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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 carried out?"

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

During the inflammatory stage, there is the occurrence of papules and pustules on the nose, cheeks, chin, and glabella (the area between the two eyebrows), which is a centro-facial distribution. The other stage of the disease would be the rhinophyma more commonly found in men, which is a deformation of the dermal tissue with an increase in the volume of the nose.

There are also rarer forms, such as the so-called Morbihan form, which presents as oedematous. 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 symptoms of rosacea or erythrosis without the presence of rosacea. In such cases, it is advisable to avoid factors that cause irritation and vasodilation to prevent worsening, but this condition does not predict the onset of rosacea.

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

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

Question No. 3: "Does rosacea really 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 similar manner to adult rosacea. In addition, granulomatous forms or aseptic nodules are described, taking the shape of a persistently evolving inflamed spot. However, infantile rosacea is rare. There is limited literature data, but the progression is described by specialists as chronic."

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

"It is said that this disease is more common in 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 through cognitive bias."

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

"It is not uncommon to experience ocular symptoms in rosacea : chalazions, blepharitis, dry eyes, conjunctivitis, and even keratitis. While the association is not always present, the opinion of an ophthalmologist is sought at the slightest doubt. Conversely, some patients may present with ocular rosacea without any 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 can be debilitating on a daily basis. Visual impact is exceptional in dermatological practice."

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

"No, it's a disease that does not threaten life expectancy. It only impairs the quality of life. There are no after-effects to fear. Rosacea does not leave scars, unlike acne for example. There is no described superinfection."

Question No. 8: "To what extent are patients consulting for rosacea informed about their condition?"

"The information available online is plentiful but of varying reliability. 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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