Rosacea Health (cont.)

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Rosacea Symptoms and Signs

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People with rosacea have red faces often accompanied by inflammatory papules and pustules. The skin changes can be similar to acne, but comedones (blackheads) are not present. Occasionally, the eyelids and conjunctiva can become involved, resulting in ocular irritation and rarely chronic corneal damage. More rarely, there is fibrosis (scarring) of the connective tissue of the facial skin associated with hypertrophy (enlargement) of the sebaceous glands, resulting in a thickened appearance. Thickening of the skin of the nose (rhinophyma) can be cosmetically debilitating.

When to Seek Medical Care

Adults with persistently red facial skin associated with papules and pustules should visit a physician. This is especially true if the eyelids are involved.

Rosacea Diagnosis

The correct diagnosis requires the presence of persistent facial redness that may be accompanied by inflammatory papules and pustules. There are no confirmatory laboratory tests to diagnose rosacea, although occasionally a skin biopsy will be necessary to support the diagnosis.

Rosacea may be confused with a variety of other conditions, including systemic lupus erythematosus, seborrheic dermatitis, commonly cutaneous sarcoidosis. Since the diagnosis of rosacea depends upon its clinical appearance, it may be necessary to perform certain laboratory tests to exclude some of these other conditions.

Rosacea Treatment

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Depending on the severity of this condition, topical or systemic treatment may be necessary. Topical therapy includes the application of topical antibiotics such as metronidazole (MetroCream, MetroGel, MetroLotion, Noritate), sulfacetamide (Novacet, Plexion, Plexion SCT, Plexion TS, Rosanil Cleanser, Rosula, Rosula Cleanser, Sulfacet-R, Zetacet Wash), or perhaps azelaic acid (Azelex, Finacea, Finevin).

If topical therapy is insufficient, oral antibiotics are frequently beneficial. Frequently used oral antibiotics include amoxicillin (Amoxil, Amoxil Pediatric Drops, Moxatag, Trimox) and tetracycline (Ala-Tet, Sumycin) or one of its analogues like doxycycline (Adoxa, Alodox, Avidoxy, Doryx, Monodox, Oracea, Oraxyl, Periostat, Vibramycin, Vibramycin Calcium, Vibramycin Monohydrate, Vibra-Tabs) and minocycline (Dynacin, Minocin, Minocin PAC, Myrac, Solodyn). Systemic treatment with antibiotics may inhibit the development of rhinophyma and is effective in controlling blepharitis (inflammation of the eyelid). Rarely, very severe cases may require isotretinoin (Accutane, Amnesteem, Claravis, Sotret), an oral retinoid. The overall goal of treatment is control the symptoms rather than cure the condition.

Research studies have objectively shown that there is evidence that topical metronidazole and azelaic acid are effective treatments for rosacea. There is evidence that oral metronidazole and tetracycline are effective as well.

Treatment of the telangiectatic component (dilated blood vessels) of rosacea with lasers or intense pulsed light of the appropriate wavelength can diminish the redness. Individual blood vessels can also be treated with electrosurgical destruction. There is also a novel, promising form of medical therapy currently being studied which utilizes a drug similar to that present in long-acting nasal decongestant sprays (like Afrin). Rhinophyma can be improved by "paring down" excess nasal tissues using electrosurgical or microwave devices.


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