CLINICAL REVIEW Diagnosis and Treatment of Rosacea

Background: Rosacea is a common skin disorder affecting middle-aged and older adults. Many patients mistakenly assume that early rosacea is normally aging skin and are not aware that effective treatments exist to prevent progression to permanent disfiguring skin changes. Methods: The medical literature was reviewed on the pathophysiology, diagnosis, and treatment of rosacea. MEDLINE was searched using the key search terms “rosacea, ” “rhinophyma, ” “metronidazole,” “Helicobacter pylori, ” and “facial redness.” Results and Conclusions: Rosacea is easily diagnosed by physician observation, and physicians should initiate discussion of rosacea treatment with patients. Effective treatment of rosacea includes avoidance of triggers, topical and oral antibiotic therapy, both topical and oral retinoid therapy, topical vitamin C therapy, and cosmetic surgery. (J Am Board Fam Pract 2002;15:214–7.) As the general population ages and the baby boomers increasingly dominate clinical practice, a frequent complaint is the red face. Of the many causes of the red face, rosacea will be the diagnosis for approximately 13 million Americans.1 Although not a life-threatening condition, rosacea produces conspicuous facial redness and blemishes that can have a deep impact on a patient’s self-esteem and quality of life. Rhinophyma, the most prominent feature of advanced rosacea, is often mistakenly associated with alcoholism, as caricatured by W.C. Fields, further stigmatizing rosacea patients. A sur-vey by the National Rosacea Society reported that 75 % of rosacea patients felt low self-esteem, 70% felt embarrassment, 69 % report frustration, 56% felt that they had been “robbed of pleasure or happiness, ” 60 % felt the disorder negatively af-fected their professional interactions, and 57 % be-lieved that it adversely affected their social lives.2 Much of this suffering is unnecessary, however, because rosacea is a condition that can be easily diagnosed and effectively treated in most patients. Methods We undertook a literature review on the patho-physiology, diagnosis, and treatment of rosacea us-ing MEDLINE. Key search terms included “rosa-cea, ” “rhinophyma, ” “metronidazole, ” “Helicobacter pylori, ” and “facial redness.