bubble_chart Overview

Rosacea, also known as acne rosacea or acne erythematosa, is a diffuse facial redness, particularly in the central area of the face, accompanied by papules, pustules, and telangiectasia.

bubble_chart Etiology

The cause of the disease is not yet fully understood. It may occur on the basis of seborrhea, where various harmful factors inside and outside the body lead to dysfunction of the vasomotor nerves in the affected area, resulting in long-term dilation of capillaries. Factors such as alcohol consumption, smoking, irritating diets, digestive tract disorders, endocrine dysfunction (especially during menopause), psychological factors, focal infections, cardiovascular diseases, intestinal parasites, and prolonged exposure to temperature extremes (e.g., high-temperature work environments, sun exposure, cold, wind, etc.) can all trigger or worsen the condition.

Recently, some domestic researchers have proposed that 100% of rosacea cases are caused by Demodex mite infections, suggesting that rosacea be renamed "Demodex dermatitis." Although this claim remains controversial and requires further validation, we believe that Demodex mites are one of the causes of rosacea, and for some cases, they may even be the sole cause. Demodex mites often reside in enlarged facial hair follicles, with several mites clustering together, particularly in erythematous papular or pustular lesions, where they are easily detected. In China, metronidazole is commonly used to treat rosacea, as it is believed to have a killing effect on Demodex mites. The author has also tested this treatment on several cases, observing that erythematous papules or pustules can diminish or heal within a few days.

bubble_chart Pathological Changes

Histopathology:

1. Erythematous stage Dilation of capillaries in the skin and hair, with nonspecific inflammatory infiltration around the blood vessels.

2. Papule and pustule stage The histopathology of papules shows nonspecific chronic inflammatory infiltration, often with clustered epithelioid cells visible in the center of the infiltration. The histological appearance of pustules is characterized by the aggregation of neutrophils within the hair follicles.

3. Rhinophyma stage The pathological changes include epidermal proliferation, increased and markedly hypertrophic sebaceous glands. The majority of the dermis is occupied by sebaceous glands. There is hyperplasia and thickening of connective tissue, dilation of capillaries, and a grade I inflammatory reaction.

bubble_chart Clinical Manifestations

This disease commonly occurs in the central part of the face, primarily on the tip and wings of the nose, followed by the cheeks, chin, and forehead. It is often symmetrically distributed, mostly affecting middle-aged individuals, with a higher incidence in women. Many patients also experience seborrhea, giving the face an oily appearance. The skin lesions manifest as erythema, telangiectasia, and inflamed follicular papules and pustules. The course of the disease is slow and can be divided into the late stage [third stage], though the boundaries between stages are not clearly defined.

1. Erythematous Stage: The local skin shows diffuse flushing or scattered erythema, initially transient and intermittent, but with repeated occurrences, it becomes persistent and eventually permanent. The skin in the affected area becomes oily, with dilated capillaries and small blood vessels, particularly noticeable on the tip and wings of the nose, appearing in a branching pattern. Sometimes, the telangiectasia is more pronounced than the flushing, and vice versa.

2. Papule and Pustule Stage: As the condition progresses, batches of follicular acne-like papules and pustules appear on the erythematous base, but without the formation of acne. This is especially severe on the tip of the nose, where telangiectasia becomes more pronounced, forming a crisscrossing spiderweb-like pattern. A few cases may concurrently develop conjunctivitis or blepharitis.

3. Rhinophyma Stage: In longstanding cases, due to hyperplasia and hypertrophy of the sebaceous glands and connective tissue, along with vascular dilation, the tip of the nose becomes enlarged, forming nodular protrusions of varying sizes, known as rhinophyma. The surface is uneven, with visibly enlarged sebaceous gland openings that exude white, sticky sebum when squeezed. The capillaries are significantly dilated.

bubble_chart Treatment Measures

Avoid alcohol and irritating foods, eliminate foci of infection, correct gastrointestinal disorders and endocrine imbalances, prevent constipation, and avoid local exposure to excessive cold or heat.

1. Internal Medication

(1) Vitamin B complex preparations, such as vitamin B₂, B₆, and compound vitamin B.

(2) Chloroquine 0.25g, twice daily for 2 weeks, then reduce to 0.125g daily for 1–2 months, not exceeding 3 months.

(3) Metronidazole 0.2g, three times daily for 2–4 weeks, suitable for papule and pustule lesions with detected Demodex mites.

(4) For prominent papule and pustule lesions, oral antibiotics such as tetracycline 0.25g, 2–4 times daily for 4 weeks, then reduced to 0.25g once daily for 3–6 months. Other antibiotics like erythromycin or minocycline may also be used.

2. Topical Treatment

(1) Commonly used sulfur-containing preparations, such as compound sulfur lotion or white lotion, or the following prescriptions:

Sulfur 4g, zinc sulfate 4.5g, potassium polysulfide (sulfurated potash), rose water up to 100mL.

Sulfur 7g, glycerin 3g, alcohol 12mL, water 40mL, lime water up to 100mL.

Sulfur 6g, resorcinol 3g, zinc oxide lotion up to 100mL.

Sulfur 5g, ichthammol 10g, zinc oxide 10g, glycerin 15g, water up to 100mL.

Resorcinol 5g, camphor 5g, ichthammol 5g, sulfur 10g, soft soap 20g, zinc oxide paste or compound zinc paste up to 100g. Alternatively, apply 30–40% sodium thiosulfate solution and 3% hydrochloric acid solution alternately to the face. Note: Always apply the sodium thiosulfate solution first, wait 3–5 minutes until dry, then apply the 3% hydrochloric acid solution.

(2) Chloramphenicol-salicylic acid tincture (chloramphenicol and salicylic acid in 75% ethanol).

(3) 10% metronidazole cream or gel, etc.

3. Physical Therapy

(1) Electrolysis is suitable for small areas of telangiectasia.

(2) Cryotherapy is suitable for the rhinophyma stage.

bubble_chart Differentiation

1. Acne is mainly seen in adolescence. In addition to affecting the face, the lesions often involve the chest and back, presenting with typical acne, while the nose is usually unaffected.

2. Facial eczema manifests as polymorphic lesions with intense cutaneous pruritus, without capillary or follicular orifice dilation. Eczematous lesions are also commonly found on areas other than the face.

3. Discoid lupus erythematosus presents as well-defined peach-red or bright red patches with central depression and atrophy, follicular keratotic plugs, and often covered with adherent nail-plate-like scales. The lesions are typically distributed in a butterfly pattern. {|102|}