Definition Rosacea is a Latin word meaning (Like-Roses), is an Acne-like rash, caused by disorder of the Pilo- Sebaceous unit, often affect the central region of the face (Centro-facial) characterized by: 1-Hyper-reactivity of superficial vessels and capillaries to external stimuli, thereby reflecting temporary or persistent redness of the face area,

Central emergence and expansion of capillary vessels (Telangiectasia) surface and/or accompany an inflammatory papules or in severe cases there are burst of pustules, symptoms vary within a broad spectrum between one person to another, from different symptoms of temporary redness of the face to continuous redness, vascular dilatation, papules and pustules.

Epidemiology Rosacea often seen in patients from third to sixth decade, peak incidence in the fourth or fifth decade of life, affects both genders, but affects women more than men, rhinophyma type afflicts mostly men. Acne rosacea affects white people, II-I-type classification (Fitzpatrick) and is rare in Africans or Asians.

Incidence In a study conducted in Sweden to 809 desk officers, found that 81 either have the disease or had it at some point, and concluded that the incidence among white is about 10%, another study believe that nearly 14 million people are affected in the United States, but the incidence of this disease is not known yet, due to the lack of proper studies and to errors in diagnosis.

A-hormonal and B-neurological mechanism, both mechanisms leading to equal results and may interact with each other, and often the external factors (stimuli) play a role in activating those mechanisms, particularly the increase in temperature, the so-called (Heat Stimuli), if the heat source is oral i.e. (hot drinks),

Chemicals and Food intake: hot spices, alcohol and hot drinks are considered to be an aggravating factors in rosacea, and certain medications used to treat cardiovascular diseases (such as Amiodarone) may aggravate or cause rosacea, topical steroids for prolonged period may cause so-called steroid acne or rosacea-like disease, (Nicotinic acid) may aggravate rosacea, some reported acne cases similar to Rosacea after using vitamin (B6, B12).

6-Microbes: many believe that the mite or the apportunistic microbe of the pilosebacous unit (Demodex folliculorum, brevis), causes rosacea supports this belief:

a- The Demodex favours areas affected often by rosacea, (the central zone of face) b- The number of Demodex is increased in aging skin old age, (where rosacea is rare in children). c- Studies have shown that most patients with rosacea carry antibodies most probably against Demodex, and about 22% of patients have confirmed antibodies against Demodex. d- Many studies have also shown a colonization of demodex in Rosacea patients.

Types of Rosacea (4 types) 1. Erythemotelangiectatic Rosacea. Features include continuous erythema in the central region of the face, telangactasia is very common but not essential for diagnosis of this type, and accompanying symptoms may be a tingling sensation and or burning sensation in the face, or the Central face, oedema or roughness or some facial desquamation, patients usually give history of transient or non-transient erythema.

2. Papulopustaular Rosacea. Characterized by continuing erythema and the appearance of transient papules or pustules in the Central face, papules and pustules may appear elsewhere, for example, around the mouth or around the eyes, nose this type of rosacea is very similar to Acne Vulgaris, this type of rosacea may coexist with acne and comedones may appear thus it is very crucial to notice accompanying symptoms i.e. (tingling and burning sensation) This type often appears with or after the emergence of the first type (Erythemotelangiectatic Rosacea) but telangiectasia might be obscure due to papules and pustules and continues erythema, but might appear after good treatment,

3- Phymatous Rosacea The most common type is Rhinophyma,

This type can appear in other parts of the face (nose, Chin and cheeks) the affected area often shows pores enlargement, or may show some telangiectasia too, in the case of Rhinophyma accompanying symptoms are severe. This type often appears with or after a period of Erythemotelangiectatic Rosacea, or type II (Papulopustaular Rosacea)

4- Ocular Rosacea For the diagnosis of this case 1 or more of the following symptoms should coexist with rosacea Continuous or transit Conjunctival reddness The sense of foreign body in the eye blurry vision, tingling or burning or overly photo sensitivity appearance of telangiectasia within the conjunctiva or swollen or redness around the eye inflammation of eyelids (Blepharitis) or conjunctivitis (Conjunctivitis) or irregular eyelid border.

Other Rosacea types 1. Glandular Rosacea Men are more frequently affected usually around the eyes and in women around the chin telangactasia is and erythema is not seen due to thikned skin and severe seborrhea 2. Granulomatous Rosacea 10% of all rosacea there are brownish papules and pustules on face, in about 50% eyes might be involved, some believes its part of what is so called lupus maliaris disseminatous faciei.

Diagnosis Full and detailed history (including medications)is required, diagnosis is made clinical Other conditions should be rolled out Acne vulgaris Folliculitis Polycythemia vera Dermatomyocytis Lupus erythematousus Carcinoid tumor Mastocytosis Mitral stenosis

Treatment Sunscreen Avoidance of chemicacl irritants and habitis that aggrivate rosacea including alcohol and cosmetic for those with (Erythemotelangiectatic Rosacea)

Topical medications Metronidazole Sodium sulfacetamide and sulfur Azelaic acid Benzoyl peroxide Tretinoin Erythromycin and Clindamycin

Oral medications Tetracyclines Macroloides (e.g Erythromycin) Metronidazole isotretinoin

Other facial rejuvenation (ablative and non-ablative) laser show good results in treatment of solar damage and connective tissue remodelling thus improving Rosacea.