14 - 79 - ROSACEA Flashcards
In general, what are the possible signs and symptoms of rosacea
- flushing
- transient erythema
- persistent erythema
- telangiectasia
- papules
- pustules
- phymata
- edema
- pain
- stinging or burning
- pruritus (very rarely)
hallmark of rosacea
flushing
in younger female and male patients, what are often the first symptoms
flushing and erythema
Persistent erythema (from Greek erythros, red) is defined as erythema that lasts for at least how many months
3 months
in older adults, what are often the first symptom
telangiectasia
It constitutes an abnormal redness of the skin or mucous membranes caused by vasodilation of arterioles or capillaries, resulting in increased perfusion and thus redness.
Erythema
Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the NOSE
rhinophyma
Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the CHIN
GNATHOPHYMA
Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the FOREHEAD
METOPHYMA
Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the EYELIDS
BLEPHAROPHYMA
involves reactive vascular changes in the face that can be observed in normal individuals for a few seconds or few minutes
flushing
Physiologically, it can occur in response to various stimuli, especially heat, certain foods, alcohol, exercising, or stressful emotional stimuli.
flushing
Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than how many minutes?
5 - 10 mins
Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than 5 to 10 minutes because of ___________
neuropeptide release
most common complaint in patients with rosacea
Prolonged and frequent flushing
Transient erythema is a prolonged unphysiological flushing that persists for more than _______ mins and possibly as long as weeks or a few months but for no more than 3 months.
5 minutes
T/F. Blushing is not a feature of rosacea
True
almost exclusively induced by emotionally stressful situations and not by spicy food or other rosacea trigger factors
Blushing
It is characterized by sudden transient (mostly <5 minutes), pinkish involuntary redness of the peripheral cheeks, ears, retroauricular areas, neck, and chest, which can occur over years and often starts in early adulthood
Blushing
“Pale islands” in between the salmon-like redness are also characteristic of
blushing
distinct subform of rosacea defined by chronic, therapy-resistant, 0.2- to 0.3-cm-sized, often follicular brown-red or red papules that can develop to epithelioid (lupoid), granulomatous plaques and nodules on the cheek, forehead, or chin.
The skin appears thickened and erythematous.
Typically, the centrofacial and perioral regions of the face are affected.
LUPOID OR GRANULOMATOUS ROSACEA
rare, acute or subacute, developing, maximal variant of rosacea with acne conglobatelike progression and predilection for postadolescent (20–30 years) women, particularly pregnant women
ROSACEA FULMINANS PYODERMA FACIALEO’LEARY
Common Rosacea Triggers
subtype of rosacea characterized as persistent central facial erythema, frequent flushing; may be telangiectatic vessels
Subtype 1: erythematotelangiectatic
subtype of rosacea characterized as erythematous dome-shaped papules, some with surmounting postulation in a centrofacial distribution on a background of persistent erythema
Subtype 2: papulopustular
subtype of rosacea characterized as Persistent facial swelling with hypertrophy of tissue (rhinophyma);
phymatous
subtype of rosacea characterized as Ocular inflammation (eg, blepharitis, conjunctivitis, or meibomian gland dysfunction; chalazion)
Ocular rosacea
T/F. The bilateral facial location of a presentation is considered typical but not essential.
True
T/F. Flushing, telangiectasia, and inflammatory papules or pustules are considered major features and are diagnostic of rosacea.
False
considered major features but are not diagnostic of rosacea.
