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    Rosacea is a chronic inflammation of the central face characterized by flare-ups, flushing, erythema, telangiectasia, lesions with papules/pustules and possible remission and relapse conditions. It has been conventionally defined by a certain age or period for its occurrence but as we have seen in many cases there is no typical age for its occurrence. It also has been correlated with certain ethnic background and skin types particularly fair skinned people but now it is found affecting people of all different backgrounds and skin of color people. Infact diagnosis of rosacea is very challenging and difficult in skin of color. The underlying cause of rosacea includes aberrant immune system, environmental factors, genetics and most importantly microbial flora of our skin. Sometimes only one factor predominantly plays its part and sometimes all the factors play together to cause an inflammatory response in rosacea. It mostly affects women but causes very severe form in men in cases of rhinophyma. Rosacea is a condition which in some cases co-exists with different other skin conditions and ocular manifestations and may present comorbidities with other parts of the body especially correlating with intestinal inflammation. There are further theories with this condition and more yet to explore which needs further investigation.

    According to the classification based on phenotypical characteristics, we will explore the characteristic patterns of each phenotype going deeper into skin.

    Flushing in Rosacea [Phenotype 1] :

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    Flushing is usually but not always the earliest sign of rosacea which is marked by the redness of the skin with persistent episodes. Though the redness is caused by the dilation of the blood vessels beneath the skin but in its initial level, the early signs of flushing do not show the typical visible blood vessels appearing immediately. Flushing is characterized by a sudden feeling of warmth, tender, stinging, dry and itchiness of the skin. In this stage you can see your pores are very little enlarged contrasting to its natural state and are restored to its natural state when the flushing disappear. It depends on its frequency and comes and goes on its own but with physical responses such as stress and stress of their own flushing, anxiety, fear and other emotional states, it prolongs its time to disappear. Some people only show the flushing condition and never develop the other phenotypes of rosacea but for some people it is the onset and early sign of rosacea which furthers down to other phenotypes appearing at later stages. We will consider the other phenotypes later to delve into a deeper understanding of rosacea.

    You can read earlier post on phenotypes to know about characteristics and other information.

    Written and Illustrated by Apurva Tathe

  • Posts

    • "Facial flushing,  telangiectasias, inflammatory papules and pustules, facial burning/stinging sensation, skin dryness, edema, and ocular manifestations are characteristics of  rosacea." Dermatol Online J. 2020 Feb 15;26(2): Full text The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders. Saric-Bosanac S, Clark AK, Sivamani RK, Shi VY
    • "Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors." Dermatol Ther. 2020 Apr 10;:e13394 Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome? Dursun R, Durmaz K, Oltulu P, Ataseven A
    • "In each species, clinical and molecular studies have shown that the host's immunological interactions with Demodex mites are an important, but not fully understood, aspect of how Demodex can live in the skin either as a harmless commensal organism or as a pathogenic agent." J Eur Acad Dermatol Venereol. 2020 Apr 15;: Demodex: A skin resident in Man and his best friend. Foley R, Kelly P, Gatault S, Powell F
    • Subungal Discoloration with Hemotoma or Disease A subungal discoloration usually is associated with a hematoma on finger or toe nails. [1] There are numerous images associated showing this available in a google search. However, subungal discoloration can be associated with disease. "Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration." [2] Subungal Discoloration with Tetracycline Long Term Use The authors of one paper on this subject explain that it is important to let patients know that long term use of tetracyclines, i.e., doxycycline, minocycline, for rosacea this subungal discoloration may be one of the side effects and risks. The report states, "We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms." [2] End Notes [1] Subungual hematoma, Wikipedia [2] Cureus. 2020 Apr 24;12(4):e7810 Out of the Blue: A Case of Blue Subungual Discoloration Associated with Prolonged Tetracycline Use. Ahmad Y, Boutros H, Hanna K
    • "Head-to-head trials show that azelaic acid and ivermectin might be slightly better than metronidazole." Topical treatments for rosacea. Can Fam Physician. 2019 Nov;65(11):803 Fritsch P, Kolber MR, Korownyk C
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