Back issues No.3 - 2004 / Original Study  

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Rosacea:An Often Overlooked or Misdiagnosed Disease
Fu-Sen Hsieh , J Yu-Yun Lee , Mark Ming-Long Hsu
Dermatol Sinica 22 : 213-220, 2004

Rosacea is a common disease in fair-skinned individuals but is less common in people with darker skin. Reports about rosacea among Chinese are scarce. The purpose of this study was to document the clinical aspects of rosacea among Taiwanese. Cases of rosacea diagnosed in our Department during 1989-2002 were retrieved. The clinical diagnosis was based on the findings of central facial flushing with obvious triggering factors, non-transient erythema, papules, pustules or/and sebaceous hyperplasia. Only cases whose diagnosis was further confirmed by clinical photos or/and skin biopsies were included in this report. There were 74 females and 35 males, aged from 15-76 years(mean 38 years). The onset was between 20 and 50 years in three quarters of the patients. Rosacea was classified as erythematotelangiectatic type(stage I) in 50% of the patients, papulopustular type(stage II) in 38%, and rhinophyma(stage III) in 11%. Granulomatous rosacea was diagnosed in 5 patients and ocular rosacea in 9. The male/female ratio was 1:3 in stage I and stage II, but was 1:1 in stage III. The incidence of rosacea was about 0.12% among our new patients(109/80,000 new patients), but the real number could be higher. The main trigger factors were hot weather(71%), sun exposure(67%), indoor heat(47%), stress(43%), spicy foods(41%) and alcohol(37%). Eleven patients had other concurrent facial lesions, including acne vulgaris, steroid rosacea, contact dermatitis, seborrheic dermatitis and discoid lupus erythematosus. Prior diagnoses were known in 39 patients; more than half of them were treated as facial allergy, acne vulgaris, contact dermatitis, seborrheic dermatitis or lupus erythematosus. Our study suggests that rosacea was frequently overlooked or misdiagnosed because it is easily confused with other inflammatory facial dermatoses, such as acne vulgaris, seborrheic dermatitis, contact dermatitis and lupus erythematosus. Therefore, these facial dermatoses should be carefully differentiated from each other. Since these dermatoses are fairly common, physicians should also be aware that patients may present with more than one disease at the same time. The finding of frequent facial flushing or persistent erythema with obvious triggering factors should alert physicians to the possibility of rosacea, so that misdiagnosis and mistreatment could be avoided. Since the former Chinese translation of "酒渣" easily lead to misconception of excessive alcohol drinking and is unfair to the patient. We propose that name to be eschewed and replaced by "玫瑰斑", which is a better translation and convey the original meaning "rosy" of the medical term "rosacea".

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