ACNE ROSACEA.
Definition. — Acne rosacea is charac terized by a chronic congestion of the face, causing vascular dilatations; and by changes in the cutaneous glands and tissues, giving rise to seborrhoea, inflam matory acne, and hypertrophic changes.
Symptoms.—The nose and malar emi nences are especially prone to this dis order. It may also affect the forehead, chin, the neighborhood of the alm nasi, the cheeks, and less commonly the side of the neck. In women the chin is occa sionally invaded.
There are three forms of acne rosacea.
The first is the erythematous and telangiectasic. It may be characterized by temporary congestive spots on the face, showing themselves especially after meals and in the evening. These spots may be accompanied by no other lesion. This form is usually present in connec tion with more or less seborrhoea, espe cially on the nose, which is generally very oily. Again, the erythematous variety may be characterized by small vascular dilatations on the nose or malar eminences, which dilatations develop gradually, unite with one another, and form a net-work. This net-work is uni form in hue at a distance, but near by may be seen to be formed of congested surfaces over which are spread vascular dilatations. This degree of the erythem atous form is almost always accompanied by seborrhoea, enlarged nose, and dilated glandular orifices, especially in women toward the menopause and in wine drinkers. (Hebra.) The nose may become slightly violet hued and be cold to the touch.
The second form is the erythematous acne, or true acne rosacea. In addition to the erythematous and congestive feature, there may be found in this variety a true acneic element: papules and pustules. In some cases the acne appears before the congestion. There is a congestive red base with fine vascular dilatations and papulo-pustules of various sizes, often resting on an indurated violet-red base.
In this variety there may also be in crease in number and size of the vascular dilatations, increase in size and depth of the acneic indurations, and proliferation and hypertrophy of the derma.
The third form is the hypertrophic acne, or rhinophyma. In this variety the glandular orifices are much enlarged, while the glands themselves may be ten to fifteen times increased in size. The tissues around them proliferate, forming a variety of pachyderma. The nose may be red or violet-hued, covered with en larged orifices, greatly increased in size, falling down to the chin. Its exterior may be mammillated. (Brocq.) Two subdivisions of this form are ren dered necessary by the difference in the pathology of each. The first, glandular, presents an embossed aspect, the hyper trophy being due especially to hyper trophy of the pilo-sebaceous glands; the second, elephantiasic, presents a smooth aspect, being due to chronic oedema; there are also vascular dilatations, with sclerosis of the derma. (Vidal and Le
loir.) Etiology. — Women suffer more than men from the erythemato-telangiectasic and acneic forms. Men only suffer from hypertrophic acne. It usually appears between 30 or 40 years. In women, rosacea develops usually at from 30 to 45 years, and increases decidedly toward the menopause, after which it may re cede. It may also, however, develop at puberty. In young women and girls it is frequently due to chlorosis, dysmenor rhoea, or sterility. In some it recurs at each conception.
Some authorities claim that, among the constitutional causes (which affect women more than men), heredity plays an important part. The disease is said to be more frequent in children of arthri tic subjects, or of those who may have suffered from acne rosacea.
Cold feet, urethral and uterine dis turbances, and constipation are also re corded as causes of the disease. The cause of acne may be found in the mouth or teeth and be unilateral if the cause is one-sided. (E. Besnier, Doyon).
Dyspepsia, neuralgia, hemicrania, working with the head inclined forward, and disease of the nasal fosse are among the less frequent etiological factors (which affect men more than women), while high heat, overheated rooms, high wind, sea-air, cold, and cold water are occasional causes, especially in men. The disease may become started in people who for several years have indulged in excessive hydrotherapeutic treatment (Kaposi).
Certain occupations—such as those of coachman, baker, smith, fireman, glass blower—may also become primary causes of the trouble. Indiscretion in diet and alcoholic beverages are well-known fac tors. According to Kaposi, in wine drinkers the nose is bright red, in beer-drinkers it is violet, while in spirit drinkers it is soft, large, and dark blue.
Pathology. — The vascular dilatations of the face have been considered by some authorities as due to circulatory troubles caused by compression of the veins in the cranial foramina.
A certain paretic condition of the vas cular walls may often be looked upon as a cause. (Brocq.) The cutaneous nerves of the region affected have been found normal by E. Besnier. According to Leloir and Vidal, however, there is congestion of the deeper venous net-work of the skin; dilatation of the same vessels and of the perifollic ular vascular net-work, their walls being often diminished in thickness. There is also formation of new vessels.
Diagnosis.—LUPUS ERYTHEMATOSITS. — The superficial, congestive variety shows a brighter and better defined redness; crusts or squanne on the sur face; sharper and more definite edges; greater sensitiveness to pressure; slight elevation above the surrounding surface. If any cicatrix be present, it is surely lupus erythematosus.