Acne Rosacea

Acne rosacea is an inflammatory disorder predominantly affecting the central face. It is seen almost exclusively in adults, only rarely affecting patients under 30 years of age. Rosacea is seen more often in women, but those most severely affected are men. It is characterized by the presence of erythema, telangiectases, and superficial pustules, but is not associated with the presence of comedones. Rosacea only rarely involves the chest or back.

There is a relationship between the tendency for pronounced facial flushing and the subsequent development of acne rosacea. Often, individuals with rosacea initially demonstrate a pronounced flushing reaction. This may be in response to heat, emotional stimuli, alcohol, hot drinks, or spicy foods. As the disease progresses, the flush persists longer and longer and may eventually become permanent. Papules, pustules, and telangiectases can become superimposed on the persistent flush. Rosacea of very long standing may lead to connective tissue overgrowth, particularly of the nose (rhinophyma). Rosacea may also be complicated by various inflammatory disorders of the eye, including keratitis, blepharitis, iritis, and recurrent chalazion. These ocular problems are potentially sight-threatening and warrant ophthalmologic evaluation.

Treatment of Acne Rosacea

Acne rosacea can be treated topically or systemically. Mild disease often responds to topical metronidazole or sodium sulfacetamide. More severe disease requires oral tetracycline in doses ranging from 250 to 1000 mg/d. Residual telangiectasia may respond to laser therapy. Topical glucocorticoids, especially potent agents, should be avoided since chronic use of these preparations may elicit rosacea. Topical therapy of the skin is not effective treatment for ocular disease.