At a Glance - Rosacea versus seborrhoeic dermatitis (adults)

- Contributed by Dr Jean Watkins, a sessional GP in Hampshire

Rosacea

Rosacea

Aetiology

  • More common in fair skinned, 30-60 age group.
  • Aggravating factors include topical steroids and other creams, spicy foods, hot drinks, alcohol, UV light and wind.
  • Possible but, as yet, unproven connections with demodex species (mites) or Helicobacter pylori.

Presentation

  • Long-standing history of facial flushing, often with burning or stinging.
  • Papulopustular rosacea - redness of central part of face with small erythematous papules and pustules.
  • Phymatous rosacea - skin thickening and irregular nodularities of the nose, chin, forehead and eyelids.
  • Ocular rosacea - may precede skin changes. Gritty feeling in the eye, blepharitis, conjunctivitis and conjunctival telangiectasis.

Management

  • Avoid trigger factors. Regular use of sunscreen. Green tinted cosmetic helps mask erythema.
  • Papulopustular rosacea - antibiotics (tetracycline or erythromycin) for six to 12 weeks. Topical metronidazole gel. Isotretinoin in severe, persistent cases. Anti-inflammatory drugs such as diclofenac. Antiflushing medication such as clonidine.
  • Phymatous rosacea - topical isotretinoin. Surgical correction.
  • Ocular rosacea - lid hygiene, artificial tears, tetracycline or erythromycin, metronidazole.

SEBORRHOEIC DERMATITIS
Seborrhoeic dermatitis

Aetiology

  • Inflammatory reaction related to excess proliferation of the normally present yeast, Malassazia.
  • Develops after puberty - may be very persistent.
  • The immunosupressed and those with Parkinson's or stroke are particularly prone.

Presentation

  • Ill-defined pink rash with yellowish scaling.
  • Commonly affects the naso-labial folds, eyebrows, eyelids and behind the ears.
  • Often spreads to the scalp (dandruff).
  • Patch of similar rash often seen over sternum or upper back.
  • Sometimes affects axilla and inguinal region.
  • Sometimes itchy.

Management

  • Antifungal agents, such as topical ketoconazole. Systemic if severe or poor response.
  • Mild topical steroids helpful in acute flares but recurrences likely on discontinuing. Rebound effect leads to dependence.
  • Antifungal shampoos.
  • Shampoos containing salicylic acid and coal tar help to soften thick plaques.
  • Topical metronidazole gel useful on the face.
  • Blepharitis - use baby shampoo.

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