Skin-nontumor - Acne rosacea

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Skin-nontumor

Other dermatoses

Acne rosacea

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 26 August 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Common chronic dermatosis with erythema of central face, acneiform pustules and papules, telangiectasia and blepharitis (Am Fam Physician 2009;80:461)

Terminology
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● Also called rhinophyma

Clinical features
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Exists in five clinical forms:
● Erythematous, telangiectatic type (70% of cases)
● Papulopustular type
● Granulomatous type
● Hyperplastic glandular type (phymatous rosacea, which results in irregular, bulbous enlargement of the nose; the condition known as rhinophyma)
● Ocular disease

● May be associated with abnormal TLR2 (toll like receptor 2) expression, which leads to a calcium-dependent release of kallikrein 5 from keratinocytes, which may cause rosacea (J Invest Dermatol 2011;131:688)

Treatment
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● Topical metronidazole is well tolerated and efficacious for moderate to severe papulopustular rosacea
● Also topical azelaic acid, azithromycin (once daily), minocycline (40 mg dose)
● Pimecrolimus 1% cream is effective and well-tolerated treatment for steroid-induced rosacea

Clinical images
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Various images

Micro description
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● Perinfundibular, lymphocytic or granulomatous inflammation
● Occasional plasma cells, an important clue for the diagnosis
● Variable features: mild dermal edema, solar elastosis, mild perifolliculitis
● Sebaceous gland hypertrophy and scattered follicular plugging are present in most cases of rhinophyma
● Papulopustular lesions have a more pronounced inflammatory infiltrate which is both perivascular and peripilar, involving the superficial and mid-dermis; infiltrate may include a few neutrophils, as well as lymphocytes and plasma cells; Demodex mites are present in 20–50% of cases
● Granulomatous form is usually characterized by a tuberculoid reaction, often in the vicinity of damaged hair follicles; necrosis (resembling caseation) was present in 11% of patients in one series

Micro images
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Various images

Virtual slides
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Rhinophyma

Positive stains
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● Direct immunofluorescence occasionally shows immunoglobulins and complement at dermoepidermal junction

Additional references
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● eMedicine

End of Skin-nontumor > Other dermatoses > Acne rosacea

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