Rosacea represents a chronic skin condition of the external nose commonly seen in middle-aged and elderly individuals. It is characterized by erythema and dilated capillaries on the skin of the nasal tip and nasal wings, often accompanied by acne.
Etiology
The exact cause remains unclear. Possible contributing factors include alcohol consumption, a preference for spicy or irritant foods, gastrointestinal disorders and constipation, endocrine imbalances such as menstrual irregularities, vitamin deficiencies, and the parasitism of Demodex folliculorum mites.
Pathology and Clinical Staging
The pathological and clinical progression of the disease can generally be divided into three stages:
Stage I (Erythematous Stage)
The skin of the external nose exhibits redness, with enlarged sebaceous gland openings and increased secretions, giving the skin an oily appearance. Symptoms tend to worsen with alcohol consumption, meals, exposure to heat or cold, or emotional stress.
Stage II (Papulopustular Stage)
Persistent redness remains on the external nasal skin, and the dilated capillaries become more prominent. This stage is frequently accompanied by papules and pustules. Over time, the skin thickens, resulting in an orange-peel-like texture.
Stage III (Rosaceous Rhinophyma Stage)
The disease progresses further, with significant capillary dilation, hyperplasia of sebaceous glands and connective tissue. The external nasal skin eventually develops lobulated enlargement, resembling a tumor-like appearance, referred to as rhinophyma.
Diagnosis and Differential Diagnosis
The diagnosis is typically straightforward due to the characteristic clinical features.
Differentiation from conditions such as acne, capillary dilation resulting from prolonged use of topical fluorine-containing glucocorticoids, and perioral dermatitis is necessary.
Treatment
Elimination of Triggers or Causes
Reducing exposure to irritants, abstaining from alcohol and spicy foods, correcting gastrointestinal dysfunction, and regulating endocrine function are essential.
Local Treatment
Management strategies for controlling congestion, reducing inflammation, removing excess oil, and eliminating mites are utilized. In cases where rhinophyma has formed, partial surgical excision can be performed under local anesthesia. After bleeding is controlled, skin grafting with free flaps may be applied.