Section : Skin Conditions


Dr Christophe Hsu – dermatologist. Geneva, Switzerland




A common disorder affecting facial skin.

Initially carries both a vascular and an inflammatory component

– Inflammatory: Papules, pustules

– Vascular: Erythema, telangiectasia, flushing


  • Symmetrical localization on the face; may be asymmetrical
  • Nose, cheeks, forehead, chin
  • May involve a variety of ocular lesions


  • Unknown
  • Age – thirty to fifty years at onset (most common);
  • may occur from adolescence to late adult life
  • Females predominate, but severity is greater in males
  • Greater incidence in fair skinned people

Clinical Picture

  • Flushing – periodic reddening of the face (erythema)
  • Inflammatory lesions – papules, pustules
  • Edema may be present
  • Telangiectasia may be added with time
  • Ocular rosacea – accompanies vascular cutaneous rosacea
  • Comedones are characteristically absent
  • Diagnosis is made on a clinical basis
  • Rhinophyma is a late finding

Early Clues To Rosacea

  • Recurrent flushing, blushing; may last several minutes – several hours
  • Stinging in the malar areas, forehead, ears
  • Facial edema may be present

Rosacea Often Progresses In The Following Steps

  • Pre-rosacea ===> Flushing and blushing
  • Vascular Rosacea ===> Erythema and telangiectasia
  • Inflammatory Rosacea ===> Papules and pustules
  • Late Rosacea ===> Rhinophyma

Facial Flushing

  • Is a prominent feature of rosacea
  • Is usually the initial manifestation of the disease
  • Worsens during inflammatory outbreaks
  • Patients should avoid activities and aggravating factors which induce flushing


  • Enlargement of the nose
  • More common in males
  • Skin thickens
  • Enlarged follicles
  • Hyperplasia of sebaceous glands, connective tissue

Pathogenesis: Theories Proposed

  • Demodex folliculorum
  • Psychogenic stress
  • Endocrine abnormalities
  • Focal infection
  • Vascular disorder
  • Diet

Vascular Disorders

  • Leaky vessels
  • Insufficient blood flow
  • “Pooling effect”
  • Connective tissue dystrophy – leads to dilation of blood vessels

Rosacea – Aggravating Factors

  • Hot liquids
  • Sun exposure, wind exposure
  • Spicy foods
  • Extreme temperatures
  • Alcoholic beverages
  • Stress and other psychological factors
  • Prolonged use of topical fluorinated corticosteroids

Differential Diagnosis

  • Acne vulgaris
  • Seborrheic dermatitis
  • Perioral dermatitis
  • Lupus erythematosus
  • Carcinoid syndrome
  • Some may exist
Perioral Dermatitis

Perioral Dermatitis

Course Of Rosacea

  • Chronic, progressive disease
  • Periodic exacerbations and remissions common
  • May slowly increase in extent
  • Inflammatory ocular complications may occur
  • Long-term therapy may be required

Topical Steroids – Are Best Avoided

  • Can cause rebound erythema
  • Can worsen the condition in long run, although may effect impressive short-term improvement
  • If used, should be low potency for short time period

Methods Of Treatment

  • Oral antibiotics – tetracycline and others
  • Topical formulations – metronidazole, azelaic acid and others (Brimonidine…)
  • Many patients will do well with topical therapy alone.
  • For some patients, the addition for oral tetracycline for several weeks may accelerate initial response to therapy.
  • Lifestyle changes are also an important aspect of the overall treatment plan.
  • Avoidance of situations and factors that aggravate rosacea should be emphasized.

Answers To Common Patient Questions

1. Question: I have very sensitive skin due to my rosacea. How can I clean my face without causing additional irritation?

  • Answer: Only very mild soaps or mild cleansers should be used on the face. Avoid products containing alcohol or witch hazel.

2. Question : What about cosmetic use? Can I continue to wear cosmetics?

  • Answer: Yes, but use of high quality mosturizers and oil-free cosmetic products are recommended. Sunscreens of SPF 15 or higher should be used when prolonged sun exposure is expected. To reduce the redness or a rosacea flare, a green-based concealer may be used.

3. Question: Can anything make rosacea worse?

  • Answer: Certain things are known to aggravate rosacea. These include hot liquids, alcohol, spicy foods, extremes of temperature and stress.


Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore

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Category : Mal des celtes - Modifie le 11.28.2009Category : rosacea - Modifie le 11.28.2009Category : rosacée - Modifie le 11.28.2009