Acne Rosacea
Give a descriptive definition of acne rosacea.
Acne rosacea is a chronic, hyperæmic or inflammatory disease, limited to the face, especially to the nose and cheeks, characterized by redness, dilatation and enlargement of the bloodvessels, more or less acne and hypertrophy.
Describe the symptoms of acne rosacea.
The disease may be slight or well-marked. Redness, capillary dilatation, and acne lesions seated on the nose and cheeks, and sometimes on chin and forehead also, constitute in most cases the entire symptomatology.
A mild variety consists in simple redness or hyperæmia, involving the nose chiefly and often exclusively, and is to be looked upon as a passive congestion; this is not uncommon in young adults and is often associated with an oily seborrhœa of the same parts. In manycases the condition does not progress beyond this stage. In other cases, however, sooner or later the dilated capillaries become permanently enlarged (telangiectasis) and acne lesions are often present— constituting the middle stage or grade of the disease; this is the type most frequently met with. In exceptional instances, still further hypertrophy of the bloodvessels ensues, the glands are enlarged, and a variable degree of connective-tissue new growth is added; this latter is usually slight, but may be excessive, the nose presenting an enlarged and lobulated appearance (rhinophyma).
Are there any subjective symptoms in acne rosacea?
As a rule, no. Some of the acne lesions may be tender and painful, and at times there is a feeling of heat and burning.
What do you know in regard to the etiology?
In many cases the causes are obscure. Chronic digestive and intestinal disorders, anæmia, chlorosis, continued exposure to heat or cold, menstrual and uterine irregularities, and the too free use of spirituous liquors, tea, etc. are often responsible factors.
It is essentially a disease of adult life, common about middle age, occurring in both sexes, but rarely reaching the same degree of development in women as observed at times in men.
Is acne rosacea easily recognized?
Yes. The redness, acne lesions, dilated capillaries, and, at times, the glandular and connective-tissue hypertrophy; the limitation of the eruption to the face, especially the region of the nose; the evident involvement of the sebaceous glands, the absence of ulceration, taken with the history of the case, are characteristic.
It is to be distinguished from the tubercular syphiloderm and lupus vulgaris, diseases to which it may bear rough resemblance.
State the prognosis of acne rosacea.
All cases may be favorably influenced by treatment; the mild and moderately-developed types are, as a rule, curable, but usually obstinate. It is a persistent disease, showing little, if any, tendency to disappear spontaneously.
What is the method of treatment?
Both constitutional and local measures are demanded in most cases.
Upon what is the constitutional treatment to be based?
The constitutional treatment, beyond a regulation of the diet, is to be based upon a correct appreciation of the etiological factors in the individual case. There are no special remedies. Iron, cod-liver oil, tonics, ergot, alkalies, saline laxatives, and similar drugs are to be variously prescribed.
What is the external treatment?
In many respects, both as to the preliminary measures and remedies, essentially the same as that employed in the treatment of simple acne (q. v.). The x-ray treatment is not so efficient in this disease, however, as in acne. In addition to the treatment there found, several other applications deserve mention:—
In many cases Vleminckx's solution is valuable, applied diluted with one to ten parts of water. Also, a mucilaginous paste containing sulphur:—
℞ Mucilag. acaciæ, ................................ fʒiij
Glycerinæ, ...................................... fʒij
Sulphur, præcip., ................................ ʒiij. M.
℞ Calcis, .......................................... ℥ss
Sulph. sublimat., ................................ ℥j
Aquæ, ............................................ ℥x.
To be boiled down to ℥vj and filtered.
Or a similar paste with the glycerine in the foregoing replaced with ichthyol may be used.
In what manner are the dilated bloodvessels and connective-tissue hypertrophy to be treated?
The enlarged capillaries are to be destroyed by incision or by electrolysis. Properly managed the vessels may be thus destroyed, but unless the predisposing causes have disappeared or have been remedied, a new growth may take place.
If the knife is employed, the vessels are either slit in their length or cut transversely at several points. The method by electrolysis is the same as used in the removal of superfluous hair (q. v.).; the needle may, if the vessel is short, be inserted along its calibre, or if long, may be inserted at several points in its length.
Excessive connective-tissue growth, exceptionally met with, is to be treated by ablation with the scissors or knife.