Lecture of rosacea

2021-02-05 12:00 AM

The disease lasts for months and years and may be accompanied by hyperplasia of sebum and angioedema, which distorts the nose, forehead, around the eyes, ears, chin. Sometimes it is also in the neck, chest, joint, back, scalp.



Rosacea is a chronic, acne-like disorder of the facial sebaceous hair follicles accompanied by capillary response to heat, flushing of heat, and later, capillary dilatation. .

This disease, formerly known as Acne rosacea, but not always accompanied by acne, can first develop acne and later blush. The disease affects aesthetics.

Etiology and epidemiology

The disease usually appears in the age group 30-50, more women than men, but the lion's nose (Rhinophyma) is mainly seen in men.

The root cause is unknown, and love plays the role of several factors such as:

There is a long history of flushing, which is increased with thermal stimuli when eating, drinking, or drinking hot beverages or alcohol.

When going to the sun, cook the stove near a hot oven and the blushes get worse.

Maybe a long time before having acne.

There may be a blush without previous acne or oily skin.

Clinical symptoms

Position: cheek area, nose, chin, middle of nose, forehead.

Lesions usually consist of 4 stages:

Stage 1: Flushing (flushing, blushing), feeling "hot" in the face, feeling like drinking, blushing is known as rosacea.

Stage 2: blush, frequent persistent erythema in the cheeks, nose, accompanied by dilated capillaries (telangiectasis).

Stage 3: frequent persistent erythema, capillary dilatation, papules and pustules, circular red papules 2 - 3 mm, small pustules <1 mm.

Stage 4: erythema is often deeper, thickened capillaries are dilated, papules and pustules are round, red, cloudy, the middle area may have persistent hard edema, acne.

The disease lasts for months and years, and may be accompanied by hyperplasia of sebum and angioedema, which distorts the nose, forehead, around the eyes, ears, chin. Sometimes it is also in the neck, chest, joint, back, scalp. Especially when the lion's nose wall (Rhinophyma), the nose is big, red, and lumpy. Seborrheic hyperplasia of the forehead, around the eyes, chin.


Skin histopathology: dilated capillaries, surrounding nonspecific inflammatory cell infiltrates (stage 2) with papules and vasodilation, inflammatory infiltrates around epithelial cell follicles, lymphocytes, some cells giant, with pustular pustules with a focal follicle (stage 3). Diffuse connective tissue hyperplasia, seborrheic hyperplasia, epithelial granulomas, giant cells, no pea-free residue (stage 4).


Implementing the quadrants

Red cheek skin, dilated capillaries.

There are papules, pustules.

Thereafter, connective tissue hyperplasia, hyperplasia of sebum, nodules, deformation of the nose, face and lion's nose

Differential diagnosis

Acne is usually: red inflammatory papules, squeezed with acne, or added pustules, inflamed masses, pus-coated cysts, sebum.

Dermatitis: the cheeks, nasal grooves, between the two eyebrows, the skin is red, slightly stained, has a scaly, papule.

Systemic lupus erythematosus: erythema of the nose and cheeks, slight swelling, fever, fatigue, alopecia, weight loss, joint pain, kidney damage, antinuclear antibodies (+).

Lasts many years, or relapses, after years of illness sometimes self-relieving, men may develop lion's nose (Rhinophyma).


In place

Apply Metronidazole gel 0.75% 2 times / day or topical antibiotic erythromycin gel.

Vasodilation, lion nose burning CO2 laser, burning electricity.

Antibiotic-resistant purulent papules can be caused by Demodex folliculosum applied to Eurax cream, Lindane solution or sulfur and salicylic acid soaps.


Metronidazole 250 mg 2 tablets / day.

Using Metronidazole, a lot can cause leukopenia, should be used instead of:

Tetracycline 250 mg 4 capsules daily for 3 weeks or Erythromycin 1 g / day in 2 divided doses for 2-4 weeks.

Then maintenance dose of Tetracycline 250 mg 2 tablets/day x 9 weeks alternating with rest period.

Either Doxycycline 100 mg 2 tablets / day or Minocin 50 mg 2 tablets / day.
(Taking Doxycycline is a drug that can have phototoxic phenomena, so you should drink it in the summer when you need to shade the sun).

In severe cases, using Isotretinoin 0.5 mg / kg / day for 20 weeks or low dose 0.1 to 0.2 mg / kg / day.


Avoid drinking alcohol and hot beverages.

Avoid emotional stress.