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Encyclopedia > Rosacea
Rosacea
Classification & external resources
Moderate erythematotelangiectatic and mild papulopustular rosacea.
ICD-10 L71.
ICD-9 695.3
DiseasesDB 96
MedlinePlus 000879
eMedicine derm/377 

Rosacea (IPA: /rəʊˈzeɪʃə/) is a common but often misunderstood condition that is estimated to affect over 45 million people worldwide. It affects white-skinned people of mostly north-western European descent, and has been nicknamed the 'curse of the Celts' by some in Ireland. It begins as erythema (flushing and redness) on the central face and across the cheeks, nose, or forehead but can also less commonly affect the neck and chest. As rosacea progresses, other symptoms can develop such as semi-permanent erythema, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose (rhinophyma). The disorder can be confused and co-exist with acne vulgaris and/or seborrheic dermatitis. Rosacea affects both sexes, but is almost three times more common in women, and has a peak age of onset between 30 and 60. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis, as rosacea is primarily a facial diagnosis. Wikipedia does not have an article with this exact name. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // L00-L99 - Diseases of the skin and subcutaneous tissue (L00-L08) Infections of the skin and subcutaneous tissue (L00) Staphylococcal scalded skin syndrome (L01) Impetigo (L02) Cutaneous abscess, furuncle and carbuncle (L03) Cellulitis (L04) Acute lymphadenitis (L05) Pilonidal cyst (L08) Other local infections of skin and subcutaneous tissue (L081) Erythrasma... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Erythema is an abnormal redness of the skin caused by capillary congestion. ... Telangiectasias, or spider veins, are small dilated blood vessels near the surface of the skin; usually they measure only a few millimeters. ... An abscess is a collection of pus collected in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e. ... Rhinophyma is a descriptive term for a large, bulbous, ruddy appearance of the nose caused by granulomatous infiltration. ... This article is about a skin disease commonly found during adolescence. ... Seborrhoeic dermatitis is a skin disorder affecting the scalp, face and trunk causing scaly, flaky, itchy, red skin. ...

Contents

Subtypes and symptoms

There are four identified rosacea subtypes[1] and patients may have more than one subtype present.

  1. Erythematotelangiectatic rosacea: Permanent redness (erythema) with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin (telangiectasias) and possibly burning or itching sensations.
  2. Papulopustular rosacea: Some permanent redness with red bumps (papules) with some pus filled (pustules) (which typically last 1-4 days); this subtype can be easily confused with acne.
  3. Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea can also affect the chin (gnatophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma).[2] Small blood vessels visible near the surface of the skin (telangiectasias) may be present.
  4. Ocular rosacea: Red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning.

There have been other descriptive terms applied to presentations of rosacea, but these are not formally accepted as subtyes of rosacea:[3] Erythema is an abnormal redness of the skin caused by capillary congestion. ... For a person to flush is to become markedly red in the face and often other areas of the skin, from various physiological conditions. ... This article does not cite any references or sources. ... Telangiectasias (tee-LAN-jek-TAY-ja) are small enlarged blood vessels near the surface of the skin, usually they measure only a few millimetres. ... A papule is a small, solid and usually conical elevation of the skin. ... An abscess is a collection of pus collected in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e. ... Rhinophyma is a descriptive term for a large, bulbous, ruddy appearance of the nose caused by granulomatous infiltration. ... Erythematotelangiectatic rosacea, the mildest form of the condition, is characterized by persistent facial redness. ...

  • Granulomatous rosacea.[4]
  • The rare and severely scarring Rosacea fulminans (pyoderma faciale) occurring exclusively in women after adolescence and most commonly in their early 20s,[5][6]
  • Perioral dermatitis, which is better described as periorificial dermatitis, but similarly treated with topical metronidazole.[7]
  • Persistent edema of rosacea.[citation needed]
  • Rosacea Conglobata.[citation needed]
  • Persisting redness and oedema of the upper half of the face has been termed Morbihan disease.[8][9]

Rosacea sufferers often report periods of depression stemming from cosmetic disfigurement, painful burning sensations, and decreases in quality of life.[10] H&E section of non-caseasting granuloma seen in the colon of a patient with Crohns disease In medicine (anatomical pathology), a granuloma is a group of epithelioid macrophages surrounded by a lymphocyte cuff. ... Dermatitis is a blanket term literally meaning inflammation of the skin. It is usually used to refer to eczema, which is also known as Dermatitis eczema. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ...


