Rosacea

Rosacea, coupe rose, copper rose, facial rose, acne erythematosa, acne rosacea.

Common inflammatory dermatosis that affects the face and in some cases also the scalp, neck, back and chest.

Depending on the study

• Incidence: 1.65/1,000 person-years (UK)
• Prevalence: 2.3% (Germany)
• Prevalence: 10% (Sweden)
• Prevalence: 22% (Estonia)

• While women are most often affected from the age of 35, the initial manifestation in men is not common until around the age of 50
• In rare cases, children can also be affected
• Peak in age: 76-80 y.
• Pat. with skin type I-II (n. Fitzpatrick) are more frequently affected
• Ocular involvement: in 20% (3-58% depending on study)
• In 20% ocular involvement before cutaneous manifestation visible

• Morbus Morbihan: More common in males
• Rosacea fulminans: More common in females

• Preliminary stage (rosacea diathesis):
  • Sudden onset and subsiding erythema ("flushing and blushing") triggered by endogenous and exogenous stimuli
• Subtye I: Rosacea erythemato-teleangiectatica
  • Persistent erythema, telangiectasias, pruritus, stinging, burning, scaling, dry skin
• Subtype II: Rosacea papulopustulosa
  • Erythematous, often multiple, partly succulent papules and pustules with finely lamellar scaling, lymphoedema
• Subtype III: Glandular-hyperplastic rosacea
  • Mostly men, connective tissue and sebaceous gland hyperplasia on nose (rhinophyma), chin/jaw (gnathophyma), forehead (metophyma), ear (otophyma) or eyelid (blepharophyma)

Not yet conclusively clarified.

• Multifactorial aetiology (genetics, immunological, neurological, inflammatory causes, UV radiation, dysregulation of blood and lymph vessels) is assumed. Demodex mites are seen as a cofactor.

• Predisposing factors
  • Irritating chemical substances, e.g. cosmetics such as soap
  • Abrupt temperature change, heat/cold, wind
  • Hot food
  • Alcohol (in men still controversial, however in women shown clear association with white wine and spirits)
  • Psychological stress
  • Nicotine probably has no influence on the course

• Functional erythema
  • Fleeting (flush-like), to prolonged erythema is the first sign of rosacea
• Subtype I (rosacea erythemato-teleangiectatica):
  • Erythema persisting for hours to days. In addition, increased telangiectasias (rosacea teleangiectatica) are seen
• Subtype II (rosacea papulopustulosa):
  • Erythematous, often grouped, finely lamellar scaling and succulent papules. Pustules (sterile) may also occur. There may also be extensive oedema. Demodex mites may be visible.
• Subtype III (phymatous rosacea/ rosacea glandulohyperplastica):
  • Large, inflammatory nodules and infiltrates. Connective tissue and sebaceous gland hyperplasia (phymosis) occur especially on the nose (rhinophyma).

• Ocular rosacea, "stage" IV (ophthalmorosazea): ocular involvement with blepharitis, conjunctival irritation, keratitis.

• History of present illness
• Deterioration due to trigger factors?
• Clinical picture (telangiectasias, no comedones, beginnings of phymatous hypertrophy)
  • ROSCO criteria: Diagnostic is persistent facial erythema and phyma. Major criteria are flushing and papulopustules, and telangiectasia.
• Biopsy

Face, sometimes upper body.

Avoid sun exposure, rapid temperature changes, spicy food, alcohol, caffeine, other triggers that may have been observed by the patient

Chronic disease, provide for longer-term therapy.

