What is rosacea?

Rosacea is a chronic disease of the central-facial regions that is quite common (according to some data it is the reason for 2-3 % of the dermatological specialist visits), more widespread among middle-aged women, but also present among men, in which the most serious forms often appear. Rosacea occurs in predisposed subjects (heredity is well demonstrated in many cases), probably through the action of factors such as nervous, digestive, food, infectious or climatic. It is a disease with a polyphasic course, i.e. articulated in several stages of development (listed below) whose succession is not fixed by a general rule: for example, a rosacea can evolve from stage II to stage IV without passing through stage III.

Stage I (flush stage)

Paroxysmal flushing of the face, especially after meals, but also during small emotional traumas, changes in ambient temperature, ingestion of alcohol or beverages or hot foods. Vasodilatation affects the central region of the face and can be associated with conjunctival hyperemia with tearing; it often extends to the scalp and ears, triggering behavioural reactions.

Stage II (rosacea erythematous-teleangectasic or couperose stage)

Permanent facial erythema (erythrosis) sprinkled with telangiectasias of the cheeks and nose, sometimes associated with a diffuse oedema of the frontal, nasal and zygomatic regions, which may also be more marked in correspondence of one or the other of them. This oedema, sometimes imposing (lymphedematous rosacea), can be slightly hardened (solid facial oedema) and make it difficult to lift the skin in folds with the fingers.

Stage III (rosacea papulopustular)

Inflammatory papules appear on an erythema background; sterile, non-primitively follicular pustules appear more rarely, particularly on the cheeks. The appearance of the disease at this stage is typical.

Stage IV (facial or fima elephantiasis)

So-called fima are a very rare event. They are connective hyperplasias and sebaceous glands of some areas, already home to recurrent flushes. The most common site is the nose and in particular its lower half, which becomes large, turgid, lobulated, covered with coarse telangiectasia (rhinophyma); more rarely are affected chin (gnatofima), forehead (frontofima), eyelids (blepharofima) and earpads (otofima). In 40% of cases the rosacea regression is spontaneous and occurs after years of evolution, in the other cases the disease evolves and worsens “due to re-ignition” triggered by factors such as the change of season, bad weather, digestive episodes, endocrine climate or psycho-affective events. A considerable percentage of those affected by rosacea suffer from migraines, often at stages of aggravation of the disease. Complications are mainly ocular and iatrogenic. An evolutionary rosacea can be complicated or preceded (20% of cases) by blepharitis, conjunctivitis, xerophthalmia and sclerocorneal ulcerations, while vascular infiltration of the cornea can cause severe keratitis also responsible for blindness.

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