
Differential diagnoses
Common acne or pimples on the face that develop around puberty. Unlike acne, there are no comedones in rosacea.
tinea pustoli (fungal infection of the skin).
Dermatitis around the mouth.
Infectious folliculitis (staphylococcal, gram-negative acne).
Systemic lupus erythematosus that causes a butterfly rash.
What is the course and prognosis of the disease?
Eating hot drinks and foods, drinking alcohol (red wine) or contact with heat and sunlight can aggravate rosacea. Therefore, patients are advised to avoid these items. This disease is chronic and lasts for several years. During this period, it is sometimes severe and sometimes mild.
Treatment of skin rosacea
Diet and cosmetics
The patient should avoid drinks and spicy and hot foods, as well as alcohol and red wine. These foods make the disease worse.
Avoiding sunlight in this disease is a rule and the patient should use sunscreen creams with high SPF. Also, cosmetic powder creams with a green base cover the redness of these wastes.
Topical drugs
Metronidazole gel or solution (such as Metrogel) can be used to treat rosacea with metronidazole.
Sulfastamide and sulfur lotion are very effective along with topical treatment with metronidazole.
The use of sulfacetamide and sulfur (Sulfacet-R or AVAR) is very useful for oily skin. This medicine is available in colored and colorless forms. AVAR is available as a cream or gel. A special green product from AVAR in the form of cream and gel can hide the redness of the skin.
Clindamycin gel (Clindagel) or the use of clindamycin and erythromycin solutions, tampons or lotions are also effective in treating rosacea, but their effectiveness is less than metronidazole.
Oral medications
Treatment of rosacea with oral medications is more effective than topical medications, especially for controlling papules and pustules. Oral therapeutic drugs include the following:
Tetracycline with a dose of 500 mg twice a day.
Erythromycin (Erythromycin) with a dose of 500 mg twice a day.
Doxycycline at a dose of 100 mg twice a day.
Minocycline at a dose of 100 mg twice a day.
During a period of 2 to 4 weeks of treatment with high oral antibiotics, the pustules are usually controlled.
In many cases, this mode then responds to lower values. For resistant cases, oral metronidazole with a dose of 250 mg can be used.
The right soap
Using the right soaps can be very effective in treating the disease. Soaps containing 10% sulphastamide and 5% sulfur are considered the best soaps for treating rosacea.
Treatment with traditional medicine and herbs
The use of herbal masks can be useful in controlling the disease, but they should not replace the main treatment of the disease. Among herbal masks and herbal teas, the following can be mentioned:
Chamomile leaf mask.
Green tea mask.
Lavender mask.
Oatmeal Mask
Fenugreek tea
Treatment of ocular rosacea
Eye symptoms in this disease are treated with oral antibiotics. After the improvement of the disease, the use of drugs should be stopped or stopped gradually. The rate of response after treatment cannot be predicted. Recurrent disease should be treated, then the amount of medicine should be gradually reduced to the minimum that provides sufficient control. For chronic and recurrent cases or cases that do not respond to treatment, isotretinoin drugs such as Accutane, Roaccutane or Dekutane should be used for 20 weeks.
Rhinophyma treatment with laser
Rhinophyma is treated with electrical surgery (electrosurgery), carbon dioxide laser surgery, and plastic surgery.
important points
In rare cases, the disease can present with granulomatous lesions, called granulomatous rosacea, very similar to lupus or sarcoidosis. Patients may experience long-term edema or swelling of the face, which is called solid edema. In the research conducted, the effect of chromophore gel along with phototherapy in the treatment of this disease has been confirmed.
If the patient stops using this cream after long-term and continuous treatment with topical steroids, skin lesions similar to this disease will develop, which is called steroid rosacea. As a result, a rapid and severe flare-up with papules and pustules occurs. At this time, the patient resumes the use of the causative drug, and as a result, this vicious cycle repeats itself.
