79: Rosacea Flashcards
What is the hallmark symptom of rosacea?
The hallmark of rosacea is flushing.
How does the prevalence of rosacea differ between genders?
Rosacea affects women more than men at a ratio of 3:1.
What are the common clinical findings associated with rosacea?
Common clinical findings include:
- Flushing
- Transient erythema
- Persistent erythema
- Telangiectasia
- Papules and pustules
- Phymatous changes
- Edema
- Pain, stinging or burning, pruritus (rarely)
What is the typical age of onset for rosacea in women and men?
The normal age of onset for rosacea is 35 to 45 years in women and 45 to 55 years in men.
What is persistent erythema and how long does it last?
Persistent erythema is characterized by erythema that lasts for at least 3 months and is caused by vasodilation of arterioles or capillaries, leading to increased perfusion and redness.
What are the characteristics of rhinophyma in rosacea?
Rhinophyma is characterized by:
- Persistent, firm, nonpainful, nonpitting swelling of the tissue of the nose.
- Occurs almost 20 times more often in male patients.
- Initially appears in the skin of the alae nasi and at the distal end of the nose as dilated patulous follicles.
- Resembles a “peau d’orange” appearance of the nose.
What is the likely diagnosis for a patient with persistent erythema lasting over 3 months?
The likely diagnosis is persistent erythema associated with rosacea. It is caused by vasodilation of arterioles or capillaries, leading to increased perfusion and redness.
What are the key clinical findings associated with rosacea, and how do they vary by age and gender?
Key clinical findings of rosacea include:
- Flushing
- Transient erythema
- Persistent erythema
- Telangiectasia
- Papules and pustules
- Phymatous changes
- Edema
- Pain, stinging, or burning (rarely)
Variations by age and gender:
- Younger patients: Flushing and erythema are often the first symptoms.
- Older adults: Telangiectasia is more common.
- Male patients: More likely to develop rhinophyma.
How does the progression of rosacea manifest, and what triggers can exacerbate the condition?
The progression of rosacea is described as a ‘crescendo’ manifestation, characterized by:
- Increased numbers of flushes after exposure to trigger factors.
Common triggers include:
- Temperature changes
- Spicy foods
- Alcohol consumption
- Stress
- Sun exposure
What is rhinophyma, and how does it differ in presentation between male and female patients?
Rhinophyma is a form of phymata characterized by:
- Persistent, firm, nonpainful swelling of the tissue of the nose.
- Occurs almost 20 times more often in male patients than in female patients.
- Initially appears in the skin of the alae nasi and at the distal end of the nose as dilated patulous follicles.
- The appearance resembles a ‘peau d’orange’ due to prominent humps and grooves.
In contrast, female patients are less likely to develop this condition, and when they do, it may present less severely.
What are the characteristics of the fibrous form of rhinophyma?
- Asymmetry of nasal swelling due to diffuse hyperplasia of connective tissue and sebaceous hyperplasia.
- Large actinic comedones can be prominent, referred to as “potato nose.”
What is flushing in rosacea and what are its common triggers?
Flushing in rosacea is a pathophysiological neurovascular process experienced for more than 5-10 minutes due to neuropeptide release. Common triggers include:
- Heat
- Hot steam (kitchen, beverages)
- Red wine and certain alcoholic beverages
- Medications (e.g., Niacin, topical glucocorticoids)
- Noxious cold
- Hormonal changes (menopause)
How does blushing differ from flushing in rosacea?
Blushing is almost exclusively induced by emotionally stressful situations and is not triggered by spicy food or other rosacea factors. It has a pinkish appearance and is characterized by:
- Sudden transient redness (mostly <5 mins)
- Involuntary redness of the peripheral cheeks, ears, neck, and chest
- Often starts in early adulthood
- “Pale islands” in between salmon-like redness are characteristic of blushing.
What is telangiectasia and its significance in rosacea?
Telangiectasia is a permanent visible dilated blood vessel on the skin or mucosal surface. It is classified as a primary feature of rosacea and can coexist with or without other rosacea features.
What are papules and pustules in the context of rosacea?
Papules can occur with or without pustules and can develop into cysts and nodules, referred to as rosacea conglobata.
What subtype of rosacea is characterized by asymmetric nasal swelling with a ‘potato nose’ appearance?
This is fibrous rhinophyma, a subtype of phymatous rosacea. It is characterized by diffuse hyperplasia of connective tissue and sebaceous hyperplasia, often with large actinic comedones.
What physiological mechanism underlies flushing triggered by hot beverages and red wine?
Flushing in rosacea is a neurovascular process caused by neuropeptide release, leading to prolonged vasodilation and erythema.
What are the key differences between flushing and blushing in rosacea, and how do their triggers differ?
Flushing:
- Pathophysiological neurovascular process lasting more than 5-10 minutes.
- Associated with stinging, burning pain.
- Can occur with persistent erythema, papules, pustules, or phymata.
- Common triggers include heat, hot steam, red wine, certain medications, noxious cold, and hormonal changes.
Blushing:
- Induced by emotionally stressful situations, not by food or other triggers.
- Characterized by sudden transient pinkish redness, mostly lasting <5 minutes.
- Occurs on rosacea-atypical sites and often starts in early adulthood.
What are the clinical implications of the different forms of rhinophyma in rosacea?
Fibrous Form:
- Asymmetry of nasal swelling due to connective tissue and sebaceous hyperplasia.
- Prominent large actinic comedones, known as “potato nose.”
Fibroangiomatous Form:
- Nose appears copper to dark red, grossly enlarged with ectatic veins and pustules.
Gnathophyma:
- Involves the central chin.
Otophyma:
- Involves lower half of the ears and lobes.
Clinical Implications:
- Higher incidence of basal and squamous cell carcinomas in rhinophyma-affected skin compared to nonlesional skin.
What systemic symptoms may accompany flushing in rosacea, and what is their clinical significance?
Flushing in rosacea may be accompanied by:
- Wheezing
- Diarrhea
- Headache
Clinical Significance:
- These symptoms indicate a potential role of nerves and mast cells in the flushing process.
- The release of gastrin hormonal mediators from the GI tract can lead to frequent facial flushing, persistent vasodilation, and telangiectasias, highlighting the systemic nature of rosacea.
How does the presence of telangiectasia relate to the diagnosis of rosacea?
Telangiectasia is characterized by:
- Permanent visible dilated blood vessels on the skin or mucosal surface.
- Classified as a primary feature of rosacea.
- Can coexist with or without other rosacea features, aiding in the diagnosis of the condition.
What are the potential complications associated with papules and pustules in rosacea?
Papules and Pustules:
- Can occur with or without pustules.
- May develop into cysts and nodules, known as rosacea conglobata.
Potential Complications:
- Risk of secondary infections due to pustule formation.
- Cosmetic concerns and psychological impact due to visible lesions.
- Possible scarring if cysts or nodules develop.
What is the typical distribution and characteristics of papules in rosacea?
Papules in rosacea typically have a centrofacial distribution and are characterized by a lack of comedones and scales. They are mostly small, low pain, dome-shaped, and red in color, often appearing as multiples. Lesions tend to occur symmetrically on centrofacial skin but can extend to the neck, chest, and forehead.
What are the ocular manifestations associated with rosacea?
Ocular rosacea involves the eyelids, eyelashes, or eyes and can lead to blindness if left untreated. It occurs in 25% of patients with rosacea and 50% of those with papules and pustules. Patients may experience a ‘foreign body’ sensation, itching, burning, stinging in the eyes, and grittiness around the eyes, along with red, swollen, crusty, or scaly margins. Telangiectasia of the conjunctiva may also occur.