Acne Rosacea and Perioral Dermatitis Flashcards
etiologies for rosaciea
The etiology of rosacea is poorly understood. Cutaneous vascular changes, inappropriate activation of the immune system, UV and microbial exposure (ie, Demodex mites), and disruption of the epidermal barrier have all been implicated as playing a role in the pathogenesis in this condition. There have been reports of familial rosacea, so an underlying genetic predisposition has not been ruled out.
4 main subtypes of the disease
- erythematotelangiectatic,
- Papulopustular
- Phymatous
- and ocular rosacea.
most common subtype of rosacea
Erythematotelangiectatic rosacea the most common of the 4 sub-types, presents with persistent erythema of the central portion of the face with intermittent flushing. Telangiectasias can also occur.
Patients often complain of stinging or burning sensations on the skin.
differentiating papulopustular rosacea from acne vulgaris
like acne, in papulopustular rosacea, acneiform papules and pustules predominate There is also erythema and edema of the central face with relative sparing of the periocular areas.
The absence of comedones can help to differentiate papulopustular rosacea from acne.
In phymatous rosacea, chronic ____ and ___ result in marked thickening of the skin with ____ hyperplasia, resulting in an enlarged, ____ appearance of affected skin, most commonly on the ___ (rhinophyma). Men are more often affected.
In phymatous rosacea, chronic inflammation and edema result in marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin, most commonly on the nose (rhinophyma). Men are more often affected.
in this type of rosacea, the patients complain of dry and irritated eyes. there are complications of Keratitis, scleritis, and iritis are potential but infrequent complications.
ocular rosacea
treatment of rosacea
In severe cases, use of both an oral and topical therapy is often warranted. Treatment often varies depending on rosacea subtype.
Advise patients to avoid triggers that aggravate vasodilation (eg, hot beverages, spicy foods, chocolate, and alcohol).
topical and systemic therapries for rosacea
Many topical medications are effective in the treatment of rosacea, but they are significantly more effective in the treatment of papulopustular rosacea than the erythematotelangiectatic type.
• Topical therapies for rosacea include the following:
• Metronidazole 0.75% cream or lotion twice daily for patients with normal to dry skin types. • Azelaic acid 15% gel has been shown to be equally as effective as topical metronidazole. • Sodium sulfacetamide with 5% sulfur is available in a lotion, cream, suspension, or cleanser • Erythromycin or clindamycin lotion, solution • Calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream • Ivermectin 1% cream • Permethrin 5% cream
Systemic Therapy includes the use of either oral antibiotics or isotretinoin.
• Oral antibiotics:
• Tetracycline 500 mg every 12 hours for 1 month, then taper to 1 p.o. every 24 hours
for 2 weeks, or • Doxycycline 100 mg every 12 hours for 1 month, then taper slowly over several
weeks, or • Erythromycin 333 mg every 8 hours in the same schedule.
• Low-dose oral isotretinoin has been used in recalcitrant cases (0.2 mg/kg/day, then decrease
dose to 0.1 mg/kg/day or 0.05 mg/kg/day).
downside of topical rosacea treatment
it may temporarily reduce facial erythema but may cuase rebound erythema
what sex is affect more by perioral dermatitis and what area is spared in PD?
It manifests as an erythematous papular and pustular eruption involving the nasolabial folds, the upper and lower cutaneous lip, and the chin. There is often sparing of the skin at the vermillion border.
Perioral dermatitis is seen almost exclusively in women aged between 18 and 40. A number of factors have been implicated in causing this condition, such as topical fluorinated glucocorticoids (including inhalers), fluorinated toothpastes, and oral contraceptives.
differentiating PD from rosacea
Perioral Dermatitis can be very difficult to distinguish from rosacea.
However, it tends to be more concentrated on the lower face and often shows relative sparing of the peri-oral skin
what happens when PD starts to involve the eyelids
Periorbital involvement, predominantly the lower and lateral eyelids, may occur. The term “periorificial dermatitis” is then preferred to peri-oral dermatitis.
treatment for PD is basically the same as rosacea, but what is the exception
In patients with a history of steroid exposure, topical corticosteroids should be discontinued with tapering as necessary. Topical pimecrolimus 1% has been shown to be beneficial in these patients.
Except for the use of sunscreens which is not necessary for perioral dermatitis, treatment is almost identical to the treatment for rosacea.
erythemato-telangiectatic rosacea
papulopustular rosacea
phymatous rosacea
perioral dermatitis– look at the perioral sparing making it different than rosacea
ocular rosacea
first line topical therapy for rosacea
metronidazole creams or gels for oily skin
first line systemic therapy for rosacea
tetracyclin first line, then isotretinoin last line.
perioral dermatitis
periorificial dermatitis affecting the lower eyelid
therapy for PD
basically the same for rosacea.
- discontinue topical corticosteroids if they are in use and then try abx, metronidazole or isotretinoin. don’t really need a sunscreen tho.
