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Rosacea (acne rosacea)
Classic presentation with papules and pustules on forehead, cheeks, and nose. There is erythema but few telangiectasias.
Erythema of the nose is highly characteristic of rosacea. Pustules present on the cheeks. Acne can present with the same lesions and distribution.
Years of active inflammation permanently alter the dermis and distort the structure of the nose. This is called rhinophyma.
The eye is involved in about 50% of cases. Many problems are reported; grittiness and mild conjunctivitis are common complaints.
DESCRIPTION
Facial acne-like eruption, but without comedones. Does not scar like acne. Ocular disease common. Flushing is common.
HISTORY
• More common in people of Celtic origin. • May persist for years and require long-term suppression. • Spicy foods, emotional situations, alcohol and sunlight exacerbate. • Ocular grittiness and soreness common.
PHYSICAL FINDINGS
• Erythema, telangiectasias, and pustules primarily on forehead, cheeks, nose. • Telangiectasia not a constant feature. • Difficult to make diagnosis if pustules absent. • Long-term nasal disease distorts nose (rhinophyma). • Conjunctivitis may occur.
TREATMENT
Few pustules and mild erythema are treated topically. This treatment minimally effective for erythema. Erythema may be treated with laser. Topical medication may control disease or maintain remission when applied q.d. to b.i.d. Use mild preparations in this easily irritated area: • 10% sodium sulfacetamide (multiple brands) q.d. • Metronidazole: Noritate cream 1%, 30 g; Metrocream 0.75%, 45 g; metrolotion 0.75%, 59 mL; metrogel 1%, 60 g; metronidazole 0.75%, gel 45 g, cream 45 g, lotion 59 mL. • Azeliac acid: Finacea gel 15%, 30 g; azelex cream 20%, 30 g, 50 g. • Clindamycin: Cleocin T gel 1%, 30 g, 60 g; Cleocin T 1%, lotion 60 mL; clindagel 1%, 40 mL, 75 mL; Clindamax lotion 1%, 60 mL; evoclin foam 1%, 50 g, 100 g. • Aczone gel 5%, 30 g, 60 g. Oral antibiotics. Very effective for papules, pustules, and ocular involvement. Tetracycline 250 or 500 mg b.i.d. • Doxycycline 50 mg, 75 mg, 100 mg b.i.d. • Minocycline 50 mg, 75 mg, 100 mg b.i.d. • Erythromycin 500 mg b.i.d. • Trimethoprim/sulfamethoxazole 80–400 mg, 160–800 mg b.i.d. • Isotretinoin and prednisone. For very severe cases.
