Red & Spotty Face - Rosacea & Perioral Dermatitis

Question 1

What are the clinical features of Rosacea?

Answer 1

• “RED” and “SPOTTY” face.
• Exacerbated by alcohol, spicy foods, emotion and changes in temperature.
• Photoexacerbation - it gets worse in the sunshine.

Question 2

If someone has Rosacea, what might have happened to them when they were embarrased in their youth?

Answer 2

Easily blush.

Question 3

What is the typical age group & demographic of patients with Rosacea?

Answer 3

30-40 y/o

Fair-skinned

Female

Question 4

What are the 4 typical subtypes of Rosacea?

Answer 4

1. Papulopustular
2. Erythemo-telangiectatic
3. Phymatous
4. Ocular

Question 5

What type of rosacea is this?

Answer 5

Papulopustular

Question 6

What type of Rosacea is this?

Answer 6

Erythemo-telangiectatic

Redness is primarily a problem. Redness due to enlarged and tortuous blood vessels in the upper dermis.

Question 7

What type of Rosacea is this?

Answer 7

Phymatous

Sebaceous hyperplasia with subcutaneous swelling and varying degrees of erythema.

Question 8

What type of Rosacea is this?

Answer 8

Ocular

• Conjunctivitis
• Blepharitis
• Chalazion
• Conjunctival telangiectasia
• Punctate epithelial keratopathy

Question 9

What % of patients experience ocular rosacea?

Answer 9

50%

Question 10

What causes rhynopyma?

Answer 10

Sebaceous hyperplasia with chronic oedema.

Question 11

What are two aetiological theories about the cause of rosacea?

Answer 11

1. Demodex mites - treat with ivermectin and metronidazole.
2. Lymphatic drainage is abnormal. (Dermatologists advise facial massage to help drain)

Question 12

What is the name of a rapid onset of papulopustules and erythem and how do you treat it?

Answer 12

Pyoderma Faciale (a.k.a. Rosacea Fulminans)

Treat with oral steroids, antibiotics and istretinoin.

Question 13

What is the treatment protocol for Papulopustular Rosacea?

Answer 13

• Doxycycline 40mg OD for 3+months.
• Metronidazole in the morning and Azelaic acid 15% at night.
• Soolantra (Topical Ivermectin) is useful.
• Sunscreen

Question 14

What is the treatment protocol for Erythemotelangiectatic Rosacea?

Answer 14

1. Treat papulopustular element as previous protocol.
2. Treat flushing and telangiectasia with IPL or Topical Brimonidine.
3. Cosmetic Camouflage.

Question 15

What is the treatment protocol for phymatous rosacea?

Answer 15

Surgical treatment with cutting diathermy.

Question 16

What is the treatment protocol for ocular rosacea?

Answer 16

• Doxycycline or cyclosporine eye drops.
• Daily morning massage around the orbit and periorbit.

Question 17

Where can we obtain advise on cosmetic camouflage?

Answer 17

Changing Faces

changingfaces.org.uk

Question 18

What is the theoretical cause for perioral dermatitis?

Answer 18

Middle aged women using too many facial creams.

(Note the vermillion border is spared)

Question 19

What is the treatment for perioral dermatitis?

Answer 19

• Doxycycline 100mg OD.
• +/- Topical retinoids.
• Topical Erythromycin is useful if needed because it is gentle.
• If resistant - use either Azithromycin orally or Clarithromycin.