Rosacea symptoms vary widely

Written by on May 15, 2008 with 0 Comments

From: ruizdelvizo
Date: Mon, 5 Jul 1999 16:38:06

Sorry to be posting these articles from the Medscape site, but I found another one on different types of rosacea.  I know we’ve had that debate on bumps vs. zits lately, but according to this you can have both with rosacea.  You also can get rosacea on the back of your neck!  I do get bumps back there, so it makes sense.  Anyway, here’s the article:

From Skin & Allergy News
Rosacea Presents in Many Different Ways
Sherry Boschert, San Francisco Bureau

Skin & Allergy News 30(6):42, 1999. © 1999 International Medical News Group.

MAUI, HAWAII — Every dermatologist can recognize rosacea, but few dermatologists will recognize every case of rosacea.

Classic rosacea appears in fair-complected women aged 40 years or older, giving them the tell-tale flushing, blushing, telangiectasia, and inflammatory lesions in the central portion of the face.

Less commonly, rosacea occurs in both men and women from adolescence to old age and in skins of different colors, particularly in Mediterranean or African American people, Dr. Joseph B. Bikowski said at the annual Hawaii dermatology seminar sponsored by the Skin Disease Education Foundation. Fifty percent of patients with rosacea may have eye involvement presenting as blepharitis, conjunctivitis, and keratitis independent of the severity of the facial rosacea.

Think of ophthalmic rosacea even when only subtle clues are present, such as edema or erythema of the upper and lower eyelids. Some patients’ sole complaint may be gritty, dry eyes with few, if any, clinical findings, he added.

A hordeolum, or sty (stye), may be associated with rosacea; look for ancillary papules and pustules on other parts of the face to help make the diagnosis, said Dr. Bikowski, a private practice dermatologist in Sewickley, Pa.

The disease may be localized to one area of the face in a form he called "plaque rosacea." Old medical textbooks described the papules and pustules on the scalp, usually seen in elderly men, as acne necrotica, but this too is rosacea, Dr. Bikowski added.

Rosacea may affect the nape or the lateral aspects of the neck. The papules and pustules may resemble those of scabies, insect bites, or pseudofolliculitis barbae.

Isolated inflammatory papules of rosacea may appear on the shoulders, back, or even midchest, looking like seborrheic dermatitis, he said at the meeting, also sponsored by the Cleveland Clinic Foundation.

The classical diffuse, soft edema associated with rosacea may be replaced by hard edema. Look for swelling in the forehead, glabella, eyelids, nose, or cheeks or for a recently recognized variant called "rosaceous lymphedema," Dr. Bikowski said.

The erythema and inflammatory lesions, while usually moderate in severity, may range from mild to severe, from a few isolated pustules to large nodules, and with erythema so severe it mimics other flushing diseases. On the other hand, just the slightest amount of flushing and blushing may be the first signs of early rosacea.

Rosacea is well known to cause rhinophyma, particularly in men, but it also can produce a phyma of the chin, forehead, eyelids, or earlobes.  Dr. Bikowski described a "pseudorhinophyma" to watch out for, seen in some men who wear thick, heavy glasses that constrict blood flow.  Switch the patient to glasses with silicon nose pieces and within a month the edema, erythema, and swelling of the nose should disappear.

Four unusual types of rosacea are more difficult to recognize: lupoid or granulomatous rosacea, with brown-red papules and nodules on the lower eyelids; Gram-negative rosacea, with multiple tiny yellow pustules; rosacea conglobata, with hemorrhagic nodular abscesses; and rosacea fulminans, with coalescent inflammatory nodules and purulent drainage from sinuses.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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