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INTRODUCTION

Rosacea is a common chronic disorder mainly of the face that tends to present in middle age but may start in the teens and twenties. It is more common in cold climates.

The condition frequently begins as an exaggerated or prolonged flushing tendency, with erythema particularly affecting the central face or butterfly area but also the chin and forehead. Initially this erythema is intermittent, but later becomes persistent. It is sometimes associated with edema; often telangiectasia develops. Sterile inflammatory papules, pustules, and nodules which can mimic acne develop, but comedones are not seen. Patients often complain that their face feels hot; burns, stings or itches; and is increasingly easily irritated by topical products.

At least half develop blepharoconjunctivitis causing itching, burning, dry, gritty or foreign-body sensations in the eye and erythema and swelling of the eyelid. Serious ocular complications can occur if untreated. More advanced cases can develop enlarged sebaceous glands and connective tissue changes resulting in bulbous, rhinophymatous nose.

Like acne, rosacea can lead to severe emotional distress with feelings of low self-esteem, and embarrassment and anxiety in social situations that may lead to social withdrawal. The cause of rosacea is unknown; it is not related to excess alcohol consumption. The differential diagnosis includes acne, perioral dermatitis, seborrhoeic dermatitis, lupus erythematosus and flushing disorders.

CONTROLLING AND MANAGING ROSACEA

(A) GENERAL MEASURES

Minimize factors that cause flushing or irritation of affected skin - sun exposure, emotional stress, hot weather, alcohol, spicy food, exercise, wind, hot baths, cold weather, sudden changes in temperature, hot drinks and skin care products that burn, sting or irritate.

Use an emollient pH-neutral, soap-free cleanser, combined with a low-irritant face cream with sunscreen (hypoallergenic +/- tinted) and/or (green-tinted) foundation, to reduce irritation and mask erythrotelangiectatic features. Sun protection plus sun avoidance measures are essential. Use cool drinks, cool packs and spray bottles to keep cool in hot weather, and exercise during cooler periods of the day or in air-conditioned facilities. Vasodilating medications such as systemic corticosteroids, nitrates and calcium channel blockers can worsen rosacea.

Avoid topical corticosteroids, as even hydrocortisone withdrawal can cause a severe flare. Avoid skin care products containing alcohol (eg.

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