DEPARTMENT OF DERMATOLOGY & VENEREOLOGY

FACULTY OF MEDICINE
UNIVERSITAS HASANUDDIN

ACNE ROSACEA
Wahyudi C011171381
Rifah Hijriyani Fahmi C011171578
Angie Ramadhani Koedoeboen C011171801
Shawnee Priscilla Sie XC061201128

Supervisor:
Resident:
dr. Idrianti Idrus, Sp.KK,
dr. Nahda Yaumil C. Haq
M.Kes
DEFINITION

Rosacea is a chronic inflammatory disease accompanied by a range of

facial skin manifestations, including redness, non-transient erythema,
papules/pustules, telangiectasia, and phymatous changes. Secondary
manifestations, such as itching, burning, or stinging, are frequently
observed in patients with rosacea.

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
EPIDEMIOLOGY

• Worldwide distribution of 5%, especially in low photo type populations

(I and II in the Fitzpatrick classification)
• Slight female predominance
• Age of 30 to 60 years
• May affect both white and black races Sweden (10%)
Russia (5%)
Germany (12%)
Estonia (20%)
France (3%)
United States (5%)

Columbia (3%)
ETIOLOGY

Infectio
Food Drugs
n
Immunologic
al

Other factors:
Vitamin deficiency
Weather Hormonal imbalance
PATHOGENESIS

Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th Ed. United States of America: Elsevier Limited;
CLINICAL MANIFESTATIONS

• A symmetric skin disease

• Locations: central face, nose, chin, central cheeks, glabella, forehead (more
common in bald men), neck and trunk (rare).
• Clinical features:
 Flushing
 Transient erythema
 Persistent erythema
Rosacea presentation with centrofacial
 Telangiectasia redness due to both lesions and background
 Phymata erythema

 Papules and pustules

 Ocular rosacea

Johnson SM, Berg A, Barr C. Managing Rosacea in the Clinic: From Pathophysiology to Treatment – A Review of the Literature. Journal of Clinical and Aesthetic Dermatology. 2020;13 (4 Suppl
Flushing – pathophysiological neurovascular process in the
central face for >5-10 minutes

Transient Erythema – prolonged unphysiological flushing

that persists for >5 minutes but for no >3 months

Persistent Erythema – erythema that lasts for at least 3

months; an abnormal redness of the skin or mucous Flushing & Transient Persistent Erythema
membranes caused by vasodilatation of arterioles or Erythema
capillaries

Telangiectasia – a permanent visible dilated blood vessel on

the skin or mucosal surface

Papules and pustules – mostly small, low pain, dome shaped,

Papules and Pustules
and red in color, present as multiples.
Telangiectasia

Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. 9th Ed. West Sussex: John Wiley & Sons, Ltd; 2016.
Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
Phymata – a persistent, firm, nonpainful, nonpitting
swelling of the tissue of the nose, chin, forehead, or eyelids.

Ocular rosacea – involves the eyelids, eyelashes, or eyes.

(+) foreign body sensation of itching, burning, and stinging
in the eyes. Ocular Rosacea
Rhinophymata

Rosacea conglobate – a rare, chronic, and severe form of

rosacea resembling acne conglobate with hemorrhagic
nodular abscesses and indurated plaques on erythematous
background.

Rosacea fulminans – a rare, acute or subacute variant of

rosacea with acne conglobate-like progression.

Rosacea Fulminans
Rosacea Conglobate

Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. 9th Ed. West Sussex: John Wiley & Sons, Ltd; 2016.
James, WD, Berger TG, Elston DM. Andrew’s Diseases of the Skin Clinical Dermatology. 11th Ed. United States of America: Elsevier Inc.; 2011.
Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th Ed. United States of America: Elsevier Limited; 2018.
DIAGNOSIS

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
DIFFERENTIAL DIAGNOSIS

Acne Vulgaris Lupus Erythematosus Seborrheic Dermatitis

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education;
2019.
Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th Ed. United States of America: Elsevier Limited; 2018.
 Perioral Dermatitis

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education;
2019.
Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th Ed. United States of America: Elsevier Limited; 2018.
TREATMENT

• A characteristic of rosacea is the sensitivity of the skin on the face with vascular hyperactivity.
• Many patients complain of sensitivity to cleaning materials and cosmetics.
• The patients need to be educated about trigger factors and ways to care for the skin in general as a step
to maintain skin integrity in the long term and for successful treatment.
Topical Therapy
• Tetracycline, Clindamycin, Erythromycin ointment 0,5-2,0%
• Metronidazole 0.75% gel or cream effective for papules and pustules
• Imidazole itself or with ketoconazole or Sulphur 2-5%
• Isotetrinoin cream 0,2%
• Anti-parasite to kill D. folliculorum, for example: Lindane, Crotamiton, benzyl benzoate.
• Low potency corticosteroids (Hydrocortisone 2%)
Systemic Therapy

