Rosacea and Periorificial Dermatitis

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Rosacea and Periorificial Dermatitis

Epidemiology

• Seen in all skin types, but considerably more common in patients with skin phototypes I–II.

• Onset generally in the 4th decade of life.

Clinical Features

• Highly variable degree of severity, from a few papulopustules to extreme distortion of the nose.

• Lesions typically develop on the face, especially its central portion; uncommonly other sites such as the scalp and chest are involved.

• Etiology is multifactorial, including vascular hyperreactivity, alterations in innate immunity, e.g. cathelicidins, and Demodex plus its commensal bacteria.

• Table 30.1 lists the four major types of rosacea (Figs. 30.1–30.5) and their characteristics.

Table 30.1

Four major types of rosacea.

An individual patient may have more than one form. Some patients also have seborrheic dermatitis and/or actinic damage.

Fig. 30.1 Erythematotelangiectatic rosacea. Persistent erythema of the medial and lateral cheeks is seen. In this patient, there are no telangiectasias, indicating mild disease. Courtesy, Frank C. Powell, MD.

Fig. 30.2 Dermatoheliosis in a skin phototype I patient. Telangiectasias and erythema due to chronic actinic damage are particularly marked on the facial prominences. Features of dermatoheliosis overlap with those of erythematotelangiectatic rosacea. Courtesy, Frank C. Powell, MD.

Fig. 30.3 Rosacea. A Moderate papulopustular rosacea of the forehead. Note the superficial nature of the inflammatory lesions. B Moderate to severe papulopustular rosacea. There is a typical centrofacial distribution of erythema, telangiectasias, papules, and pustules. In addition, the skin has a scaly, crusty surface, and this is often a sign of more severe disease. Courtesy, Frank C. Powell, MD.

Fig. 30.4 Rhinophyma – early versus advanced disease. A Tortuous, telangiectatic vessels on the distal aspect of the nose contribute to its hyperemic appearance; this hyperemia may predispose to the subsequent hypertrophic changes of rhinophyma. Note the early sign of dilated follicles. B Distortion of nasal tissue due to tissue hypertrophy. Electrosurgery or laser therapy can be used to debulk and resculpt this nose. Courtesy, Frank C. Powell, MD.

Fig. 30.5 Ocular rosacea. A

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Apr 22, 2016 | Posted by admin in Dermatology | Comments Off

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