Rosacea: recognition and management for the primary care provider.

Rosacea is a common facial dermatitis that currently affects an estimated 13 million Americans. It is a chronic and progressive cutaneous vascular disorder, primarily involving the malar and nasal areas of the face. Rosacea is characterized by flushing, erythema, papules, pustules, telanglectasia, facial edema, ocular lesions, and, in its most advanced and severe form, rhinophyma. Ocular lesions are common, including mild conjunctivitis, burning, and grittiness. Blepharitis, the most common ocular manifestation, is a nonulcerative condition of the lid margins. Rosacea most commonly occurs between the ages of 30 to 60, and may be seen in women experiencing hormonal changes associated with menopause. Women are more frequently affected than men; the most severe cases, however, are seen in men. Fair complexioned individuals of Northern European descent are most likely to be at risk for rosacea; most appear to be pre-disposed to flushing and blushing. Alcohol, stress, spicy foods, and extremes of temperature have all been implicated, but have not been found to actually cause rosacea. Early diagnosis by the primary care practitioner, management with systemic antibiotics such as tetracycline, and topical agents such as metronidazole, in conjunction with patient education and lifestyle modifications, can achieve remission in most instances.