Muhammad Haidar Ilhamullah, S.
Ked
Anne Listiane, S.Ked
Supervisor : dr. Nur Rahmah. M. Kes, Sp.KK
What is rosacea ?
Chronis relapsing disorder with
variable degress of...
Persistent centrofacial erythema
Telengiectasias
Inflammatory papules
Inflammatory pustules
Nodules
Edematous plaques (non-pitting)
Ocular inflammation
Phymatous changes
Subtypes of rosacea
Each subtypes is graded into mild, moderate and severe (grade I-III)
CLASSIFICATION OF ROSACEA
1. ERYTHEMATOTELANGIECTATIC
ROSACEA
Patient typically have skin phototype I or II.
Severity of erythematotelangiectatic
rosacea
2. PAPULOPUSTULAR ROSACEA
Centrofacial eruption of multiple, small (3mm),
dome-shaped, erythematous papules, some of
whice are surmounted by a seropustule can appear
singly or in crops.
Severity of papulopustular rosacea
Mild papulopustular rosacea
Moderate papulopustular rosacea of the forehead .
Note the superficial nature of the inflammatory lesions.
Severe papulopustular
rosacea
Dense erythema,
papules,
pustules, Nodules,
telangiectasias
severe, diffuse.
Variable plaque-like
edema
3. PHYMATOUS ROSACEA
Severity of phymatous rosacea
The aerliest clinical of rhinophyma is the appearance of dilated pores
(pustulous fillicles) One the distal portions of the nose.
4. Ocular rosecea
Severity of ocular rosacea
Common, may be first sign of rosacea.
Variant of rosacea
1. Granulomatous rosacea:
persistent red brown to skin-colored
facial papules with a characterictic
non-caseating granulomatous
histology .
2. Rosacea conglobata:
inflammatory facial cysts with
associated scarring.
3. Rosacea Fulminans (pyoderma
faciale): characteristized by
exsplosive onset of inflammatory
papules and pustules superimposed
on a back-ground of facial erythema
& fever may occur.
Clinical features
Generally, erythema , which is
often accompanied by a burning
sensation, gradually becomes more
persistant, is easy triggerd by
minor irritans, and associated with
increasingly prominent
telangiectasia.
Diagnosis
Usually made on clinical findings.
Wolff K, Johnson RA, Fitzpatrick color atlas & synopsis of clinical dermatology. 6th ed. USA:
Mcg raw hill;2009.p.810 - 814
Additional Examination
HISTOPATHOLOGY EXAMINATIONS
Histopathology may be helpful when the facial
distribution is atypical or when granuloma
formation is suspected.
LABORATORY EXAMINATIONS
Histopathology
Jones JB. Rosacea. Rosacea, Perioral Dermatitis, and Similar Dermatoses, Flushing and
Flushing Syndrome. In: Burns T, Breathnach S, Cox N, Griffths C, editors. Rooks Text Book
of Dermatology. 7th ed. Massachusets: Blackwell Publishing Company; 2004.
Histopathology
Histological
appearance
of
granulomat
ous rosacea
Jones JB. Rosacea. Rosacea, Perioral Dermatitis, and Similar Dermatoses, Flushing and
Flushing Syndrome. In: Burns T, Breathnach S, Cox N, Griffths C, editors. Rooks Text Book
of Dermatology. 7th ed. Massachusets: Blackwell Publishing Company; 2004.
Differential Diagnostic
Acne Vulgaris
A 20-year old male in this case of papulopustular acne, some
inflamatory papules become nodular and thus represent early stages
of nodulocystic acne.
Perioral Dermatitis
Preferential location on the chin but also on the lower eyelids in a
64-yearold woman. but it would be unusual for rosacea to involve
the perioral region and eyelids but sparing the cheeks and nose.
Differential Diagnostic
Seborroic Dermatitis
Seborrheic dermatitis of face: adult-type Erythema and yellow-orange scaling
annular of the forehead, cheeks, nasolabial folds, and chin. Scalp and
retroauricular areas were also involved.
Differential Diagnostic
SLE
Acute systemic lupus erythematosus Bright red, sharply defined erythema
with slight edema and minimal scaling in a butterfly pattern on the face. This is
the typical malar rash. Note also that the patient is female and young.
Differential Diagnostic
Dermatomiositis
Violaceous erythema and edema on the face, particularly in the periorbital and
malar regions. The patient could barely lift his arms and could not climb stairs. He
had pulmonary carcinoma.
Treatment of Rosacea
Prognosis
To effectively treat rosacea, practitioners
must recognize the clinical spectrum of
rosacea phenotypes and what lies
outside that spectrum.
Therapeutic success is achieved by
inducing remission of signs and
symptoms, and by minimizing and
controlling relapses.
Steinhoff M, Schauber J,Schelmez M. Facial erythema rosacea etiolohy, different pathophysiologies
and treatment options. Department of dermatology and allergy, Ludwig-maximiliam Universty of
Munich. Germany. 2016
THANK YOU
FOR
YOUR ATTENTION