What are the diagnostic features of rosacea
What are the Major features of rosacea
What are the secondary features of rosacea
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Inflammatory papules and pustules
MAJOR FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Edema
secondary feature
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- dry sensation of skin
secondary feature
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Persistent centrofacial erythema associated with periodic intensification by potential trigger factors
DIAGNOSTIC FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- TELANGIECTASIA
MAJOR FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Phymatous changes
DIAGNOSTIC FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Flushing or transient erythema
MAJOR FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Stinging sensation of the skin
SECONDARY FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Burning sensation of the skin
SECONDARY FEATURE
Identify if this is Diagnostic, Major or Secondary Feature of rosacea
- Ocular manifestation
MAJOR FEATURE
Classification of rhinophymata: Distal end, apex of nose
Group 1
Classification of rhinophymata: Complete nose, including bridge and nasofacial sulci
Group 4
Classification of rhinophymata: Distal half of nose, apex, alar nodules
Group 3
Classification of rhinophymata: Distal half nose, apex, alae,
Group 2
Classification of Ocular rosacea: pain, photosensitivity, blurred vision, loss of eyelashes, severe conjunctival inflammation, corneal changes, scleritis or episcleritis, uveitis, iritis
Severe
Classification of Ocular rosacea: burning of eyes; crusting or irregularity of eyelid margins with erythema and edema; formation of chalazion or hordeolum)
Moderate
Classification of Ocular rosacea: mild itch, dryness or grittiness of the eyes; fine scaling of eyelid margins; telangiectasia and erythema of eyelid margins; mild conjunctival injection.
Mild
For persistent erythema, approved therapeutic regimens
Topical brimonidine gel (1%) and oxymetazoline crème (1%)
Beta-blockers such as carvedilol can be used off label and should be tapered down
which areas of the body are rarely affected by rosacea?
forehead (more common in bald men), neck, chest, perioral or periorbital regions, or areas behind the ears
the symptom very rarely experienced by patients with rosacea
pruritus
what’s the difference of blushing from erythema and flushing?
Blushing, in contrast to flushing, is almost exclusively induced by emotionally stressful situations and not by spicy food or other rosacea trigger factors.
Blushing has a more pinkish appearance than persistent erythema or flushing and is located on rosacea-atypical sites.
It is characterized by sudden transient (mostly <5 minutes), pinkish involuntary redness of the peripheral cheeks, ears, retroauricular areas, neck, and chest, which can occur over years and often starts in early adulthood.
difference of erythema and flushing when it comes to pathophysiology
erythema is caused by vasodilation while flushing is due to neuropeptide release
These are characteristic of blushing and cannot be found in flushing or transient or persistent erythema, indicating that a more autonomic neural process, often associated with enhanced sweating, also a sign of autonomic neural involvement
“Pale islands” in between the salmon-like redness
rare, acute or subacute, developing, maximal variant of rosacea with acne conglobate-like progression and predilection for postadolescent (20–30 years) women, particularly pregnant women
ROSACEA FULMINANS (PYODERMA FACIALE-O’LEARY)
Despite the horrendous clinical picture, systemic symptoms such as fatigue, fever, arthralgia, and anaemia are usually absent.
When the disease is controlled, it does not recur.
areas of predilection of rosacea
central face, nose, chin, central cheeks, and glabella
most consistent abnormality seen in histopath
The most consistent abnormality is a change in the collagen of the upper dermis, so-called** “solar elastosis.”** This represents the result of chronic actinic damage.
This location of diagnostic and major features is essential for rosacea diagnosis
centrofacial location
Essential skin care advice elements
(1) avoidance of trigger factors,
(2) usage of foundations and facial coverage without aggravating symptoms of rosacea,
(3) use of sunscreen SPF (sun protection factor) of at least 30+,
(4) frequent use of moisturizers if dry skin is an issue,
(5) usage of drying cleansing for an oily nose,
(6) regular use of gentle cleansers for the whole face,
(7) use of matte green–toned foundations to mask skin redness, and
(8) avoidance of rubbing the face.
If erythema is associated with mild, moderate, or severe pain, what treatment can be given
, topical or systemic analgesic therapy such as **lidocaine gel (up to 4%), polidocanol cream (in mild cases), **or even systemics such as nonsteroidal antiinflammatory drugs (eg, ibuprofen) should be applied; antidepressants or neuroleptics (eg, amitriptyline, gabapentin, pregabalin) may also need to be prescribed
