Common skin condition characterized by facial flushing that may be triggered by a number of factors e.g. alcohol, stress

Aetiology

• Most commonly affects middle-aged women, particularly those with a fair complexion

Pathophysiology

• Not entirely understood; involves chronic inflammation of the skin and is especially associated with triggers that increase body temperature
  • It is believed that both genetic and environmental factors contribute to the disease
  • The immune response to the Demodex mite, a component of the normal human microbiome, has also been implicated

Clinical features

• Recurrent facial flushing
  • Visible blood vessels
  • May occur long before onset of rash
  • Can be triggered by sunlight, alcohol, hot drinks, stress, spicy food

• Rash: erythema with papules and pustules seen on the nose, chin, cheeks and forehead with sparing of naso-labial folds

• Rhinophymatous rosacea: more common in men, this subtype leads to a swollen, bulbous nose with enlarged sebaceous glands and prominent hair follicles
  • The skin becomes erythematous, thickened, scarred, and exhibits a rough, waxy surface

Investigations

• Clinical diagnosis
• When necessary, a skin biopsy can be used to rule out other differential diagnoses e.g. seborrheic dermatitis, acne vulgaris, lupus erythematosus

Management

General measures

• Avoid triggers
• Camouflage creams
• Sun protection