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Rosacea is a type of acne affecting more commonly patients over 30 years of age. It is more frequent in women but more severe in men.

This disease causes persistent inflammation on the central region of the face (and, rarely, on the chest or back) for more than 3 months, and includes features such as erythema, telangiectases and superficial pustules. This skin condition is not associated with comedones ,unlike acne vulgaris.

The development of rosacea is related to the patient's tendency for facial flushing (redness of the skin due to several physiological conditions such as heat, cold, emotions, exercise, spicy foods, hot drinks or alcohol). In this condition, flushing tends to be more pronounced and to last longer, until it eventually becomes permanent.

There are 4 subtypes of acne rosacea, based on their specific signs and symptoms, that allow the treatment to be more specific.

Erythematotelangiecta tic

This subtype's more predominant sign is central facial flushing (usually sparing the skin around the eyes) and the specific symptoms are burning and stinging (which tend to exacerbate with the use of topic agents).

The skin is usually fine and non-sebaceous, unlike the other subtypes. In contrast, the congested areas of the skin develop thicker and rougher.

Papulopustular

This is the "classic" subtype, more frequent in middle-aged women. It presents as central face redness with erythematous papules of small dimensions, surmounted by pointy pustules.

Phymatous

This subtype is characterized by irregular thickenings and nodules of the skin, typically in the nose, skin, forehead, ears and eyelids.

Ocular

This may be the first manifestation of the illness, ranging from months to years, although the ocular signs may appear simultaneously with the cutaneous'.

The ocular signs are keratitis, blepharitis, iritis, conjunctivitis, conjunctival telangiectases and chalazion .The symptoms are eye stinging or burning, dryness, photophobia or foreign body sensation.

Treatment

Before and during the treatment, the triggering factors should be avoid, so an individual approach to try to identify them is necessary. All patients should avoid astringents, toners, waterproof cosmetics requiring solvents to be removed, or products containing sodium lauryl sulfate.

The topic treatment includes high SPF sunscreen, which should block UV-A and UV-B and contain protective silicones

The oral treatment include antibiotics, immunosuppressants, corticosteroids and retinoids.

Laser treatment has several options: nonablative laser for skin remodeling, vascular laser for vessel reduction and intense pulsed-light therapy for facial rejuvenation.

Acne rosacea can achieve a clinical cure, with varying degrees of residual symptomatology (scarring, stinging, residual erythema) and may relapse in some patients.

Learn more about this author, Rita Peixoto.
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