Rosacea

Telangiectases and papules (A) are seen here on the nose of a 55-year-old man. Another photograph of the same patient shows sharply demarcated sparing of the periorbital area (B). This man has stage 1 rosacea; stages 2 and 3 involve the appearance of pustules as well. He reported constant flushing and blushing in response to emotional upset and anything else that increased his body temperature.

Chronic overexposure to sunlight and excessive alcohol consumption also appear to foster the exaggerated vasodilatory response that seems to be a prerequisite for the development of rosacea. An acneiform inflammatory eruption of poorly understood origin but unrelated to acne, rosacea is more common in those of northern European ancestry than in those with darker skin. Rosacea also spares the perioral area, but it is often seen on the convex surface of the chin and occasionally on the scalp.

While rosacea can coexist with acne, it is distinguished from that common malady by rosacea’s characteristic distribution pattern, by the complete lack of comedones, and by the age of the typical patient (30
to 50 years), which is considerably older than the age range associated with acne.

The differential diagnosis for rosacea also includes systemic lupus erythematosus, dermatomyositis, seborrhea (with which rosacea often coexists), and perioral dermatitis, among others. However, rosacea is extremely common, and it is usually quite distinct in its morphology and distribution.

Rosacea is typically so predictably responsive to treatment with topical metronidazole and/or oral tetracycline that failure to respond calls the diagnosis into question. n