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Interview with Dr. AMODE: "Diagnosis and Pathophysiology of Rosacea."

Interview with Dr. AMODE: "Diagnosis and Pathophysiology of Rosacea."

If you believe you are suffering from rosacea, a diagnosis can then be made. Dr. AMODE, a Dermatologist and Venereologist in Paris, explains in this interview how rosacea is diagnosed, as well as providing information on the pathophysiology of this skin condition.

Summary
Published April 23, 2024, updated on April 25, 2024, by Kahina, Scientific Editor — 5 min read
Rosacea

Question No.1: "How is the diagnosis of rosacea conducted?"

"Rosacea is multifaceted. Its diagnosis is primarily clinical and additional tests are not necessary. It is based on the combination of a set of signs. The first stage of the disease corresponds to the occurrence of vasomotor flushes, persistent erythema, or rosacea, that is, telangiectasias (dilated vessels).

During the inflammatory stage, papules and pustules appear on the nose, cheeks, chin, and glabella (the area between the two eyebrows), indicating a central facial distribution. The other stage of the disease would be the rhinophyma which is more commonly found in men, and is characterized by a deformation of the dermal tissue with an increase in the size of the nose.

There are also rarer forms, such as the so-called Morbihan form, which presents as edematous. Finally, the disease does not necessarily progress. The stages of severity are often stable over time.

The diagnosis is straightforward at the stage of papules and pustules. However, some individuals may exhibit rosacea or erythrosis without rosacea. In such cases, it is advisable to avoid irritation and vasodilation factors to prevent worsening, but this condition does not predict the onset of rosacea."

Question No. 2: "How can we differentiate rosacea from eczema or other skin diseases?"

"Although there are sometimes mixed forms of "acne and rosacea", acne involves retentive lesions, microcysts, and comedones that are not present in rosacea. Furthermore, it is rare that one can confuse eczema with rosacea. Eczema is characterized by erythematous scaly vesicular plaques, so the presentation is very different."

Question No. 3: "Does rosacea truly affect women more than men?"

"The data is varied, but rosacea is indeed present in both men and women. The distribution is fairly uniform. However, it is possible that men may be less likely to consult a dermatologist for mild to moderate rosacea."

Question No. 4: "What about infantile rosacea?"

"Infantile rosacea presents in a manner similar to adult rosacea. Additionally, granulomatous forms or aseptic nodules are described, taking the shape of a persistently evolving inflamed pimple. However, infantile rosacea is rare. There is limited literature data, but specialists describe its progression as chronic."

Question No.5: "Is rosacea more common in certain regions?"

"It is said that this disease is more common among populations of Celtic descent and those with light skin types. However, there are cases in all populations, including those with dark skin types, who may encounter more difficulties in obtaining an early diagnosis due to the increased difficulty for the clinician to detect erythema or due to cognitive bias."

Question No. 6: "What about ocular rosacea?"

"It is not uncommon to have ocular symptoms in rosacea : chalazions, blepharitis, dry eyes, conjunctivitis, and even keratitis. While the association is not systematic, the opinion of an ophthalmologist is sought at the slightest doubt. Conversely, some patients may present with ocular rosacea without skin signs. Therefore, there is no parallel between the severity of skin involvement and ocular involvement. The latter can lead to a deterioration in quality of life, as dryness and inflammation of the eyelids are disabling on a daily basis. Visual impact is exceptional in dermatological practice."

Question No. 7: "Are there long-term effects of rosacea?"

"No, it's not a life-threatening disease. It only affects the quality of life. There are no lasting effects to fear. Rosacea does not leave scars, unlike acne for example. There are no reported cases of superinfection."

Question No. 8: "How well-informed are patients who consult for rosacea about their condition?"

"There is a wealth of information available online, but its reliability varies greatly. Some patients are experts on the disease, while others may be poorly informed or misinformed. It is the dermatologist's responsibility to provide clear information and guide the patient towards reliable sources."

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