Medical symptom checker - Butterfly rash on face - Rosacea
Rosacea is associated with persistent non comedonal inflammation which affect the facial skin The aetiology of rosacea is unknown. However it may co - exist with acne vulgaris as well as photosensitivity.It affects 1 % of the dermatology outpatient and it is common. It affects women more than men especially middle age to elderly people.
Based on the history and inspection from the patient, we can reveal the signs of erythema, pustules, papules and telangiectasia on the face. Patient also complains of sore and gritty eyelids/eye as a sign of blepharitis and conjunctivitis.
While inspecting the patient, we able to detect erythema ( redness ) on the forehead, cheeks and nose and nasolabial folds. Papules and pustules may be visible. Rhinophyma or disfiguring on the nose may present .Inflammation of the lids with crusts or conjunctivitis/blepharitis may present. However no comedones are present.
Pathologically, there will be a variable degree of lymphocytic inflammatory cell infiltrates, oedema, vascular dermal ectasia which in later stage may present as granulomatous in severe cases.
Normally no investigation is required as the diagnosis is made based on inspection. Blood test may be required just to detect any antinuclear antibodies ( anti DsDNA) mostly in female just to exclude systemic lupus erythematosus. Rarely necessary for us to take swab of pustule to rule out any sign of infection.
The management of rosacea includes medical treatment and surgical treatment. The medical treatment involves topical metronidazole which is responsive to papules as well as pustules. However, rebound erythema ( rebound redness ) may present with the usage of topical steroid ( need to avoid topical steroid ) and topical steroid also has a minimal effect in reducing rosacea. Other treatment include erythromycin and oral oxytetracycline.
Isotretinoin is medication that only be used by prescription from the specialist only . It is uses in refractory case and may leads to hyperlipidemia and teratogenic effects. Any redness and flushing may be cover by cosmetic.
If the patient suffer from severe rhinophyma, surgical approach is required. The surgical approach involves excision of excessive soft tissue by plastic surgery.Other alternative includes carbon dioxide laser therapy for rhinophyma. Any erythema and telangiectasia may be treated with pulsed dye laser.
The patient is advice to avoid any alcohol and spicy food
The complication of rosacea include persistent facial redness or facial erythema and facial scarring especially the nose.
The prognosis is good . Rosacea may spontaneously improve over months and years, however it may relapse and remit.
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