Chapter 053. Eczema and Dermatitis (Part 14)

Acne Rosacea Acne rosacea, commonly referred to as rosacea, is an inflammatory disorder predominantly affecting the central face. Those most often affected are Caucasians of northern European background, but it is seen in patients with dark skin also.
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Chapter 053. Eczema and Dermatitis (Part 14) Chapter 053. Eczema and Dermatitis (Part 14) Acne Rosacea Acne rosacea, commonly referred to as rosacea, is an inflammatorydisorder predominantly affecting the central face. Those most often affected areCaucasians of northern European background, but it is seen in patients with darkskin also. It is seen almost exclusively in adults, only rarely affecting patients Acne rosacea. Prominent facial erythema, telangiectasia, scattered papules,and small pustules are seen in this patient with acne rosacea. (Courtesy of RobertSwerlick, MD; with permission.) There is a relationship between the tendency for facial flushing and thesubsequent development of acne rosacea. Often, individuals with rosacea initiallydemonstrate a pronounced flushing reaction. This may be in response to heat,emotional stimuli, alcohol, hot drinks, or spicy foods. As the disease progresses,the flush persists longer and longer and may eventually become permanent.Papules, pustules, and telangiectases can become superimposed on the persistentflush. Rosacea of very long standing may lead to connective tissue overgrowth,particularly of the nose (rhinophyma). Rosacea may also be complicated byvarious inflammatory disorders of the eye, including keratitis, blepharitis, iritis,and recurrent chalazion. These ocular problems are potentially sight-threateningand warrant ophthalmologic evaluation. Acne Rosacea: Treatment Acne rosacea can be treated topically or systemically. Mild disease oftenresponds to topical metronidazole or sodium sulfacetamide. More severe diseaserequires oral tetracyclines: tetracycline 250–500 mg bid, doxycycline 100 mg bid,or minocycline 50–100 mg bid. Residual telangiectasia may respond to lasertherapy. Topical glucocorticoids, especially potent agents, should be avoided sincechronic use of these preparations may elicit rosacea. Topical therapy of the skin isnot effective treatment for ocular disease. Skin Diseases and Smallpox Vaccination Given the potential threat of a bioterrorism attack with smallpox,vaccinations against smallpox are available to the general public, although they arenot recommended. Because of a higher incidence of adverse events associatedwith smallpox vaccination in patients with a history of certain skin diseases,including atopic dermatitis, eczema, and psoriasis, such vaccination iscontraindicated in patients with these conditions in the absence of a bioterrorismattack and a real or potential exposure to smallpox. In the case of such exposure,the risk of smallpox infection outweighs the risk of adverse events from thevaccine (Chap. 214). Further Readings James WD et al: Andrews Diseases of the Skin Clinical Dermatology, 10thed. Philadelphia, Saunders-Elsevier, 2006 Wolff K, Johnson RA: Fitzpatricks Color Atlas and Synopsis of ClinicalDermatology, 5th ed. New York, McGraw-Hill, 2005 Wolff K et al (eds): Fitzpatricks Dermatology in General Medicine, 7th ed.New York, McGraw-Hill, 2008 Wolverton SE (ed): Comprehensive Dermatologic Drug Therapy.Philadelphia, Saunders, 2001 Bibliography Ellis MW, Lewis II JS: Treatment approaches for community-acquiredmethicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis18:496,2005 [PMID: 16258322] Kowalski TJ: Epidemiology, treatment, and prevention of community-acquired methicillin-resistant Staphylococcus aureus infections. Mayo Clin Proc80:1201,2005 [PMID: 16178500] Krueger JG: The immunologic basis for the treatment of psoriasis with newbiologic agents. J Am Acad Dermatol 46:1, 2002 [PMID: 11756941] Nghiem P et al: Tacrolimus and pimecrolimus: From clever prokaryotes toinhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 46:228,2002 [PMID: 11807435] Peto R, zur Hausen H: Viral Etiology of Cervical Cancer. Banbury Report.Cold Spring Harbor, NY, Cold Spring Harbor Laboratory, 1986