Rosacea is a chronic facial skin condition of unknown cause. It is characterized by marked involvement of the central face with transient or persistent
erythema,
telangiectasia, inflammatory papules and pustules, or
hyperplasia of the connective tissue. Transient
erythema, or
flushing, is often accompanied by a feeling of warmth. It usually lasts for less than five minutes and may spread to the neck and chest. Less common findings include erythematous plaques, scaling,
edema, phymatous changes (thickening of skin due to
hyperplasia of sebaceous glands), and ocular symptoms. The National
Rosacea Society Expert Committee defines four subtypes of
rosacea (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (granulomatous). Treatment starts with avoidance of triggers and use of mild
cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum
sunscreens (minimum sun protection factor of 30). For inflammatory lesions and
erythema, the recommended initial treatments are topical
metronidazole or
azelaic acid. Once-daily
brimonidine, a topical
alpha-adrenergic receptor agonist, is effective in reducing
erythema.
Papulopustular rosacea can be treated with systemic
therapy including
tetracyclines, most commonly subantimicrobial-dose
doxycycline.
Phymatous rosacea is treated primarily with
laser or light-based
therapies.
Ocular rosacea is managed with lid hygiene, topical
cyclosporine, and topical or systemic
antibiotics.