1. Marks R. Histopathology of Rosacea. Arch Dermatol 1969;100:683.
2. Steigleder GK. Die rosacea-artige Dermatitis: ein neuartiges Krankheitsbild *. DMW - Deutsche Medizinische Wochenschrift 1969;94:1393-8.
3. Sjolin KE. Acne aestivalis. A histopathological study. Acta Derm Venereol Suppl (Stockh) 1979;59:171-6.
4. Wilkin JK. Effect of Subdepressor Clonidine on Flushing Reactions in Rosacea. Arch Dermatol 1983;119:211.
5. Hoting E, Paul E, Plewig G. Treatment of Rosacea with Isotretinoin. International Journal of Dermatology 1986;25:660-3.
6. Black AA, McCauliffe DP, Sontheimer RD. Prevalence of Acne Rosacea in a Rheumatic Skin Disease Subspecialty Clinic. Lupus 1992;1:229-37.
7. Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. Journal of the American Academy of Dermatology 1993;28:443-8.
8. Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol 1993;128:650-9.
9. Jansen T, Plewig G, Kligman AM. Diagnosis and Treatment of Rosacea fulminans. Dermatology 1994;188:251-4.
10. Wilkin JK. Rosacea. Arch Dermatol 1994;130:359.
11. Quarterman MJ, Johnson DW, Abele DC, Lesher JL, Hull DS, Davis LS. Ocular rosacea: signs, symptoms, and tear studies before and after treatment with doxycycline. American Journal of Ophthalmology 1997;124:426.
12. Erdogan FG. Efficacy of Low-Dose Isotretinoin in Patients With Treatment-Resistant Rosacea. Archives of Dermatology 1998;134:884-5.
13. Lonne-Rahm TFMBS-B. Stinging and Rosacea. Acta Dermato-Venereologica 1999;79:460-1.
14. Plewig G, Kligman AM. ACNE and ROSACEA. Springer Science + Business Media; 2000.
15. Plewig G, Kligman AM. Acne Inversa.  ACNE and ROSACEA: Springer Science + Business Media; 2000:309-41.
16. van Zuuren EJ, Powell FC, Graber M. Interventions for acne rosacea.  The Cochrane Database of Systematic Reviews: Wiley-Blackwell; 2000.
17. Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K. Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea. Journal of the European Academy of Dermatology and Venereology 2001;15:441-4.
18. Goldman D. Tacrolimus ointment for the treatment of steroid-induced rosacea: A preliminary report. Journal of the American Academy of Dermatology 2001;44:995-8.
19. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology 2002;46:584-7.
20. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. Journal of the American Academy of Dermatology 2004;51:327-41.
21. Dirschka T, Tronnier H, Folster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol 2004;150:1136-41.
22. Pelle MT, Crawford GH, James WD. Rosacea: II. Therapy. Journal of the American Academy of Dermatology 2004;51:499-512.
23. Powell FC. The Histopathology of Rosacea: ‘Where’s the Beef?&rsquo. Dermatology 2004;209:173-4.
24. Wilkin J, Dahl M, Detmar M, et al. Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. Journal of the American Academy of Dermatology 2004;50:907-12.
25. Powell FC. Rosacea. New England Journal of Medicine 2005;352:793-803.
26. Gomaa AHA, Yaar M, Eyada MMK, Bhawan J. Lymphangiogenesis and angiogenesis in non-phymatous rosacea. J Cutan Pathol 2007;34:748-53.
27. Guzman-Sanchez DA, Ishiuji Y, Patel T, Fountain J, Chan YH, Yosipovitch G. Enhanced skin blood flow and sensitivity to noxious heat stimuli in papulopustular rosacea. Journal of the American Academy of Dermatology 2007;57:800-5.
28. Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br J Dermatol 2007;157:474-81.
29. Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nature Medicine 2007;13:975-80.
30. Powell F. Rosacea. Informa Healthcare; 2008.
31. Yamasaki K, Gallo RL. The molecular pathology of rosacea. Journal of Dermatological Science 2009;55:77-81.
32. McAleer MA, Fitzpatrick P, Powell FC. Papulopustular rosacea: Prevalence and relationship to photodamage. Journal of the American Academy of Dermatology 2010;63:33-9.
33. Steinhoff M, Schmelz M, Schauber J. Facial Erythema of Rosacea – Aetiology, Different Pathophysiologies and Treatment Options. Acta Dermato Venereologica 2014:0.
34. Reinholz, M. (2016). S1-Leitlinie: Rosazea. Awmf.org. Retrieved 1 June 2016, from http://www.awmf.org/leitlinien/detail/ll/013-065.html