Rosacea: A Common, Yet Commonly Overlooked, Condition

Rosacea: A Common, Yet Commonly Overlooked, Condition
B. WAYNE BLOUNT, M.D., M.P.H., and ALLEN L. PELLETIER, M.D.
University of Tennessee Health Science Center, Memphis, Tennessee
Rosacea is a common, but often overlooked, skin condition of uncertain etiology that can lead to significant facial disfigurement, ocular complications, and severe emotional distress. The progression of rosacea is variable; however, typical stages include: (1) facial flushing, (2) erythema and/or edema and ocular symptoms, (3) papules and pustules, and (4) rhinophyma. A history of exacerbation by sun exposure, stress, cold weather, hot beverages, alcohol consumption, or certain foods helps determine the diagnosis; the first line of treatment is avoidance of these triggering or exacerbating factors. Most patients respond well to long-term topical antibiotic treatment. Oral or topical retinoid therapy may also be effective. Laser treatment is an option for progressive telangiectasis or rhinophyma. Family physicians should be able to identify and effectively treat the majority of patients with rosacea. Consultation with subspecialists may be required for the management of rhinophyma, ocular complications, or severe disease. (Am Fam Physician 2002;66:435-40,442. Copyright© 2002 American Academy of Family Physicians.)
Introduction
Rosacea is a common, but often overlooked, skin condition that can lead to significant facial disfigurement, emotional suffering, and serious ocular complications if left untreated. Little is known about the epidemiology of rosacea, but the condition most frequently occurs in persons between 30 and 50 years of age and in fair-skinned persons of northern European descent. Studies have shown that women are affected about two to three times more frequently than men. Rosacea may be underdiagnosed because patients may not discuss the symptoms with their physician and because some physicians may not recognize the disorder. Rosacea may be overlooked in nonwhites because of a low index of suspicion or because skin pigmentation results in an atypical presentation. Ocular complications and late manifestations of rosacea may occur in a disproportionate number of dark-skinned persons. Although rosacea can occur in the teenaged years, the incidence of rosacea in this age group is probably low. The incidence of rhinophyma, the most obvious stigma of rosacea, is unknown and occurs more often in men. The prevalence of rosacea appears to be increasing in the United States; this may be a result of the aging of the "baby-boom" generation, rather than an increase in incidence.

More:
Pathophysiology
Clinical Features
Differential Diagnosis
Complications
Treatment
* Prevention
* Antobiotics
* Second-Line Therapies
* Treatment of Ocular Rosacea
* Treatment of Erythema and Flushing
* Treatment of Telangiectasis
* Treatment of Rhinophyma
* New Concepts and Treatments
Patient Education