General Illness Information
Medical Term: Adult Acne
Description: Chronic inflammation of facial skin, usually the cheeks and nose; tendency to appear between the ages of 30 and 50. It is more common in women, but more severe in men. Extensive nose involvement (i.e. a bulbous red nose), mostly in men; called rhinophyma.
Causes: Unknown. May be worsened by stress, warm drinks, hot or spicy foods, and alcohol.
Prevention: Marked reduction or elimination of alcoholic and hot beverages may be helpful in some patients. It is important to note that it is not the caffeine but the temperature (hotness) of the tea and coffee that is the culprit. Emotional stress may be a precipitating factor in some people.
Signs & Symptoms
Patients with rosacea usually have a long history of episodic flushing of their face with increases in skin temperatures, in response to heat stimuli in the mouth (hot liquids), spicy foods and alcohol. Some patients may present with constant flushing and feeling of heat in the face.
- Red, thickened skin on the nose and cheeks;
- Small blood vessels are visible on the skin surface;
- Papules (small raised bumps) and pustules (small, white blisters with pus) on the affected skin;
- Persistent flushing of the nose, cheeks and forehead;
- Face tender to touch.
- Late symptoms: chronic rosacea presents with telengectasia (superficial blood vessels which are easily visible through the skin) and with marked sebaceous hyperplasia (papules) and thickening of the skin causing disfigurement of the nose, forehead, eyelids, ears, and chin.
- Rhinophyma – enlarged nose;
- metophyma – enlarged cushion-like swelling of the forehead;
- blepharophyma – swelling of the eyelids;
- otophyma – cauliflower-like swelling of earlobes;
- gnathophyma – swelling of the chin.
- Red eyes as a result of chronic inflammation of the eyelids and the conjunctiva (white of the eyes). Rarely, some patients may present with corneal ulcers. This is a serious problem and should be assessed by an ophthalmologist.
- Overuse of corticosteroid creams in treatment of other skin disorders;
- Nervousness and stress;
- Fair complexion;
- Excess alcohol consumption.
Diagnosis & Treatment
- Seek care early;
- Avoid alcohol;
- Do not use cortisone preparations, including non-prescription preparations (they may cause the condition to worsen);
- Don’t use oil-based makeup. Use the thinner, water-based preparations;
- Take measures to reduce stress;
- Counseling if disfigurement causes distress;
- Surgery to remove excess tissue (occasionally)
- The first line of treatment would be a topical, such as metronidazole gel or cream 0.75%, applied twice daily is very effective;
Topical antibiotics such as erythromycin gel may be effective;
- If metronidazole fails, or for more severe disease, add broad-spectrum oral antibiotics (such as tetracycline or minocin). Oral tetracycline is the antibiotic of choice because it is most effective, with few side effects in long-term use;
- Oral isotretinoin (Accutane®) may be prescribed in more resistant cases and for patients with more severe disease;
- Surgical correction may be required for rhinophyma.
Generally no restrictions, however, exposure to sun and heat may exacerbate this condition.
- Avoid spicy foods, alcohol or anything that causes the face to flush.
Symptoms can be controlled with treatment. Remissions and frequent flare-ups may be expected.