Rosacea — Clinical Case (Wikimedia Commons)

Diagnosis: Rosacea

Coniferous Forest Set. Clinical photograph sourced from Wikimedia Commons (CC BY 2.0). Attribution: YVC Biology Department.

Clinical Presentation

Central facial erythema with telangiectasia, papules, and pustules (no comedones — distinguishes from acne). Flushing episodes. Phymatous changes with sebaceous hyperplasia in advanced cases. Ocular symptoms: grittiness, burning, blepharitis.

Clinical History

Typical onset 30-50 years, more common in fair-skinned individuals (Celtic heritage). Triggers: sun, heat, spicy food, alcohol, emotional stress, hot beverages. May have ocular symptoms preceding skin findings.

Treatment

General: trigger avoidance, sun protection, gentle skincare. Papulopustular: topical metronidazole, ivermectin, azelaic acid; oral doxycycline. ETR: brimonidine gel, oxymetazoline. Phymatous: isotretinoin, surgical/laser reshaping.

Differential Diagnosis

Acne vulgaris, Seborrheic dermatitis, Lupus erythematosus, Perioral dermatitis, Carcinoid syndrome, Polycythemia vera

Key Learnings

The absence of comedones helps distinguish rosacea from acne. Demodex density is increased in rosacea — ivermectin has anti-Demodex and anti-inflammatory properties. Ocular rosacea may require ophthalmology co-management.

Tags: rosacea, inflammatory, facial, erythema, telangiectasia