Rosacea erythematosa L71.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 04.04.2023

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erythematous rosacea; Rosacea; Rosacea stage I; Rosacea teleangiectatic stage; vascular rosacea (e)

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Stage I rosacea with transient, seizure-like facial redness (flushing) and swelling that can be triggered by numerous stimuli.

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w>m (?); familial clustering. Caucasian skin is considered a disposition factor. A prevalence of 22% was reported in a population of working people > 30 years. Rosacea would therefore be the most common skin disease (see below rosacea - overview).

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Not fully elucidated.

Genetic dispositions with abnormalities in innate immunity (these involve the antimicrobial peptide cathelicidin and its activator kallikrein 5), concomitant vascular dysfunction is considered the most likely cause. This recruits a vicious circle of dermal damage, vasodilatation, vascular damage, and inflammatory tissue reaction.

Trigger factors are UV-rays, X-rays, heat, cold, excitation, coffee, alcohol, tea, hot spices (pepper, curry), temperature fluctuations, external (too fatty) cosmetics and hormonal fluctuations (menstruation, pregnancy, menopause). Controversially, the influence of Helicobacter pylori is discussed.

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mostly between the 30th-60th year of life; mostly increased with increasing age, approx. 5% of the world population affected

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face, cheeks, nose, forehead, chin, lateral neck areas

Clinical features
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Precursory form (transient erythema): First signs of incipient rosacea with a tendency to flush-like, functional erythema, which manifests itself as fleeting, soft red or even bright red spots on the face. They disappear completely in the early stages of rosacea. They reappear with stimuli such as: change from cold to warmth, spicy food, hot drinks like tea or coffee, alcohol, stress situations. These flush symptoms are accompanied by heat waves, sometimes with an increased tendency to sweat, which is perceived as uncomfortable by those affected.

Over the course of months or years, the redness persists for hours and days, later permanently. Patients also complain about the seizure-like and variable blood fillings of the affected regions. The affected skin becomes increasingly firm due to a persistent slushy oedema (+ slight dermal fibrosis) (a flat erythema develops into red plaque). There is a tendency towards the development of telangiectasias (rosacea teleangiectatica), which are mainly nasolabial and localized in the cheek area.

Fig. see below Rosacea

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S.u. rosacea

External therapy
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Brimonidine (prep. Mirvaso®) can be recommended for the treatment of erythematous rosacea. In clinical trials, brimonidine gel had significantly greater improvements in rosacea facial erythema than placebo. Brimovudine is a very effective therapy for rosacea facial erythema. The drug acts via reversible (!) vasoconstriction over a 12-hour period. The onset of action is often detectable after 30 minutes. Experience has shown that the success of treatment improves with increasing treatment duration. The most common side effects (incidence ≥ 1%) during short-term treatment were flushing, erythema, burning of the skin, and contact dermatitis.

Most common side effects during long-term use (incidence: ≥4%) were: flushing (10%), redness (8%), worsening of rosacea (5%), nasopharyngitis (5%), burning of the skin (4%), increased intraocular pressure (4%), and headache (4%).

The gel is applied daily in approximately pea-sized amounts to the affected areas. The effect is expected within a 30-minute period.

Radiation therapy
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For the therapy of telangiectasia, appropriate laser systems (see laser below) or flash lamp technology (IPL technology - see laser below) are suitable.

Diet/life habits
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S.u. rosacea

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The maximum variant of erythematous rosacea is called rosacea edematosa or M. Morbihan.

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  1. Del Rosso JQ et al (2013) Management of facial erythema of rosacea: what is the role of topical α-adrenergic receptor agonist therapy J Am Acad Dermatol 69 (Suppl 1): S44-56
  2. Lim HS et al (2014) The efficacy of intense pulsed light for treating erythematotelangiectatic rosacea is related to severity and age. Ann Dermatol 26:491-495
  3. Piwnica D et al (2014) Vasoconstriction and anti-inflammatory properties of the selective α-adrenergic receptor agonist brimonidine. J Dermatol Sci 75:49-54
  4. Urban J et al (2014) Optical coherence tomography imaging of erythematotelangiectatic rosacea during treatment with brimonidine topical gel 0.33%: a potential method for treatment outcome assessment. J Drugs Dermatol 13:821-826


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Last updated on: 04.04.2023