ROSACEA CLINICAL FEATURES.

Rosacea, formerly called acne rosacea, is a chronic inflammatory eruption of the flush areas of the face and especially the nose. It is characterized by erythema, papules, pustules, and telangiectasia and, often, by hypertrophy of the sebaceous glands. The latter condition, known as rhinophyma, will be discussed subsequently. Usually the mid-face is involved and most frequently the nose and cheeks, with the brow and chin also affected at times. The eyelids and eyes may be involved to produce ocular rosacea. Rosacea may be superimposed upon seborrhea. Rosacea occurs most often in middle-aged women; the most severe cases, however, are seen in men. In the mild form of rosacea there is but slight flushing of nose and cheeks and possibly the fore-head and chin. The conjunctivae may be affected. As the process becomes more severe, the lesions become a deeper red or purplish red with chronic dilatation of the superficial capillaries (telangiectasia) and inflammatory acneiform pustules. In the most severe form lesions develop, which are deep-seated indolent pustules, funincles, or cystic nodules that may resemble acne conglobata with large abscesses, discharging sinuses, and keloidal scarring. The eyelids may become involved, with blepharitis and conjunctivitis. The eye itself may be affected, with keratitis, iritis, and episcleritis. Granulomatous Rosacea. Mullanax and Kierland, have called attention to a distinctive form of papular rosacea designated as granulomatous rosacea. This type of rosacea is found not only on the butterfly areas but also on the lateral areas and periorally. The discrete papules appear as yellowish brown nodules upon diascopy and as noncaseating epitheliold cell granulomas resembling sarcoidosis, tuberculosis, or other granulomas histologically. ETIOLOGY. A number of factors seem to be concerned with the etiology of rosacea. The disease occurs most frequently between the ages of 30 and 50 and mostly in women. There is a suggestion of endocrine factors, especially menopausal; one definite type begins at menopause. Another factor is that of vasomotor lability, which is especially pronounced in menopause and may be closely connected with the pathogenesis of rosacea. Traditionally, caffeine-containing beverages-tea and coffeehave been proscribed on the ground that since both cause flushing, and both contain caffeine, caffeine must be responsible. Wilkin showed that this is not the case: it is heat that is the common and responsible cause. Hot water, even if merely held in the mouth and not swallowed, causes the same degree of flushing as hot coffee; cold coffee, and caffeine (200 mg), cause no flushing at all. Alcohol is well known as an inducer of facial flushing, of course.

The continued application of fluorinated corticosteroids may induce a rosacealike syndrome consisting of severe erythema with telangiectases and pustules. This may also be seen in perioral dermatitis.