Rosacea and Periorificial Dermatitis

Published on 05/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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30

Rosacea and Periorificial Dermatitis

Clinical Features

Highly variable degree of severity, from a few papulopustules to extreme distortion of the nose.

Lesions typically develop on the face, especially its central portion; uncommonly other sites such as the scalp and chest are involved.

Etiology is multifactorial, including vascular hyperreactivity, alterations in innate immunity, e.g. cathelicidins, and Demodex plus its commensal bacteria.

Table 30.1 lists the four major types of rosacea (Figs. 30.130.5) and their characteristics.

Variants include granulomatous rosacea and periorificial dermatitis.

Granulomatous rosacea.

Red to red-brown papules secondary to granulomatous inflammation (Fig. 30.6).

Periorificial dermatitis.

Originally referred to as perioral dermatitis but lesions can surround other orifices, hence the term periorificial.

Affects children and adults.

Lesions around the mouth and nose > eyes.

Monomorphic pink papules and fine pustules (Figs. 30.7 and 30.8) admixed with eczematous patches and thin plaques, sometimes with fine scale.

Lesions recur over weeks to months.

May initially improve with topical CS but ultimately this treatment leads to exacerbation and should not be used.

If topical CS are an exacerbating factor, taper strength of CS over a period of weeks or substitute topical calcineurin inhibitors in order to reduce rebound.

Mid-facial edema:

Erythematous, firm, nonpitting, painless swelling of the mid-face (Fig. 30.9).

Rosacea fulminans:

Acute facial plaque studded with pustules.

DDx: Table 30.2.

Rx: Tables 30.3 and 30.4.

For further information see Ch. 37. From Dermatology, Third Edition.