Skin-nontumor / Clinical dermatology
Other dermatoses
Acne rosacea

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 17 June 2016, last major update July 2011

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PubMed Search: Acne rosacea [title]

Cite this page: Acne rosacea. PathologyOutlines.com website. http://pathologyoutlines.com/topic/skinnontumoracnerosacea.html. Accessed December 3rd, 2016.
Definition / General
  • Common chronic dermatosis with erythema of central face, acneiform pustules and papules, telangiectasia and blepharitis (Am Fam Physician 2009;80:461)
Terminology
  • Also called rhinophyma
Clinical Features
  • Exists in five clinical forms:
    • Erythematous, telangiectatic type (70% of cases)
    • Papulopustular type
    • Granulomatous type
    • Hyperplastic glandular type (phymatous rosacea, which results in irregular, bulbous enlargement of the nose; the condition known as rhinophyma)
    • Ocular disease

  • May be associated with abnormal TLR2 (toll like receptor 2) expression, which leads to a calcium-dependent release of kallikrein 5 from keratinocytes, which may cause rosacea (J Invest Dermatol 2011;131:688)
Treatment
  • Topical metronidazole is well tolerated and efficacious for moderate to severe papulopustular rosacea
  • Also topical azelaic acid, azithromycin (once daily), minocycline (40 mg dose)
  • Pimecrolimus 1% cream is effective and well-tolerated treatment for steroid-induced rosacea
Clinical Images

Images hosted on other servers:

Various images

Micro Description
  • Perinfundibular, lymphocytic or granulomatous inflammation
  • Occasional plasma cells, an important clue for the diagnosis
  • Variable features: mild dermal edema, solar elastosis, mild perifolliculitis
  • Sebaceous gland hypertrophy and scattered follicular plugging are present in most cases of rhinophyma
  • Papulopustular lesions have a more pronounced inflammatory infiltrate which is both perivascular and peripilar, involving the superficial and mid-dermis; infiltrate may include a few neutrophils, as well as lymphocytes and plasma cells; Demodex mites are present in 20 – 50% of cases
  • Granulomatous form is usually characterized by a tuberculoid reaction, often in the vicinity of damaged hair follicles; necrosis (resembling caseation) was present in 11% of patients in one series
Micro Images

Images hosted on other servers:

Dermis of a patient with rosacea

Positive Stains
  • Direct immunofluorescence occasionally shows immunoglobulins and complement at dermoepidermal junction
Additional References