37 Rosacea (Acne Rosacea)
CLINICAL APPLICATION QUESTIONS
A 50-year-old woman is seen in your office for facial discoloration that has been very persistent for the past 2 months. She also complains of frequent styes and constant gritty eye discomfort with lid granulation each morning. Initial observation shows a striking but- terfly erythema.
1. What items in the specific history would help you distinguish rosacea from lupus erythematosus (LE)?
2. What physical findings would help you to distinguish rosacea from LE?
3. What laboratory data are indicated?
4. Assuming that physical findings and lab results are consistent with rosacea, what is the most appropriate treatment for this patient?
APPLICATION GUIDELINES Specific History
Rosacea is a disorder that presents most typically in the third, fourth, and fifth decades of life. It is seen occasionally in younger adults, and there are uncommon reports of oth- erwise typical rosacea in childhood. Presentation in adult patients beyond the fifth decade is fairly common. Women seem more frequently affected than men. This preference may be misleading, however, because of male machismo that prevents seeking help for skin disorders. Men are subject to the more severe and deforming variants. Although heritage is not an absolute protection, rosacea is rare in heavily pigmented skin types, whereas western Europeans, especially those of Celtic ancestry, are especially vulnerable. Onset may be explosive and may follow exposure to one of the provoking factors listed below.
Most cases start insidiously, but inexorably worsen without medical intervention. Many patients will state on the initial visit, “I have watched this change for months (or years) and I finally have to do something about it.” The earliest and most persistent symptoms are erythema and fine telangectasias distributed symmetrically over the central face, but sparing the eyelids, upper forehead, and lips.
Evolution of Disease Process
The erythema and telangectasia of rosacea initially wax and wane from day to day, but gradually become more conspicuous and more persistent. The disease may retain this morphology throughout the course of the patient’s life. This is referred to as erythematous
From: Current Clinical Practice: Dermatology Skills for Primary Care: An Illustrated Guide D.J. Trozak, D.J. Tennenhouse, and J.J. Russell © Humana Press, Totowa, NJ