Erythrotelangiectatic Rosacea - Causes, Clinical Features, Diagnosis, and Treatment

Introduction:

Erythrotelangiectatic rosacea is a common inflammatory skin disorder that can impact the quality of life. Treatment starts with general measures such as gently cleaning the skin and avoiding exacerbating factors such as temperature change, UV (ultraviolet ) rays, stress, alcohol, and some foods. It is characterized by constant redness on the face, which may be due to small blood vessels under the skin surface becoming enlarged and visible; these symptoms most often flare up and disappear. However, without appropriate treatment, the redness around the nose and cheek may get more persistent, cover most of the skin, and become permanent. Most often, it occurs between 30 to 60 years of age.

What Is Erythrotelangiectatic Rosacea?

Rosacea is a skin condition mainly affecting the central area of the face. Rosacea is common and is characterized by predominant facial redness. It has a typical relapsing and remitting course, with the symptoms controlled by lifestyle measures, general skin care changes, and medications.

Who Gets Erythrotelangiectatic Rosacea?

It often affects women more than men; in some studies, it is shown as equal gender distribution. It mainly occurs at 30, the severity increases with age, and the disease is rarely seen in children. It is more common in the following conditions:

• Fair-skinned people.

• Blue-eyed people.

• Indo-European or north-European country people.

• More complicated and under-recognized in patients with neutral skin-colored people.

What Causes Erythrotelangiectatic Rosacea?

The cause is multifactorial and includes below conditions:

• Genetic and environmental conditions.

• Impaired skin barrier in which affected skin displays bacterial colonization and inflammation.

• Dysregulation of the immune response system may cause excessive inflammation.

• Vasodilatation (the dilation of blood vessels, which decreases blood pressure).

• Lymphatic dilatation (superficially lymphatic dilatation by a wide range of scarring processes).

• Angiogenesis (formation of new blood vessels).

• Bacterial growth in the small intestine may play a role in skin inflammation.

• Neurocutaneous mechanisms include UV light, temperature change, eating spicy foods, alcohol, physiological stress, air pollution, and tobacco smoking.

• Eating items that contain cinnamon, chocolate, tomatoes, and citrus.

• Drinking hot coffee or tea.

• Ultraviolet can damage the dermal layer and increase skin inflammation.

• Affected skin is more sensitive to exposure to sunlight.

• Risk factors include those who have genetic links to rosacea.

• Women are more likely to develop the condition than men.

• Men who develop this condition have more severe symptoms than women.

What Are the Clinical Features of Erythrotelangiectatic Rosacea?

Cutaneous features include the following:

• Flushing (transient recurrent erythema).

• Blushing or redness is expected around the nose and cheeks.

• Redness involving the forehead, chin, ears, neck, and scalp.

• Telangiectasia (small dilated blood vessels that can occur near the skin surface or mucous membrane) are also common.

• Thickening of the skin due to sebaceous glands (small oil-producing gland attached to the hair follicle and releases a fatty substance, the sebum, into the follicular duct and then to the surface of the skin) of the face.

• Burning, pricking, dryness, warmth, or mild swelling on the affected area.

• Pre-erythrotelangiectatic rosacea is a stage involving only flushing.

What Are the Complications?

The main complication of untreated erythrotelangiectatic rosacea are:

• Increased anxiety and depression.

• Low self-esteem and social isolation.

• Some features are physical discomfort, for example, ocular symptoms.

It has been said that patients may also have the following:

• Depression.

• Hypertension.

• Cardiovascular diseases.

• Anxiety disorder.

• Diabetes mellitus.

• Migraine.

• Rheumatoid arthritis.

• Helicobacter pylori infection.

• Ulcerative colitis, and dementia.

Clinical features vary in different types of skin, primarily diagnosed in fair-skinned patients, and tough to identify the critical features in skin-colored patients.

How Is it Diagnosed?

Two significant criteria are used in patients with darker erythema and telangiectasia. First, it is more difficult to visualize.

Major Criteria:

• Flushing or transient central facial erythema.

• Telangiectasia (visible blood vessels excluding nasal, which is common).

• Ocular rosacea (lid margin, blepharitis, keratitis, conjunctivitis, sclerokeratitis, anterior uveitis).

Minor Criteria:

• Burning (feeling warmth) sensation on the affected area of skin.

• Stinging (pricking) sensation on the skin.

• Edema (swelling).

• Dry feeling on the skin.

• Skin biopsy is considered in case of diagnostic uncertainty.

What Is the Differential Diagnosis for Rosacea?

Other conditions that could present similar cutaneous features include the following :

• Acne vulgaris.

• Carcinoid.

• Drug reaction.

• Photo damaged skin.

• Systemic lupus erythematosus.

• Eczema.

• Steroid-induced rosacea.

• Steroid-induced acne.

What Is the Treatment for Rosacea?

General measures include skincare and lifestyle advice by encouraging patients to record symptoms to identify the triggers. The most common triggers include spicy food, hot baths, exercise, sun exposure, cosmetic products, medications, alcohol, dairy, and marinated meat. Avoid these triggers that rosacea identifies the following.

General Skin Care Advice:

• The patient should moisturize the skin frequently.

• Use gentle cleansers rather than traditional soaps due to the risk of irritation.

• Use sunscreens with SPF (sun protection factor) more than or equal to 30 (zinc oxide or titanium oxide), which protects visible light protection better than chemical sunscreens.

• Avoid using exfoliants for the skin.

• Avoid alcohol-based topical products.

• Avoid using topical steroids, which may aggravate the condition.

• Cosmetics with green tint are beneficial to minimize the appearance of redness on the face.

• Microdermabrasion treatment to reduce the thickening of the skin.

• Avoid drinking alcohol.

• Alcohol, witch hazel, and menthol may irritate the symptoms.

Physiological Consideration:

• Accessing the patient's psychological burden of the disease.

• Considering psychological support where it is necessary.

Specific Measures:

• Oral beta-blockers (Carvedilol).

• Oral Clonidine may reduce flushing.

• Intense pulsed light therapy and vascular laser in persistent erythema.

• Topical Erythromycin.

• Oral Tetracycline.

• Oral Erythromycin.

• Oral Doxycycline.

• Gabapentin.

• Amitriptyline oral.

General management by increasing dietary intake of omega-3 fatty acids, warm compresses, and gentle eyelid cleansing to express sebum trapped in the meibomian (large gland inside the eyelid) gland. The first line of medical management from mild to moderate topical Azithromycin and Doxycycline can be used.

Conclusion:

Though erythrotelangiectatic rosacea is not life-threatening, it is a chronic disease that requires long-term management with relapsing and remitting symptoms. Therefore, detecting as early as possible may prevent and control the severity of the disease, which is very important in this type of skin disease. This can be treated earlier to control the severity of the symptoms.