Skin nontumor

Other diseases of skin appendages


Last author update: 1 July 2011
Last staff update: 26 February 2024

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PubMed Search: Acne rosacea

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Rosacea. website. Accessed May 19th, 2024.
Definition / general
  • Common chronic dermatosis with erythema of central face, acneiform pustules and papules, telangiectasia and blepharitis (Am Fam Physician 2009;80:461)
  • Also called rhinophyma
Clinical features
  • Exists in 5 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)
  • 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

Microscopic (histologic) description
  • 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
Microscopic (histologic) images

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Dermis of a patient with rosacea

Positive stains
  • Direct immunofluorescence occasionally shows immunoglobulins and complement at dermoepidermal junction
Additional references
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