Psoriasis and Rosacea Seborrhea (Bellanger) Flashcards
A skin disease that affects the middle third of the face, causing persistent redness over the areas of the face and nose. There is no confirmatory lab test and no cure.
rosacea
Rosacea usually occurs in those __ to __ years of age and is more common in ____. Etiology is unknown and the major pathogenic components are inflammatory, vascular and neural/hormonal.
30; 50; women
The clinical presentation of subtype 1 rosacea
erythematotelangiectatic:
persistent erythema of central face
easily irritated facial skin
The clinical presentation of subtype 2 rosacea
papulopustular:
subtype 1 +
dome-shaped erythematous papules and some pustules
The clinical presentation of subtype 3 rosacea
phymatous (Rhinophyma):
thickened skin with prominent pores
+/- subtype 1 & 2
The clinical presentation of subtype 4 rosacea
ocular rosacea: both eyes are usually affected conjunctivitis blepharitis styes keratitis
Rosacea aggravating factors:
- ____ sun exposures
- stress/anxiety
- humidity/extremes of weather/wind
- exercise
- ____ beverages
- smoking
- ____ and ____ foods
- medications (?)
- prolonged
- alcoholic
- hot; spicy
- eg., vasodilative drugs, calcium channel blockers, opiates
Rosacea non-pharmacologic basic skin care:
- avoid potentially exacerbating factors
- gently ____ free skin cleanser (avoid ____, ____ and ____ cosmetics)
- moisturizer
- ____ daily (>SPF 15; broad spectrum
- soap; astringents, toners, waterproof
- photoprotection
Ocular rosacea treatment:
- ____ water soaks towel compress
- ____ daily cleaning of base of lashes with baby shampoo or lid cleanser
- artificial tear replacement
- topical ____ gel
- oral ____ or ____
- refer severe cases to ophthalmologist
- warm
- twice
- metronidazole
- doxycycline; tetracycline
Rosacea topical agents (6)
- metronidazole cream/gel
- azelaic acid gel
- brimonidine gel (reduces redness only)
- benzoyl peroxide & clindamycin (papulopustular)
- salfacetamide & sulfur (erythematotelangectatic)
- topical retinoids (use with or without oral antibiotics in refractory rosacea)
Topical metronidazole
- ____ line
- ____ and ____ agent
- inhibits growth of ____
- side effects: burning, stinging, ____, ____
- face should be clean before application
- cosmetics may be used ___ minutes after application
- first
- anti-inflammatory; antimicrobial
- Demodex brevis (mites)
- dryness, itching
- 5
Azelaic acid 15% gel
- ____ and ____ agent
- for ____ to ____ papulopustular rosacea
- face should be clean before application
- cosmetics may be used after application
- side effects: burning, stinging, itching, dryness, ____
- reassess if it has not improved after 12 weeks
- anti-inflammatory; antibacterial
- mild; moderate
- scaling
Brimodine topical gel
alpha2 adrenergic agonist vasoconstricts, reducing redness in face
doxycycline (Oracea)
- ____ dose
- used only for ____ therapy for up to __ ___
- anti-inflammatory
- systemic; 12 months
Antibiotic/anti-inflammatory oral agents:
- doxycycline
- tetracycline
- minocycline
- erythormycin
- metronidazole
- 50-100 mg/day for 6-12 weeks
- 250-500 mg BID for 6-12 weeks
- 50-100 mg BID for 6-12 weeks
- 250-500 mg once or twice daily for 4-6 weeks
- 200 mg once or twice daily for 4-6 weeks
Scaly dermatoses (3)
dandruff, seborrhea, psoriasis
OTC ingredients for treatment of scaly dermatoses
coal tar ketoconazole pyrithione zinc (rinse of vs. residual) salycilic acid selenium sulfide sulfur hydrocortisone
A chronic, non-inflammatory hyperproliferative epidermal scalp condition (pruritus is common). Peak occurance is in adulthood with no gender preference.
dandruff
Dandruff treatment goals:
- reduce epidermal ____ rate of scalp skin
- minimize the cosmetic embarrassement
- minimize ____
- turnover
- itching
Dandruff general treatment approach
- for mild presentation?
- for moderate to severe presentation?
- use non-medicated shampoo, wash hair daily or every other day; leave in for 3-5 minutes; rinse thoroughly
- use OTC medicated shampoos; wash hair 2-3 times weekly for 2-3 weeks, then once weekly for control; leave in for 3-5 minutes; rinse thoroughly
A chronic, inflammatory disorder occurring in areas of sebaceous gland activity; does not have a specific cure; neither harmful or contagious
seborrheic dermatitis
Seborrheic dermatitis affected skin areas: (7)
scalp eyelids (blepharitis) face ears/ear canals mid-upper chest and back buttock crease/genital area armpits
Seborrhea triggers
HIV infection
Parkinsonism
Seborrhea causes:
- Malassezia (yeast) grows in the ____ along with bacteria
- hormones
- physical stress, fatigue, travel
- ____ deficiency
- obesity
- change of season (worsens when ____)
- sebum
- zinc
- cold
Seborrhea physical characteristics:
- ____ or dry scaling of scalp; “cradle cap”
- mildly scaling eczematous patches on face at typical locations, often with itch and ____
- itch and ____ of ear canal
- blepharitis
- well-demarcated eczematous patches on mid-upper ____
- intertrigo (webs of fingers)
- greasy
- stinging
- inflammation
- trunk
Seborrhea goals of treatment
-reduce inflammation and epidermal turnover rate and minimize/eliminate visible erythema and scaling
Seborrhea general treatment approach/management strategies:
- ____ or remove scales and crusts
- inhibit ____ colonization
- reduce erythema and itching
- avoid ____, aftershave, ____, soaps
- control secondary infections
- loosen
- yeast (Malassezia)
- perfumes; ointments
Seborrheic scales can be softened with a cream containing ____ acid and ____ or by ____/washing. Seborrheic skin should be ____ more often than usual.
salicylic; sulfur; wetting
washed
To decrease fungal growth in seborrhea, wash the ____ with ____ shampoo (first line) or ____ ____shampoo (second line). May suggest topical cream treatments, such as ____ derivatives. Sometimes ____ light therapy.
ketoconazole; selenium sulfide
imidazole
ultraviolet
Reduce seborrheic erythema and itching with corticosteroid ____ for the scalp, corticosteroid ____ for other parts of the body, and moisturizing ____ after washing. ____ shampoo and corticosteriod ____ must often be combined in therapy-resistant cases.
lotion; creams; emollients; ketoconazole; lotion
Seborrheic treatment for infants:
- remove scaling on scalp by massaging scalp with ____ ____, use a non-medicated shampoo (for severe cases, use ____ ____ 3-5% in olive oil or a water soluble base), use a soft bristle brush.
- if they are over 2 y.o., use low potency ____
- if on the face, wash with mild soap or cleanser, apply facial emollient - NO ____
- baby oil; salicylic acid
- hydrocortisone (0.5-1%)
- steroids
___ quantifies the extent and severity of skin involvement in different body regions as score. 0 means ___ ___, 72 means ___ ___
PASI (psoriasis area and severity index); no lesions; severe disease
Psoriasis goals of treatment:
- minimize/eliminate signs of psoriasis (____ and ____)
- alleviate pruritus and minimize ____
- reduce frequency of flare-ups
- ensure appropriate treatment of associated conditions such as PsA, HTN, dyslipidemia, diabetes, clinical depression, or ____
- avoid/minimize ____ ____ from topical or systemic treatments used
- provide cost-effective therapy
- provide guidance or counseling ____ ____
- maintaining/improving ____ of ____
- plaques; scales
- excoriations
- itching
- adverse effects
- as needed
- quality; life
Psoriasis lifestyle recommendations (5)
- reduce stress
- regular exercise
- weight management
- moderation of alcohol consumption
- cessation of smoking
Psoriasis non-pharmacologic treatments (3)
- moisturizers/emollients
- oatmeal baths
- sunscreen
Photochemotherapy:
- PUVA (____+ ultraviolet A light)
- MOA?
- for patients with ____, ____ psoriasis
- need skin ____ of lesion to confirm ____
- ___% effective
- psoralen
- psoralen cross-links with DNA in presence of UVA light, effects immune response in skin and lymphocytes
- severe; refractory
- biopsy; diagnosis
- 90
Photochemotherapy
- dosing?
- side effects? (6)
- 0.6-0.8 mg/kg PO Q2h before UVA exposure
- serious burns, increased risk of melanoma & non-melanoma skin CA, blistering, peeling, itching, nausea
