ROSACEA: RECOGNIZING THE OCCURENCE AND CAUSE OF ROSACEA




Awareness of the cause of rosacea is growing amongst patients. Patients with rosacea are disheartened that there is no cure for rosacea but early diagnosis and patient compliance with treatment can greatly minimize symptoms and prevent severe complications [105(2)]. The early recognition of rosacea is important since untreated rosacea can lead to disfigurement and potential vision loss [133(1)].

Range of occurrence

Rosacea is a chronic and progressive dermatosis characterized by flushing, erythema, edema, papules and pustules, telangiectasia and potential hyperplasia over the central portion of the face such as forehead, cheek, nose and chin associated with ocular symptoms [130].




It is estimated that rosacea occurs in 1 in 20 Americans. Rosacea appears in both men and women and although it may occur at any age the onset typically begins at any time after 30 and before 50 [46].

Rosacea is more often in fair skinned people of northern and eastern European descent particularly Celtic, English and Scottish. It can affect multiple members of same family due to similar complexion and genetic heritage. This condition has been observed in African Americans [10(14)] Koreans [26(4)] and other more highly pigmented individuals as well as children [9(1)].

Potential Cause of Rosacea

The new therapies for Helicobacter pylori in peptic ulcer disease have occasionally been associated with an improvement in rosacea symptoms leading to the theory that H. pylori plays a role in pathogenesis of rosacea. Study results are inconsistent but it has been suggested that H. pylori synthesizes gastrin which may stimulate flushing [50(8)].

The presence of Demodex folliculorum part of skin’s flora has also been examined as a potential cause of rosacea but with inconclusive results [28(3)].

The cause of rosacea is unknown but is commonly thought to be of vascular origin because of clinical association with flushing, development of telangiectasia and tissue swelling and ultimately tissue proliferation and rhinophyma that is enlargement of nose [105(2)].

In addition to diversity of clinical manifestations, the cause and pathogenesis of rosacea are unknown. There are no histologic or serologic markers [69].




CHARACTERIZATION OF ROSACEA – REMISSION AND RELAPSE

Rosacea a chronic and progressive dermatosis which is triggered by trauma that is cold injury, prolonged sun exposure or exposure to irritants for example soaps, benzoyl peroxide is often sufficient to initiate symptoms. At first symptoms are mild but cumulative damage results in more severe symptoms overtime in people in high risk groups or who are otherwise predisposed.

Target areas for all symptoms include cheeks, nose, chin and forehead. Women are more likely to show symptoms on cheeks and chin. In men, symptoms occur more often on nose and rhinophyma is more common in men than women. Symptoms at forehead occur at similar rates in both sexes.

Rosacea is characterized by periods of remission and relapses and occurs in three stages.

A pre rosacea stage can be identified in susceptible individuals before first stage symptoms become evident. These are frequent flushing, erythema or irritation in response to topical medications especially antiacne therapies.

Stage 1 – the first stage is vascular. Transient facial erythema appears over central areas of the face and fine telangiectasia may develop. Ocular lesions may also occur.

Stage 2 – the disorder then progresses to second stage within a year. Erythema persists and spreads and papules and pustules often develop. The presence of enlarged pores signals fibroplasias an early sign of third stage rosacea [105(2)].

Stage 3 – this last stage in addition to including an exacerbation of existing symptoms is characterized by tissue hyperplasia as inflammatory nodules bridge across progressively larger areas of the face. A proliferation of tissue may result in rhinophyma.

Rosacea is common cause of a red eye and ocular findings have been reported in 58% patient, Blepharitis, conjunctival injection, tearing, burning recurrent chalazia, corneal vascularization and scarring, episcleritis and iritis have all been reported in minor manifestations. In severe forms of rosacea progressive vision loss is possible and requires aggressive therapy [31(3)].

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