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What is rosacea?

It is a skin disease often seen in middle-aged people and is a chronic inflammatory disease. Common symptoms are swelling, dilated capillaries, and diffuse redness (a state in which the lesions are spread relatively evenly) on the face, mainly around the cheeks and nose. When the disease progresses, papules and pustules that resemble acne may also appear.

The cause of this disease is currently unknown. However, sun exposure, Demodex mites, lifestyle habits, and genetic predisposition are thought to be involved.

Rosacea is broadly classified into three types depending on the severity of symptoms. The characteristics of each are as follows.

First stage rosacea (erythematous rosacea: red face)

Temporary redness may appear on the cheeks, tip of the nose, forehead between the eyebrows, and the tip of the chin. These symptoms eventually become chronic, and capillaries dilate, leading to seborrhea (dandruff falling off). Symptoms can worsen if there is a large temperature difference or drinking alcohol, or repeatedly under sun exposure. Symptoms such as itching and hot flashes may appear.

Second stage rosacea (acne rosacea)

In addition to the symptoms seen in the first-stage, second- stage rosacea appears as pileiform papules and pustules, closely resembling acne. These symptoms primarily appear in the T-zone of the face, but eventually spread to the entire face.

Third stage rosacea (rhinophyma)

The papules on the tip of the nose begin to fuse together, along with vasodilation. They swell irregularly and eventually form a mass (reddish-purple in color). In addition, the pores become enlarged, resulting in a red nose that looks like an orange peel.

In addition to the skin symptoms mentioned above, eye diseases (keratitis, conjunctivitis, etc.) may also occur. In such case, symptoms such as pain, itching, and redness will appear in the eyes.

About treatment

Since it is a chronic skin disease and intractable, your lifestyle habits need to be reviewed in order to prevent further deterioration. For example, avoid exposure to sunlight as much as possible, avoid alcohol and spicy foods that can dilate blood vessels, and avoid taking chocolate (cacao).

Based on recent research data and our many years of treatment experience, many patients’ conditions are associated with the proliferation of Demodex mites. Therefore, it is necessary to remove a tiny superficial sample of skin with tweezers and examine it under the microscope to check for the proliferation of Demodex mites.

Specifically, our treatment involves oral administration of tetracycline, which has both antibacterial and anti-inflammatory effects. For topical medications, we use moisturizers and sulfur camphor lotion together, as well as topical treatment with metronidazole (Rozexgel)or ivermectin, which has acaricide and anti-inflammatory effects, and topical medications that improve telangiectasia. If the proliferation of Demodex mites is confirmed, oral administration of ivermectin, as acaricide agent, will be added. Skin conditions similar to acne are treated in the same way as acne.

Rosacea-like dermatitis

What is rosacea-like dermatitis?

Because it causes skin symptoms similar to rosacea, it is called dermatitis rosacea. It is mainly caused by long-term application of topical steroids or tacrolimus to the face.

Common symptoms include erythema, dilated capillaries, papules (fine bumps), and pustules that appear in the area where steroids have been applied. In addition, itching and burning sensation may also occur. Areas that are most likely to be affected include the area around the mouth, cheeks, and forehead, but it may also be limited to the area around the mouth. In this case, it is diagnosed as perioral dermatitis.

About treatment

First, a tiny superficial sample of skin is taken with tweezers and examined under a microscope to check for the proliferation of Demodex. If there is a tendency overgrowth of Demodex mites proliferation, topical metronidazole (Rozexgel)or ivermectin cream, an acaricide agent will be used, and in severe cases, oral administration of ivermectin, an acaricide, will be additionally prescribed. When the use of causative steroids and topical tacrolimus stops, it may make symptoms temporarily worse, in that case please follow your doctor's instructions. In addition, if skin symptoms such as acne become severe, oral antibiotics or topical medications may be used.