ROSACEA AND PERIORAL DERMATITIS
The commonest cause of a rash on the face is acne, typically in adolescents. Two other common causes of an embarrassing facial rash in adults are rosacea and perioral dermatitis.
What is rosacea?
Rosacea is an acne-like inflammation of the skin of the face, of unknown cause. It causes red flushing with small, red, raised bumps (papules) and, sometimes, pus-filled spots (pustules). It tends to come and go.
What are typical features of rosacea?
involves the cheeks, nose, forehead and chin
• mainly occurs between 30 to 50 years of age
• more common in women
• the nose can enlarge, especially in men
• may be tender
• can affect the eyes It is aggravated by:
• excessive sun exposure
• hot drinks
• hot and spicy foods that induce flushing
• alcohol to excess
• corticosteroid creams, especially fluorinated ones
What is a treatment principles?
Avoid or reduce aggravating factors.
• Avoid oil-based make-up.
• Your doctor may prescribe an ointment or gel.
• Take antibiotics by mouth for 8 to 10 weeks.
Individually prescribed peels, mesotherapy, laser.
Treatment for facial flushing?
There is no medicine that can prevent or stop flushing. However, some people find that certain things aggravate the skin and trigger flushing or make the flushing worse. The most common things reported that may trigger the skin to flush are: extremes of temperature (in particular, excessive heat), alcoholic drinks, strenuous exercise, stressful situations, sunlight, spicy food, hot drinks. If any of these seem to trigger bouts of flushing, or make the flushing worse, then avoiding them is sensible. Some medicines used for other conditions may also trigger flushing – for example, calcium-channel blockers. If you suspect that a medicine is making the flushing worse, then discuss this with your doctor. An alternative medicine may be available.
Treatment for facial redness (erythema) and telangiectasia (tiny blood vessels)?
There is little evidence that medication has any effect on clearing erythema or telangiectasia. However, a treatment for spots (listed below) may be advised to prevent spots from developing if you have persistent erythema. Also, people with erythema often have sensitive skin which can make erythema worse. Therefore, it is best to avoid using anything that may sensitise the skin. For example, cleansers containing acetone or alcohol, abrasive or exfoliant preparations, oil-based or waterproof make-up, perfumed sunblocks, or those containing insect repellents. Camouflage creams can help to cover and conceal erythema and telangiectasia. (The British Red Cross provides cosmetic camouflage clinics free of charge – see address below.) Another option which is becoming more popular is light or laser therapy. Briefly, a laser or very bright light of a certain wavelength can destroy tiny blood vessels under the skin but without damaging the nearby tissue. This can remove telangiectasia and improve erythema. Your doctor or skin specialist will advise if this is an option for you.
What is a treatment for spots and cysts (pustules and papules)?
Certain antibiotics are the usual treatment. They usually work well, but it is not clear why they work, as there is no proven bacterium (germ) that causes rosacea. Some antibiotics reduce inflammation in the skin as well as killing bacteria and this may be why they work for rosacea. A topical (rub-on) antibiotic called metronidazole is the common treatment if you have just a few small spots. If you have many spots or cysts then antibiotic tablets such as a tetracycline or erythromycin may be used. Some improvement may occur after 2-3 weeks of treatment. However, it commonly takes a 6- to 12-week course of antibiotics to clear spots and cysts. One reason why antibiotic treatment fails is that some people give up on treatment after a few weeks without completing the full course. When a course of antibiotic treatment is finished, the spots or cysts commonly return at some point. Therefore, repeated courses of treatment may be needed from time to time. As an alternative, once the spots have cleared, some people take a regular maintenance dose of antibiotics or use a topical antibiotic (regularly or intermittently) long-term to prevent the spots and cysts from returning. Topical azelaic acid is an alternative to topical antibiotics to treat mild-to-moderate spots. However, some people find that it can cause side-effects such as burning, stinging, itching, scaling, and dry skin. If you do not respond to any of these treatments, other therapies are sometimes tried in specialist clinics.
What are risks?
• It is harmless but tends to recur.
• It may clear up spontaneously in time.
• The best treatment is oral antibiotics, e.g. tetracyclines, but it is not an infection
What is perioral dermatitis?
It is an acne-like, scaly dermatitis of the lower face and may be a type of seborrhoea. It also has redness, papules and maybe pustules. The cause is not clear but it seems to be related to rosacea. Flushing occurs commonly. It tends to come and go. It is not a serious condition.
• involves the area around the lower nose and mouth and chin
• mainly affects young women It is aggravated by: • topical corticosteroids, especially fluorinated ones • pregnancy • oral contraception
What is the treatment?
• The best treatment is a course of antibiotics such as tetracyclines taken by mouth for 6 or 8 weeks.
• Sometimes topical ointments may be prescribed for mild cases.
• There is no special diet.