14 - 79 - ROSACEA

Question 1

In general, what are the possible signs and symptoms of rosacea

Answer 1

• flushing
• transient erythema
• persistent erythema
• telangiectasia
• papules
• pustules
• phymata
• edema
• pain
• stinging or burning
• pruritus (very rarely)

Question 2

hallmark of rosacea

Answer 2

flushing

Question 3

in younger female and male patients, what are often the first symptoms

Answer 3

flushing and erythema

Question 4

Persistent erythema (from Greek erythros, red) is defined as erythema that lasts for at least how many months

Answer 4

3 months

Question 4

in older adults, what are often the first symptom

Answer 4

telangiectasia

Question 5

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.

Answer 5

Erythema

Question 6

Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the NOSE

Answer 6

rhinophyma

Question 7

Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the CHIN

Answer 7

GNATHOPHYMA

Question 8

Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the FOREHEAD

Answer 8

METOPHYMA

Question 9

Phymatous rosacea is a persistent, firm, nonpainful, nonpitting swelling of the tissue of the EYELIDS

Answer 9

BLEPHAROPHYMA

Question 10

involves reactive vascular changes in the face that can be observed in normal individuals for a few seconds or few minutes

Answer 10

flushing

Question 11

Physiologically, it can occur in response to various stimuli, especially heat, certain foods, alcohol, exercising, or stressful emotional stimuli.

Answer 11

flushing

Question 12

Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than how many minutes?

Answer 12

5 - 10 mins

Question 13

Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than 5 to 10 minutes because of ___________

Answer 13

neuropeptide release

Question 14

most common complaint in patients with rosacea

Answer 14

Prolonged and frequent flushing

Question 15

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.

Answer 15

5 minutes

Question 16

T/F. Blushing is not a feature of rosacea

Answer 16

True

Question 17

almost exclusively induced by emotionally stressful situations and not by spicy food or other rosacea trigger factors

Answer 17

Blushing

Question 18

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

Answer 18

Blushing

Question 19

“Pale islands” in between the salmon-like redness are also characteristic of

Answer 19

blushing

Question 20

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.

Answer 20

LUPOID OR GRANULOMATOUS ROSACEA

Question 21

rare, acute or subacute, developing, maximal variant of rosacea with acne conglobatelike progression and predilection for postadolescent (20–30 years) women, particularly pregnant women

Answer 21

ROSACEA FULMINANS PYODERMA FACIALEO’LEARY

Question 22

Common Rosacea Triggers

Answer 22

Question 23

subtype of rosacea characterized as persistent central facial erythema, frequent flushing; may be telangiectatic vessels

Answer 23

Subtype 1: erythematotelangiectatic

Question 24

subtype of rosacea characterized as erythematous dome-shaped papules, some with surmounting postulation in a centrofacial distribution on a background of persistent erythema

Answer 24

Subtype 2: papulopustular

Question 25

subtype of rosacea characterized as Persistent facial swelling with hypertrophy of tissue (rhinophyma);

Answer 25

phymatous

Question 26

subtype of rosacea characterized as Ocular inflammation (eg, blepharitis, conjunctivitis, or meibomian gland dysfunction; chalazion)

Answer 26

Ocular rosacea

Question 27

T/F. The bilateral facial location of a presentation is considered typical but not essential.

Answer 27

True

Question 28

T/F. Flushing, telangiectasia, and inflammatory papules or pustules are considered major features and are diagnostic of rosacea.

Answer 28

False considered major features but are not diagnostic of rosacea.

Question 29

What are the diagnostic features of rosacea

Answer 29

Question 30

What are the Major features of rosacea

Answer 30

Question 31

What are the secondary features of rosacea

Answer 31

Question 32

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Inflammatory papules and pustules

Answer 32

MAJOR FEATURE

Question 33

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Edema

Answer 33

secondary feature

Question 34

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - dry sensation of skin

Answer 34

secondary feature

Question 35

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Persistent centrofacial erythema associated with periodic intensification by potential trigger factors

Answer 35

DIAGNOSTIC FEATURE

Question 36

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - TELANGIECTASIA

Answer 36

MAJOR FEATURE

Question 37

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Phymatous changes

Answer 37

DIAGNOSTIC FEATURE

Question 38

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Flushing or transient erythema

Answer 38

MAJOR FEATURE

Question 39

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Stinging sensation of the skin

Answer 39

SECONDARY FEATURE

Question 40

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Burning sensation of the skin

Answer 40

SECONDARY FEATURE

Question 41

Identify if this is Diagnostic, Major or Secondary Feature of rosacea - Ocular manifestation

Answer 41

MAJOR FEATURE

Question 42

Classification of rhinophymata: Distal end, apex of nose

Answer 42

Group 1

Question 43

Classification of rhinophymata: Complete nose, including bridge and nasofacial sulci

Answer 43

Group 4

Question 44

Classification of rhinophymata: Distal half of nose, apex, alar nodules

Answer 44

Group 3

Question 45

Classification of rhinophymata: Distal half nose, apex, alae,

Answer 45

Group 2

Question 46

Classification of Ocular rosacea: pain, photosensitivity, blurred vision, loss of eyelashes, severe conjunctival inflammation, corneal changes, scleritis or episcleritis, uveitis, iritis

Answer 46

Severe

Question 47

Classification of Ocular rosacea: burning of eyes; crusting or irregularity of eyelid margins with erythema and edema; formation of chalazion or hordeolum)

Answer 47

Moderate

Question 48

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.

Answer 48

Mild

Question 49

For persistent erythema, approved therapeutic regimens

Answer 49

Topical brimonidine gel (1%) and oxymetazoline crème (1%) Beta-blockers such as carvedilol can be used off label and should be tapered down

Question 50

which areas of the body are rarely affected by rosacea?

Answer 50

forehead (more common in bald men), neck, chest, perioral or periorbital regions, or areas behind the ears

Question 51

the symptom very rarely experienced by patients with rosacea

Answer 51

pruritus

Question 52

what's the difference of blushing from erythema and flushing?

Answer 52

Blushing, in contrast to flushing, is almost exclusively induced by emotionally stressful situations and not by spicy food or other rosacea trigger factors. ## Footnote 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.

Question 53

difference of erythema and flushing when it comes to pathophysiology

Answer 53

erythema is caused by vasodilation while flushing is due to neuropeptide release

Question 54

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

Answer 54

“Pale islands” in between the salmon-like redness

Question 54

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

Answer 54

ROSACEA FULMINANS (PYODERMA FACIALE-O’LEARY) ## Footnote 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.

Question 54

areas of predilection of rosacea

Answer 54

central face, nose, chin, central cheeks, and glabella

Question 55

most consistent abnormality seen in histopath

Answer 55

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.

Question 56

This location of diagnostic and major features is essential for rosacea diagnosis

Answer 56

centrofacial location

Question 57

Essential skin care advice elements

Answer 57

(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.

Question 58

If erythema is associated with mild, moderate, or severe pain, what treatment can be given

Answer 58

, 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