Rosacea

Rosacea (sometimes referred to as acne rosacea) is a chronic skin disease of unknown aetiology.

Features

• typically affects nose, cheeks and forehead
• flushing is often first symptom
• telangiectasia are common
• later develops into persistent erythema with papules and pustules
• rhinophyma
• ocular involvement: blepharitis
• sunlight may exacerbate symptoms

Rosacea - showing papules, pustules and erythema. Image used on license from DermNet NZ

Rosacea over the cheeks and nose

Management

• simple measures
  • recommend daily application of a high-factor sunscreen
  • camouflage creams may help conceal redness
• predominant erythema/flushing
  • topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
  • brimonidine is a topical alpha-adrenergic agonist
  • this can be used on an 'as required basis' to temporarily reduce redness
  • it typically reduces redness within 30 minutes, reaching peak action at 3-6 hours, after which the redness returns to the baseline
• mild-to-moderate papules and/or pustules
  • topical ivermectin is first-line
  • alternatives include: topical metronidazole or topical azelaic acid