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September 11, 2009 — Treatment options for acne rosacea seen in the family practice setting are reviewed
in an article published in the September 1 issue of American Family Physician.
"Rosacea is a common skin condition with characteristic symptoms and signs, including symmetric flushing,
stinging sensation, inflammatory lesions (papules and pustules), and telangiectasias on the face," write
Constance Goldgar, MS, PA-C; David J. Keahey, MSPH, PA-C; and John Houchins, MD, from the University
of Utah Physician Assistant Program in Salt Lake City. "Phymatous changes include thickened skin and large
pores. Clinical findings represent a spectrum of disease with one or several predominating characteristics,
including a pattern of exacerbations and relative inactivity."
Rosacea is a chronic, and sometimes progressive, dermatosis, typically presenting with central facial
erythema involving the nose, forehead, chin, and perioral areas. However, it may also cause inflammation of
the eyes and eyelids. Regardless of location, rosacea adversely affects quality of life.
Estimated US prevalence of rosacea is 14 million. Although it occurs more commonly in women and in whites,
it can affect other ethnic groups. Typical age of onset is in the 30s.
The differential diagnosis of facial rosacea includes acne vulgaris, systemic lupus erythematosus,
polymyositis, sarcoidosis, photodermatitis, drug eruptions (especially from iodides and bromides), skin
granulomas, and perioral dermatitis. For ocular rosacea, the differential diagnosis may include staphylococcal
and seborrheic blepharokeratoconjunctivitis, and sebaceous gland carcinoma.
Identifying the specific subtype of rosacea allows tailoring treatment to the individual patient, which is most
likely to result in effective control. According to the National Rosacea Society, there are 4 subtypes: