Derma - Rosacea + perioral dermatitis Flashcards
Chronic and recurrent inflammatory disorder of the pilosebaceous units and vasculature of the face
It also involves erythema of the central face that has persisted for months or more. - Red face
Rosacea
Rosacea common among what populations
Caucasians
Men and women affected
After 30 y/o onset usually
Onset of rosacea age
30y/o
Flushing, persistent erythema, papules and pustules, telangiectasia
Primary rosacea
Burning/ stinging, dry appearance, edema/plaques, ocular signs, phyma
Secondary rosacea
Are there comedones present in rosacea
None
Triggers of rosacea
Heat/cold Hot drinks Spicy foods Exercise Alcohol Strong emotions Topical irritants Medications Menopausal flushing
What diagnostic modality?
Rosacea
Exclude other cutaenous diseases such as lupus
Skin biopsy
Rosacea tx
Identification and avoidance of triggers Photoprotection Gentle cleanser and emollient Topical antibiotics Systemic: antibiotics, isotretinoin, anti-androgen
Topical antibiotics rosacea
Metronidazole cream
Azelaic acid
Clindamycin, erythromycin
Sodium sulfacetamide
Systemic antibiotics rosacea
Tetracycline
Minocycline
Doxycycline
Lymecycline
Erythromycin
Metronidazole
Chronic facial dermatitis characterized by small discrete erythematous papules and/or pustules that often become confluent on perioral and periorbital skin
Perioral dermatitis
Initial lesions of perioral dermatitis
Site
On nasolabial folds with rum of sparing around the vermillion border of lips
Usual population affected by perioral dermatitis
Women and children
Perioral dermatitis related to use of
Potent topical steroids
Highly fluorinated toothpaste
Tx perioral dermatitis
Topical antibiotics: Metronidazole cream/gel Azelaic acid Clindamycin, erythromycin Sodium sulfacetamide
Systemic antibiotics
Tetracycline, minocycline, doxycline, lymecycline
Erythromycin
Circumscribed areas of raised erythema and edema of superficial dermis
Urticaria
Acute urticatia
< 6 weeks
Chronic urticaria
> 6 weeks
Acute urticaria
Gender
Men = women
Chronic urticatia
Women > men
Age group
Acute urticaria
Any
Chronic urticaria
Age group
4th-5th decade
Signals associated with urticaria
Histamine, bradykinin, kallikrein, acetylcholine
Central swelling of variable size, surrounded by a reflex erythema
Associated with itching or sometimes burning
Transient
Wheal
Sudden pronounced swelling of lower dermis and subcutis
Sometimes pain than itching
Frequent involvement of the mucous membranes
Angioedema
Resolution
Wheal
1-24 hr
Resolution angioedema
Within 72 hours
New classification of urticaria based on its duration, frequency and cause
Spontaneous urticaria
Physical urticaria
Special types of urticaria
Disorders related to urticaria
New guidelines for routine diagnosis of urticaria
Thorough history - possible trigger factors, characteristic of urticaria
Physical examination - dermatographism test
Specific challenge and lab tests
- on basis of suspected cause
Key questions urticaria
Time of onset of disease
Frequency and duration of whealing
Associated angio-oedema
Associated subjective symptoms (e.g. pain)
Family history (urticaria, atopy)
Previous or current allergies, infections, internal diseases
Induction by physical agents or exercise
Use of drugs (NSAIDs, injections, immunisations, hormones, laxatives)
Food, smoking habits
Occupation, hobbies
Tx urticaria
H1 antihistamines
H2 antihistamines
Glucocorticoids
Epinephrine
Receptor that mediates wheal and flare reactions, bronchal constriction, mucus secretion, smooth muscle contraction, edema, hypotension, CNS depression, cardiac arrhythmias
H1 receptor
Antihistamines
May cause drowsiness
First gen antihistamines
Less of nonsedating antihistamines
Second gen H1 antihistamines
First gen antihistamines
Enumerate
Hydroxyzine hydrochloride
Diphenhydramine
Chlorpheniramine
Second gen antihistamines
Enumerate
Loratadine Cetirizine Desloratadine Levocetirizine Fexofenadine Bilastine
H2 antihistamines
Enumerate
Cimetidine
Ranitidine
Famotidine
Stabilize mast cell membranes and inhibit further histamine release
Reduce inflammatory effect of histamine and other mediators
Glucocorticoids
Glucocorticoids
How to prescribe for urticaria
40 mg prednisone in a short
Children: 1 mg/kg/d for 5 days
– alpha-adrenergic effects result in vasoconstriction of the superficial cutaneous vessels and directly oppose the vasodilatory effect of histamine
– has no effect on pruritus
Epinephrine