• Tetracycline, Clindamycin, Erythromycin

• Isotretinoin
• Metronidazole 2 × 500 mg/day – Effective when discovered early
 Symptom manifestation-dependent therapy regimen in rosacea

Medicinal
Patient Physical
Symptoms Maintenance
Management Approved Off Label Interventions

Flushing/ General measures:

Beta blockers, e.g.
transient • Patient education Oxymetazoline cream 1%
carvedilol
erythema • Avoidance of
triggers Systemic therapy: • IPL Low-dose
• Sun protection • Beta blockers, e.g. • Laser antibiotics:
• Skin care Topical therapy: carvedilol • Minocycline 50
Persistent • Doctor-patient • Brimonidine 3 mg/g mg twice weekly
erythema relationship • Oxymetazoline cream 1% Low-dose antibiotics:
• Minocycline 50 mg
every other day

• IPL
Telangiectasia
• Laser

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
 Medicinal
Patient Physical
Symptoms Maintenance
Management Approved Off Label Interventions

Papules and General measures: Mild-Moderate Mild-Moderate Topical therapy:

pustules • Patient education Topical therapy: Topical therapy: • Ivermectin 10 mg/g
• Avoidance of • Ivermectin 10 mg/g • Permethrin • Azelaic acid 150
triggers • Azelaic acid 150 mg/g • Benzyl benzoate mg/g
• Sun protection • Metronidazole 7,5 mg/g • Retinoids • Metronidazole 7,5
• Skin care • Calcineurin-inhibitors mg/g
• Doctor-patient
relationship Moderate-Severe Moderate-Severe
Topical Therapy: Systemic Therapy:
• Ivermectin 10 mg/g • Low-dose isotretinoin
Systemic Therapy: • Doxycycline
• Low-dose, modified • Tetracycline
release doxycycline 40 mg • Azithromycin
In severe and/or treatment- • Clarithromycin
resistant rosacea: In severe and/or
• Combination of topical treatment-resistant
and/or systemic anti- rosacea:
inflammatory therapy • Combination of topical
and/or systemic anti-
inflammatory therapy

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
 Medicinal
Physical
Symptoms Patient Management Maintenance
Approved Off Label Interventions

General measures: Systemic therapy: • Ablative laser

• Patient education • Low-dose isotretinoin • Surgical
Connective • Avoidance of triggers intervention (e.g.
tissue/sebaceous • Sun protection dermabrasion or
hyperplasia • Skin care tangential excision)
• Doctor-patient
relationship

Systemic therapy:
• Doxycycline: low-dose
(40 mg) or conventional
dose
• Eyelid hygiene • Low-dose isotretinoin
Ocular Rosacea • Artificial, lipid-
containing tears Topical therapy:
• Cyclosporin A
• Azithromycin
• Tetracycline
• Steroids

Kang S, Amagai M, Bruckner AL, et.al. Fitzpatrick’s Dermatology. 9th Ed. United States: McGraw-Hill Education; 2019.
Non-pharmacologic Therapy

• Maintaining skin moisture by using moisturizers

• Avoid diet trigger factors
• Avoid foods or drinks that are the trigger factors (alcohol, spicy foods, hot drinks, chocolate, processed meats); A
study shows the benefits of omega-3 fatty acids in ocular rosacea patients.
• Avoiding cigarettes and alcohol
• Using sunscreen at least SPF 30
• Avoid the use of cosmetics containing alcohol, menthol, fragrance, eucalyptus oil, waterproof, and heavy foundation
because it is difficult to remove without causing irritation
• Avoid the use of towels to dry the face
• Avoid rubbing the face
PROGNOSIS

• Rosacea has varying clinical symptoms, ranging from persistent facial redness, flushing, telangiectasia,
papules or pustule, hypertrophy, and ocular symptoms.
• A 2016 Korean study assessed the prognosis of 234 rosacea patients: 120 mixed types, 75 ETR types,
and 39 PPR types. 14 prognosis was assessed after 2 to 72 months. Total remission was obtained at
20.9% (total 49 patients, 23 mixed subtype patients, 8 types of ETR, and 18 types of PPR) with an
average time of 56 months.
CONCLUSION

• Rosacea is a chronic inflammatory skin disease that mainly attacks the cheeks, nose, chin, and forehead.
• Rosacea is characterized by recurrent episodes of flushing or temporary erythema, persistent erythema, phymatous
changes, papules, pustules, and telangiectasia. The eyes may also be involved.
• Because rosacea affects the face, the disease has a profound negative impact on quality of life, self-esteem, and well-
being.
• Topical treatments form the foundation of rosacea therapy and can be highly efficacious in reducing lesions and
decreasing the intensity of erythema. It may also help manage secondary rosacea symptoms. In addition, general
measures, such as avoiding triggers and patient education on proper skin care, work together with rosacea
medications to enhance outcomes.
THANK YOU