Causes

Richard L. Gallo and colleagues recently noticed that patients with rosacea had elevated levels of the peptide cathelicidin and elevated levels of stratum corneum tryptic enzymes (SCTEs). Antibiotics have been used in the past to treat rosacea, but antibiotics may only work because they inhibit some SCTEs. See the August 5, 2007 issue of Nature Medicine for details. Cathelicidin is an antimicrobial peptide produced in macrophages triggered by bacteria, viruses, and fungi, when the hormone 1,25-D is present. ...


Rosacea has a hereditary component and those that are fair-skinned of European or Celtic ancestry have a higher genetic predisposition to developing it. Women are more commonly affected but when men develop rosacea it tends to be more severe. People of all ages can get rosacea but there is a higher instance in the 30-50 age group. The first signs of rosacea are said to be persisting redness due to exercise, changes in temperature, and cleansing.


Triggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. There are also some foods and drinks that can trigger flushing, these include alcohol, foods and beverages containing caffeine (especially, hot tea and coffee), foods high in histamines and spicy food, as well as fruits containing high levels of antioxidants, such as red grapes. This article does not cite any references or sources. ... Caffeine is a xanthine alkaloid compound that acts as a stimulant in humans. ... This article or section does not cite any references or sources. ... Spices are strongly flavored or aromatic parts of plants used in small quantities in food as a preservative, or flavouring in cooking. ...


Certain medications and topical irritants can quickly progress rosacea. If redness persists after using a treatment then it should be stopped immediately. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion, chemical peels, high dosages of isotretinoin, benzoyl peroxide and tretinoin. Steroid induced rosacea is the term given to rosacea caused by the use of topical or nasal steroids. These steroids are often prescribed for seborrheic dermatitis. Dosage should be slowly decreased and not immediately stopped to avoid a flare up. Isotretinoin (INN) (IPA: ) is a medication used for the treatment of severe acne. ... Tretinoin is the acid form of vitamin A and so also known as all-trans retinoic acid or ATRA. It is a drug commonly used to treat acne vulgaris and keratosis pilaris. ... This article is about the chemical family of steroids. ...


Studies of rosacea and demodex mites have revealed that some people with rosacea have increased numbers of the mite, especially those with steroid induced rosacea.[11] When large numbers are present they may play a role along with other triggers. On other occasions Demodicidosis (Mange) is a separate condition that may have "rosacea-like" appearances.[12] Species Demodex brevis Demodex bovis Demodex canis Demodex caprae Demodex cati Demodex equi Demodex folliculorum Demodex ovis Demodex phyloides The demodex mites form a genus of tiny parasitic mites which live in or near hair follicles of mammals. ... Mange (from Middle English manjeue, from Old French manjue, from mangier, meaning to eat)[1] is a parasitic infestation of the skin of animals. ...


It has also been suggested that rosacea might be a neurological disorder resulting from hypersensitization of sensory neurons following activation of the plasma kallikrein-kinin system by exposure to intestinal bacteria in the digestive tract.[13] The kinin-kallikrein system or simply kinin system is a poorly delineated system of blood proteins that plays a role in inflammation, blood pressure control, coagulation and pain. ... Gut flora, or intestinal bacteria, are the bacteria that normally live in the digestive tract and perform a number of useful functions involving digestion for their hosts. ...


Treatments

Treating rosacea varies from patient to patient depending on severity and subtypes. Dermatologists are recommended to take a subtype-directed approach to treating rosacea patients.[14]


Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. The National Rosacea Society recommends that a diary be kept to help identify and reduce triggers.


It is important to have a gentle skin cleansing regimen using non-irritating cleansers. Protection from the sun is important and daily use of a sunscreen of at least SPF 15 containing a physical blocker such as zinc oxide or titanium dioxide is advised although chemical sunscreens, if non-irritating to the skin, are also an option. Sunscreen (also known as sunblock, suntan lotion) is a lotion, spray or other topical product that helps protect the skin from the suns ultraviolet (UV) radiation, and which reduces sunburn and other skin damage, with the goal lowering your risk of skin cancer. ... Zinc oxide is a chemical compound with formula ZnO. It is nearly insoluble in water but soluble in acids or alkalis. ... Titanium dioxide, also known as titanium(IV) oxide or titania, is the naturally occurring oxide of titanium, chemical formula TiO2. ...


Oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defense prescribed by doctors to relieve papules, pustules, inflammation and some redness.[15] Topical Azelaic acid such as Finacea maya help reduce inflammation. Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.[16] Isotretinoin has many side effects and is normally used to treat severe acne but in low dosages is proven to be effective against papulopustular and phymatous rosacea. This article deals with the group of antibiotics known as the Tetracyclines . ... Tetracycline (INN) (IPA: ) is a broad-spectrum antibiotic produced by the streptomyces bacterium, indicated for use against many bacterial infections. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... Minocycline hydrochloride, also known as minocycline, is a member of the broad spectrum tetracycline antibiotics, and has a broader spectrum than the other members. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ... Isotretinoin (INN) (IPA: ) is a medication used for the treatment of severe acne. ...


The treatment of flushing and blushing has been attempted by means of the centrally acting α-2 agonist clonidine, but there is no evidence whatsoever that this is of any benefit. The same is true of the beta-blockers nadolol and propanolol. If flushing occurs with red wine consumption, then complete avoidance helps. There is no evidence at all that antihistamines are of any benefit in rosacea. Clonidine is a direct-acting adrenergic agonist prescribed historically as an anti-hypertensive agent. ...


People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm (but not hot) compresses several times a day is recommended.


Dermatological vascular laser (single wavelength) or Intense Pulsed Light (broad spectrum) machines offer one of the best treatments for rosacea, in particular the erythema (redness) of the skin.[17] They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin. The light is absorbed by oxy-hemoglobin which heat up causing the capillary walls to heat up to 70ºC, damaging them, causing them to be absorbed by the body's natural defence mechanism. For other uses, see Laser (disambiguation). ... A human arm, four hours after IPL treatment. ... Cross-section of all skin layers Optical Coherence Tomography tomogram of fingertip, depicting stratum corneum (~500µm thick) with stratum disjunctum on top and stratum lucidum (connection to stratum spinosum) in the middle. ... The dermis is a layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. ... Structure of hemoglobin. ...


CO2 lasers can be used to remove excess tissue caused by phymatous rosacea. CO2 lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporise tissue. Low level light therapies have also been used to treat rosacea. One alternative skin treatment, fashionable in the Victorian and Edwardian eras, was Sulphur. Recently Sulphur has re-gained some credibility as a safe alternative to steroids and coal tar.


Famous people

Famous people with Rosacea include:

William Jefferson Bill Clinton (born William Jefferson Blythe III[1] on August 19, 1946) was the 42nd President of the United States, serving from 1993 to 2001. ... This article is about the financier. ... “Diana Spencer” redirects here. ... W. C. Fields (January 29, 1880 – December 25, 1946) was an American juggler, comedian, and actor. ... For other persons named Alex Ferguson, see Alex Ferguson (disambiguation). ... Rosie ODonnell (born March 21, 1962 in Bayside, Queens, New York) is an 11-time Emmy Award-winning American talk show host, television personality, comedienne, film, television, and stage actress. ... Mariah Carey (born March 27, 1970) is an American singer, songwriter, record producer, music video director, and actress. ... Margaret Bobonich (born June 5, 1962) was a contestant on the eleventh season of the CBS hit reality TV show, Survivor: Guatemala. ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Lisa Faulkner (born 1973) is an English actress. ... This article is about the Dutch artist. ...

See also

Wikimedia Commons has media related to:
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Wikibooks has a book on the topic of

Image File history File links Commons-logo. ... Image File history File links Wikibooks-logo-en. ... Wikibooks logo Wikibooks, previously called Wikimedia Free Textbook Project and Wikimedia-Textbooks, is a wiki for the creation of books. ... This article is about a skin disease commonly found during adolescence. ... Seborrhoeic dermatitis is a skin disorder affecting the scalp, face and trunk causing scaly, flaky, itchy, red skin. ... Keratosis pilaris (KP) is a very common genetic follicular condition that is manifested by the appearance of rough bumps on the skin and hence colloquially referred to as chicken skin. It most often appears on the back and outer sides of the upper arms (though the lower arms can also... Mange is an irritation of the skin, primarily including hair loss but might also include itching and inflammation, all caused by microscopic mites. ... Species Demodex brevis Demodex bovis Demodex canis Demodex caprae Demodex cati Demodex equi Demodex folliculorum Demodex ovis Demodex phyloides The demodex mites form a genus of tiny parasitic mites which live in or near hair follicles of mammals. ...

