acne rosacea

Introduction

chronic inflammatory red rash mainly involves the central face in 30-80 yr olds but can arise in younger patients
10% of population develop rosacea and of these, 60% develop ocular rosacea

in women, it seems that drinking white wine or liquor may trigger onset of it while drinking red wine can trigger flare ups but not trigger onset ¹⁾:
- 1-3 glasses white wine / month = 14% risk of developing rosacea
- >5 glasses white wine / wk = 49% risk of developing rosacea
- liquor = 8-28% risk of developing rosacea

characterised by erythema, flushing, +/- papules but no blackheads
may be transient, recurrent or persistent
4 main sub types:
- Erythematotelangiectatic Rosacea (facial flushing)
- Papulopustular Rosacea (papules and pustules)
- Phymatous Rosacea (enlarged nose leading to rhinophyma)
- Ocular Rosacea (inflamed eyes) - see blepharitis / dry eyes

avoid all UV light
avoid heat and other causes of vasodilatation such as exercise, alcohol, spicy foods, etc
avoid oil-based creams
avoid topical steroids
inflammatory lesions may be Rx with low dose tetracycline antibiotics, or long term low dose isotretinoin (Roaccutane)
- topical ivermectin and encapsulated benzoyl peroxide appears to be better than topical metronidazole according to a 2026 study
troublesome flushing may be helped by clonidine (Catapres) or beta adrenergic blockers
ocular rosacea is generally treated with oral antibiotics to prevent serious ocular complications:
- eg. oral azithromycin 1 g each week for 3 weeks every 3-4 months

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