Rosacea and Related Disorders

Introduction

The term “ rosacea ” encompasses a constellation of clinical findings, with the key components being persistent facial erythema and inflammatory papulopustules. Additional features are facial telangiectasias, a tendency for frequent facial flushing (sometimes referred to as “pre-rosacea”), non-pitting facial edema with erythema, ocular inflammation, and phymatous changes. The latter predominantly affect the nose and rarely the ears, forehead, chin, or eyelids. In 2002, rosacea was classified into four clinical subtypes : (1) erythematotelangiectatic; (2) papulopustular; (3) phymatous; and (4) ocular.

There is also a granulomatous variant in which more monomorphous and persistent skin-colored to dull red–brown facial papules are seen. Some authors consider rosacea conglobata , characterized by an eruption of inflammatory cystic lesions that heal with scarring and rosacea fulminans (pyoderma faciale) to be within the rosacea spectrum. In rosacea fulminans, an explosive onset of inflammatory papules and pustules is superimposed on a background of facial erythema, usually occurring in young women and sometimes during pregnancy .

History

Robert Willan is credited with the earliest medical descriptions of “acne rosacea”, detailing what is nowadays classified as papulopustular rosacea . Like acne vulgaris, rosacea was originally thought to have a “seborrheic” pathogenesis. It was Radcliff-Crocker who later postulated that repeated flushing leads to dilated leaky facial blood vessels with subsequent inflammatory skin changes.