79 - Rosacea Flashcards
Rosacea affects (men/women) more than (men/women) (3:1)
Women
Men
Hallmark of rosacea
Flushing
Characteristic of male patients with rosacea
Rhinophyma
Persistent erythema is defined as erythema that lasts for at least
3 months
Phymatous rosacea of the nose
Rhinophyma
Phymatous rosacea of the chin
Gnathophyma
Phymatous rosacea of the forehead
Metophyma
Phymatous rosacea of the eyelids
Blepharophyma
Phymatous rosacea of the lower half of the helices of the ears and the lobes
Otophyma
Compression of rhinophyma produces a white pasty matter that is composed of
Sebum
Corneocytes
Bacteria
Sometimes Demodex folliculorum mites
Y/N: The incidence of both basal and squamous cell carcinomas has been reported to be higher in rhinophyma-affected skin than in nonlesional skin
Yes
Rhinophymata are particularly frequent when associated with
Seborrhea
Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than
5 to 10 minutes
Both genders are equally susceptible to flushing without age preference, although in women, it is more frequent during
Menopause
_____ is, with erythema, the most common complaint in patients with rosacea
Prolonged and frequent flushing
Rosacea flushing can often be linked to typical trigger factors, mostly
Heat Hot steam Red wine and certain alcoholic beverages Medications such as niacin or topical glucocorticoids Noxious cold Hormonal changes (menopause) Rarely systemic disease
_____, in contrast to flushing, is almost exclusively induced by emotionally stressful situations and not by spicy food or other rosacea trigger factors
Blushing
“Pale islands” in between the salmon-like redness are characteristic of
Blushing
Permanent dilated blood vessel on the skin or mucosal surface
Telangiectasia
Forehead rosacea almost exclusively develops in patients with
Male pattern baldness
Y/N: Ocular rosacea involves the eyelids, eyelashes, or eyes of patients with rosacea, and if left untreated, bears risk of blindness
Yes
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 (_____), granulomatous plaques and nodules on the cheek, forehead, or chin
Lupoid or granulomatous rosacea
Rare, chronic, and severe form of rosacea
Hemorrhagic nodular abscesses and indurated plaques on erythematous background
Rosacea conglobate
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)
Ingestion of _____ might cause rosacea-like reaction or deteriorate a persisting rosacea
Iodides
Bromides
Potential sources of halogen exposure
Citrus-flavored softdrinks (cola drinks) (Sea)food Diagnostic radiocontrast media Pool disinfectants Certain topical antiseptics Permanent hair wave formulations Vitamin preparations Medications (eg, thyroid medication, chemotherapeutics)
Halogen rosacea typically improves in _____ after elimination of exposure
4 to 6 weeks
When a patient with rosacea is treated with topical corticosteroids for a prolonged time, the atrophic side effects of the medication sometimes lead to an aggravation of the condition
Steroid rosacea
Characteristic clinical finding is the development of miniscule yellow pustules on a preexisting or newly formed erythema background
Gram-negative rosacea
Diffuse idiopathic solid upper-facial edema
Morbihan disease or
Edematous rosacea
In (rosacea/Morbihan disease), edema is present as hard, nonpitting swellings of mainly the caudal half of the face but also the glabella
Rosacea
Demodex mites are particularly found in association with _____ lesions
Papulopustular
Commensal of human and animal skin, predominantly in oily skin close to the pilosebaceous glands, and is increased in some patients with rosacea, predominantly in those with phymata as well as papules and pustules
Demodex folliculorum
Patients with rosacea, suffer from _____, as well as _____, both markers for skin barrier dysfunction
Increased transepidermal water loss
pH increase of the facial skin
Histological analysis and transcriptome studies reveal the presence of predominantly _____ and to lower extend _____ T cells and cytokines in rosacea skin
CD4+
CD8+
The human face is to a certain extent physiologically unique because it is one of the few regions in the human skin where the blood vessels are under control of the
Sympathetic
Parasympathetic
Sensory nerves
Y/N: The skin shows normal vascular responses to application of epinephrine, norepinephrine, and acetylcholine in patients with rosacea
Yes
Perivascular inflammatory infiltrate consisting mainly of Th1 and Th17 cells, as well as macrophages and mast cells
Blood and lymphatic vessels are markedly dilated
Dermal edema
Erythematous skin and telangiectasia
CD4+ Th1 and Th17 cells, macrophages, mast cells, and plasma cells
Papules
CD4+ Th1 and Th17 cells, macrophages, mast cells, and plasma cells
Additional neutrophils can be found
Pustules
Th1 and Th17 cells, macrophages, mast cells, and more plasma cells
Glandular hyperplasia and follicular plugging without comedones can be found as well as fibrosis and increase in fibroblasts
Phymatous rosacea
Dermal edema and vasodilation as well as dermal granulomas of the tuberculoid type with T cells and macrophages as well as mutinucleated giant cells and plasma cells
Granulomatous rosacea
Differentiates rosaces from other granulomatous disorders such as lupus vulgaris
Marked upper dermal vasodilation of blood and lymphatic vessels
Most consistent histopathologic abnormality
Change in the collagen of the upper dermis, so-called “solar elastosis”
Four distinct clinical subtypes of rosacea
- Erythematotelangiectatic
- Papulopustular
- Phymatous
- Ocular rosacea
Diagnostic features of rosacea
- Persistent centrofacial erythema associated with periodic intensification by potential trigger factors
- Phymatous changes
Major features of rosacea
- Flushing or transient erythema
- Inflammatory papules and pusutles
- Telangiectasia
- Ocular manifestations
Secondary features of rosacea
- Burning sensation of the skin
- Stinging sensation of the skin
- Edema
- Dry sensation of the skin
For persistent erythema, approved therapeutic regimens are
Topical brimonidine gel (1%) Oxymetazolene cream (1%)
Off-label therapy for persistent erythema
Beta-blockers such as carvedilol
Common treatment used for flushing and transient erythema
Laser therapy
Off-label therapy for flushing and transient erythema
Topical adrenergic receptor modulators (eg, brimonidine, oxymetazoline)
Telangiactasia can only be treated with
Laser therapy
0.5% to 1.0% aethoxysclerol injections
Mild to moderate papules and pustules respond well to topical therapy such as
Ivermectin (1%) Metronidazole (0.75%-1%) Azelaic acid (15%) Sodium sulfacetamide Sulphur
Off-label therapy for papules and pustules
Oxytetracyclin 500 mg twice a day
Doxycycline 100 mg twice a day
Minocycline 50 mg/day
Erythromycin 500 mg twice a day
There is substantial evidence that _____ has a beneficial effect in early as well as established rosacea because of its inhibitory effects on sebaceous glands as well as some antiinflammatory capacity
Can also be used before laser and dermatosurgery procedures to reduce size and inflammation
Low-dose isotretinoin
