Acne Rosacea

00:01 Let's look back and revisit the case, looking for clues that may help us to look at acne rosacea.

00:07 Alright, so we're told she's a 41-year old EMT, well that's pretty typical age group for rosacea and also it's more common in women.

00:16 Next stop, we look at some of the triggers that she was describing.

00:19 Now, she does drink alcohol but in particular she said that on very hot days, it gets worse and when she eats spicy food.

00:25 Well folks, what acne rosacea will tell you there's a number of common episodic triggers that may bring on significant flares.

00:32 Exercising, drinking alcohol, spicy food and hot drinks, exposure to the sun and even emotional stress.

00:39 So that all seems to go along with acne rosacea.

00:42 Next stop, it turns out that yes, acne rosacea is commonly associated with blepharitis, conjunctivitis or even iritis.

00:49 So that supports our diagnosis too.

00:52 Next stop, the risk factors.

00:54 Someone who has a fair complexion, is more likely to get this and it's also been found to be associated with obesity and alcohol consumption.

01:02 Finally, looking at the rash itself, evidence of flushing, papules, telangiectasias and even occasionally pustules is typical of acne rosacea and what you're not seeing here is comedones.

01:14 Acne rosacea compared with acne vulgaris should never have comedones and the absence of that in our case is a clue to the diagnosis.

01:23 Alright, so our final diagnosis is acne rosacea.

01:27 Let's review a few more key features of acne rosacea.

01:31 First off, this is considered an inflammatory disease of pilosebaceous units associated with capillary hyperreactivity that ultimately looks like flushing and telangiectasis.

01:42 It's idiopathic, there are a number of things that have been associated with bringing it on but we don't know exactly what's causing it in the first place.

01:49 Sun exposure's a factor, there may be some issues with immune dysregulation or maybe it's just an inflammatory response to some as yet unidentified skin flora.

01:58 Topical corticosteroids have also been shown to worsen the disease.

02:02 In men, oftentimes, we see this much more disfiguring presentation called rhinophyma, which you can see here on the right.

02:09 Next stop, we wanna talk about how to manage our patient's acne rosacea.

02:13 First off we want to tell her to identify and avoid pertinent triggers, including the sunlight.

02:18 She also mentioned that eating spicy foods may be a contributor and the alcohol's probably not helping either.

02:24 Patients can oftentimes use topical emollients to help to soothe the skin.

02:28 And next stop, medications that we would start with would be topical brimonidine and commonly, metronidazole.

02:35 Patients with more advanced disease or more significant symptoms are often prescribed oral antibiotics particularly tetracyclines and you can even consider laser therapy under the care of a dermatologist.

02:47 So, a few key points about acne rosacea.

02:50 First off, it's characterized by repeated eruptions of facial flushing and these erythematous papular lesions.

02:57 It's more common in women and more common in those over the age of 30.

03:01 It's idiopathic but there are typical risk factors that we look for - obesity, alcohol and fair complexion.

03:08 Lastly, it's characterized by papules, pustules and telangiectasias and importantly, you should not see comedones.

03:16 We're gonna treat it by avoiding triggers and potentially starting with topical brimonidine and topical metronidazole.