79 - Rosacea Flashcards by dvojnd rivera

Rosacea affects (men/women) more than (men/women) (3:1)

Women

Men

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Hallmark of rosacea

Flushing

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Characteristic of male patients with rosacea

Rhinophyma

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Persistent erythema is defined as erythema that lasts for at least

3 months

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Phymatous rosacea of the nose

Rhinophyma

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Phymatous rosacea of the chin

Gnathophyma

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Phymatous rosacea of the forehead

Metophyma

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Phymatous rosacea of the eyelids

Blepharophyma

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Phymatous rosacea of the lower half of the helices of the ears and the lobes

Otophyma

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Compression of rhinophyma produces a white pasty matter that is composed of

Sebum
Corneocytes
Bacteria
Sometimes Demodex folliculorum mites

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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

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Rhinophymata are particularly frequent when associated with

Seborrhea

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Flushing in rosacea is a pathophysiological neurovascular process in the central face experienced for more than

5 to 10 minutes

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Both genders are equally susceptible to flushing without age preference, although in women, it is more frequent during

Menopause

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_____ is, with erythema, the most common complaint in patients with rosacea

Prolonged and frequent flushing

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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

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

Blushing

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

Blushing

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Permanent dilated blood vessel on the skin or mucosal surface

Telangiectasia

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Forehead rosacea almost exclusively develops in patients with

Male pattern baldness

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Y/N: Ocular rosacea involves the eyelids, eyelashes, or eyes of patients with rosacea, and if left untreated, bears risk of blindness

Yes

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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

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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

1. Erythematotelangiectatic 2. Papulopustular 3. Phymatous 4. Ocular rosacea

Diagnostic features of rosacea

1. Persistent centrofacial erythema associated with periodic intensification by potential trigger factors 2. Phymatous changes

Major features of rosacea

1. Flushing or transient erythema 2. Inflammatory papules and pusutles 3. Telangiectasia 4. Ocular manifestations

Secondary features of rosacea

1. Burning sensation of the skin 2. Stinging sensation of the skin 3. Edema 4. 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