Rosacea

Introduction

Rosacea is a really common chronic skin disorder that causes flushing, small inflammatory raised bumps called papules, and tiny puss filled lesions called pustules.

Now, its actual cause or aetiology is thought to be a combination of an abnormal immune response and vascular hyperreactivity after exposure to typical triggers like excessive UV light, alcohol, and temperature changes.

In addition to this, we think altered microbiome might also be associated with its development, specifically, an increased density of Demodex folliculorum, which is a type of skin mite, and bacteria like H. Pylori and Staph. Epidermidis.

As a quick summary of its management, remember 3 domains of treatment: lifestyle changes, general skincare optimisation, and medications.

You can ask patients to keep a symptom diary to detect exacerbating factors. This might help them avoid triggers like alcohol, excessive UV light and spicy food.

Advise patients to adopt healthy skincare habits like moisturising frequently, applying sunscreen regularly, and using good quality cleansers while avoiding the really cheap ones guys sometimes use.

Medications can help with flushing symptoms, and although vasoconstrictors are effective, they should only be used in the short term. Mild inflammatory papules and pustules can be managed with topical ivermectin cream while more severe cases can benefit from oral medications like doxycycline.

In terms of its clinical features, it affects a population above 30 and contrary to a common misconception, it’s just as prevalent in males as females. In general, fair-skinned patients of Celtic descent are the highest at risk.

To identify the disease, I remember the acronym FAKE because its kinda like a fake acne. Don’t forget to like the video if your finding it helpful!

F stands for Flushing. This transient erythema can feel distressing to patients, especially in social situations.

A stands for acne like lesions. Rosacea classically causes papulopustular skin changes which are often mistaken as acne but does not cause significant blackheads.

K stands for knobbly nose. In severe cases, people can develop hypertrophic thickened skin, especially on the snout. This is called rhinophyma and is more common in older men.

Finally, E stands for eyes. Incredibly, at least half of patients with this condition develop ocular rosacea. This is basically when the eyelids get inflamed causing burning and dryness.

To remember its features and management, I put everything together with the mnemonic FAKE ID.

This stands for flushing, acne like lesions, a knobbly nose, and eye involvement. The management is simply topical Ivermectin which can be stepped-up to oral doxycycline.