Footnotes

  1. ^ Wilkin J, Dahl M, Detmar M, Drake L, Liang MH, Odom R, Powell F (2004). "Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea" (PDF reprint). J Am Acad Dermatol 50 (6): 907-12. PMID 15153893. 
  2. ^ Jansen T, Plewig G (1998). "Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities". Facial Plast Surg 14 (4): 241-53. PMID 11816064. 
  3. ^ Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, Powell F (2002). "Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea" (PDF reprint). J Am Acad Dermatol 46: 584-7. PMID 15153893.  - this earlier classification noted terms of Granulomatous Rosacea, Rosacea fulminans and Perioral dermatitis as probably not meeting the accepted definitions for Rosacea. Such terms not mentioned in the later 2004 classification.
  4. ^ Helm K, Menz J, Gibson L, Dicken C (1991). "A clinical and histopathologic study of granulomatous rosacea". J Am Acad Dermatol 25 (6 Pt 1): 1038-43. PMID 1839796. 
  5. ^ Jansen T, Plewig G, Kligman A (1994). "Diagnosis and treatment of rosacea fulminans". Dermatology 188 (4): 251-4. PMID 8193395. 
  6. ^ Helm T, Schechter J (2006). "Biopsy may help identify early pyoderma faciale (rosacea fulminans)". Cutis 77 (4): 225-7. PMID 16706239. 
  7. ^ Nguyen V, Eichenfield L (2006). "Periorificial dermatitis in children and adolescents". J Am Acad Dermatol 55 (5): 781-5. PMID 17052482. 
  8. ^ Hölzle E, Jansen T, Plewig G (1995). "[Morbihan disease--chronic persistent erythema and edema of the face]". Hautarzt 46 (11): 796-8. PMID 8641887. 
  9. ^ Landow K (December 2002). "Unraveling the mystery of rosacea -- Keys to getting the red out". Postgraduate Medicine 112 (6). 
  10. ^ Panconesi, E. (1984). "Psychosomatic dermatology". Clin Dermatol 2: 94-179. PMID 6242532. 
  11. ^ Erbagcaronci Z, Özgöztascedili O (June 1998). "The significance of Demodex folliculorum density in rosacea". Int J Dermatol. 37 (6): 421-5. DOI:10.1046/j.1365-4362.1998.00218.x. PMID 9646125. 
  12. ^ a b Baima B, Sticherling M (2002). "Demodicidosis revisited". Acta Derm Venereol 82 (1): 3-6. PMID 12013194. 
  13. ^ Kendall SN (May 2004). "Remission of rosacea induced by reduction of gut transit time.". Clin Exp dermatol. 29 (3): 297-9. DOI:10.1111/j.1365-2230.2004.01461.x. PMID 15115515. 
  14. ^ Aaron F. Cohen, MD, and Jeffrey D. Tiemstra, MD (May-June 2002). "Diagnosis and treatment of rosacea". J Am Board Fam Pract. 15 (3): 214-7. PMID 12038728. 
  15. ^ Dahl MV, Katz HI, Krueger GG, Millikan LE, Odom RB, Parker F, Wolf JE Jr, Aly R, Bayles C, Reusser B, Weidner M, Coleman E, Patrignelli R, Tuley MR, Baker MO, Herndon JH Jr, Czernielewski JM (June 1998). "Topical metronidazole maintains remissions of rosacea". Arch Dermatol 134 (6): 679-83. PMID 9645635. 
  16. ^ Hoting E, Paul E, Plewig G (December 1986). "Treatment of rosacea with isotretinoin". Int J Dermatol 25 (10): 660-3. PMID 2948928. 
  17. ^ Marla C Angermeier (1999). "Treatment of facial vascular lesions with intense pulsed light". J Cutan Laser Ther. 1 (2): 95-100. PMID 11357295. 
  18. ^ Jane E. Brody. "Sometimes Rosy Cheeks Are Just Rosy Cheeks", New York Times, March 16, 2004. 
  19. ^ http://www.metrogel.com/CopingWithRosacea/CopingWithRosacea.aspx
  20. ^ http://www.elle.com/featurefullstory/11455/rosie-odonnell-page3.html
  21. ^ http://women.timesonline.co.uk/tol/life_and_style/women/fashion/article1390492.ece
  22. ^ http://www.pharmalive.com/News/Index.cfm?articleid=433576
  23. ^ http://observer.guardian.co.uk/omm/qanda/story/0,,1550882,00.html
  24. ^ http://www.nowmagazine.co.uk/body/celeb_health/Lisa_Faulkner_My_unslightly_rosacea_article_118152.html
  25. ^ http://www.about-rosacea.com/famous.htm

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links


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