Acne Roseacea

Overview: Acne Roseacea

• Acne rosacea, commonly referred to as rosacea, is a skin disorder that primarily affects individuals older than 30years.

• It is a condition that affects approximately 10% of fair-skinned people and tends to run in families.

• It has a higher prevalence in women and among individuals of northern European descent.

• Although rosacea may some- times appear similar to acne vulgaris and have comparable psychoemotional consequences, the two conditions represent distinct pathophysiologic processes.

Important Points to Consider

• Vitamin A: Given its questionable therapeutic effect and demonstrated potential for toxicity, oral supplementation with vitamin A is not recommended.

• High doses appear to be required for symptomatic control, and hypervitaminosis A has short- and long-term health risks.

• These risks include headaches, myalgias, fatigue, nausea and vomiting, dry skin and mucous membranes, hair loss, hepatitis, reduced bone mineral density, and teratogenicity.

• The topical antimicrobial benzoyl peroxide is unique in that it serves to reduce rather than to increase the antibiotic resistance of P. acnes.

• When it is prescribed in combination with other topical antimicrobials, such as erythromycin and clindamycin, benzoyl peroxide is noted to elevate treatment efficacy significantly and to decrease antibiotic resistance.

Prevention Prescription

• Maintain proper skin care: rinse gently, twice daily with warm water and a non–soap-based cleanser.

• Avoid scrubbing with abrasive materials, oil-based lotions and cosmetics, and picking at acne lesions.

• Reduce psychoemotional stress by getting adequate amounts of sleep and engaging in regular relaxation practices, such as meditation, guided imagery, breathing exercises, and massage therapy.

• Avoid potential environmental triggers such as extremes in temperature as well as dietary triggers that may best be identified by way of a dedicated elimination diet.

Therapeutic Review

Mind-Body Medicine (for acne vulgaris and rosacea)

• Practice stress management and relaxation techniques

Pharmaceutical Preparations (for acne vulgaris and rosacea)

• Azelaic acid: 20% cream or 15% gel, applied topically twice daily for acne vulgaris or rosacea

• Salicylic acid: applied topically one or two times daily for acne vulgaris

• Retinoids: applied topically once nightly for acne vulgaris

• Topical antibiotics (benzoyl peroxide, clindamycin, erythromycin, sulfacetamide, metronidazole) for acne vulgaris and rosacea (see Table 73-1)

• Oral antibiotics (erythromycin, tetracycline, doxycycline, minocycline) for acne vulgaris and rosacea

• Isotretinoin: 0.5 to 1 mg/kg/day, taken orally once or in two divided doses daily for acne vulgaris

Surgical Therapy (for acne rosacea)

• Laser therapy for associated erythema and telangiectasias

• Various surgical techniques for rhinophyma, a consequence of phymatous rosacea

Key Web Sources

• www.rosacea.org

• www.glycemicindex.com

• www.ipledgeprogram.com