Rosaceas

Maria Pia De Padova, Matilde lorizzo, Antonella Tosti 

The author has no financial interest in any of the pr oducts or equipment mentioned in this chapter. 

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It is present in rowan berries and is characteristic of the fruits of the Rosaceae. 

Rosen-geruch, m. rose odor, -gewachse, n.pi. (Bot.) Rosaceae. -holz, n. rosewood, -honig, m. (Pharm.) honey of rose, -kohl, m. Brussels sprouts, -konserve, /. (Pharm.) confection of rose, -kranz, m. rosary rose garland. 

Isotretinoin COOH Topical 0.05% cream Oral 0.251.0 mg/kg/ d Cystic acne, recalcitrant nodular acne Rosacea gram-negative folliculitis pyoderma faciale hidradenitis suppurativa cancer prevention... 

Given these findings, indications for salicylic acid peels include acne vulgaris (inflammatory and non-inflammatory lesions), acne rosacea, melasma, post-inflammatory hyperpigmentation, freckles, lentigines, mild to moderate photodamage, and texturally rough skin. 

Fig. 6.6a,b. Acne rosacea before and after three salicylic acid peels, moderate improvement... 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

The etiology and pathogenesis of rosacea are not well established and there are no histologic or serologic markers for the disease. 

The pathogenesis of rosacea is multifactorial. Vascular hyperactivity is the primary phenomenon that is complicated by inflammatory changes. Endocrine, psychological, pharmacological, immunological, infectious, thermal and alimentary factors contribute to produce vascular instability and tissue damage (Fig. 17.1). The role of Helicobacter pylori is still being discussed. 

The erythema of rosacea is caused by dilatation of the superficial vessels of the face. Visualization of the dermal capillaries is favored by skin atrophy due too photoaging. Edema can develop as a result of the increased blood flow in the superficial vessels. This edema might contribute to the late stage of fibroplasia and rhinophyma. 

Rosacea is a chronic inflammatory disorder that typically affects the central facial area. 

Rosacea is quite common, especially in middle-aged women. The disorder is frequently seen in the elderly and occasionally during childhood. It is most frequently observed in patients with fair skin, but it can also affect Asians and African Americans. 

Clinically, rosacea presents with different degrees of severity, ranging from facial erythema to evident inflammatory lesions. Symptoms of rosacea include skin dryness and sensitivity, stinging and burning [1]. 

The granulomatous variant of rosacea is characterized by papular and nodular lesions that affect the cheeks and periorificial areas (Figs. i7.9> 1710,1711 and 17.12). 

Rosacea may rarely affect the non-facial skin, especially the scalp, the neck and the shoulders. 

Skin conditions share some clinical features with rosacea ... 

An important step in the treatment of rosacea is the avoidance of factors that could cause a flare-up of the flushing through vasodilation (Table 17.1). Topical steroids are absolutely contraindicated in rosacea. 

Topical retinoic acid has been shown to have a beneficial effect on the vascular component of rosacea (0.025-0.05% cream once a day) [7]... 

Topical 5% vitamin C preparations have recently been evaluated in the erythematous stage of rosacea [8]... 

Systemic treatment of erythrosis finds its rationale in the association of rosacea with H. Pylori infection. The following scheme has heen suggested clarithromycin 250 mg twice daily + metronidazole 400 mg twice daily clarithrom-... 

Salicylic acid peelings performed at 3- to 4-week intervals are a good choice for patients with rosacea. Salicylic acid peeling has antimicrobial activity, reduces erythrosis and prevents relapses. 

In papulo-pustular rosacea 25-30% salicylic acid peeling is utilized in association with systemic treatment with metronidazole or antibiotics and topical treatment as for erythrosis (Figs. 1715,1716 and i/.i/)-... 

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