Red & Spotty Face - Rosacea & Perioral Dermatitis Flashcards
What are the clinical features of Rosacea?
- “RED” and “SPOTTY” face.
- Exacerbated by alcohol, spicy foods, emotion and changes in temperature.
- Photoexacerbation - it gets worse in the sunshine.
If someone has Rosacea, what might have happened to them when they were embarrased in their youth?
Easily blush.
What is the typical age group & demographic of patients with Rosacea?
30-40 y/o
Fair-skinned
Female
What are the 4 typical subtypes of Rosacea?
- Papulopustular
- Erythemo-telangiectatic
- Phymatous
- Ocular
What type of rosacea is this?
Papulopustular
What type of Rosacea is this?
Erythemo-telangiectatic
Redness is primarily a problem. Redness due to enlarged and tortuous blood vessels in the upper dermis.
What type of Rosacea is this?
Phymatous
Sebaceous hyperplasia with subcutaneous swelling and varying degrees of erythema.
What type of Rosacea is this?
Ocular
- Conjunctivitis
- Blepharitis
- Chalazion
- Conjunctival telangiectasia
- Punctate epithelial keratopathy
What % of patients experience ocular rosacea?
50%
What causes rhynopyma?
Sebaceous hyperplasia with chronic oedema.
What are two aetiological theories about the cause of rosacea?
- Demodex mites - treat with ivermectin and metronidazole.
- Lymphatic drainage is abnormal. (Dermatologists advise facial massage to help drain)
What is the name of a rapid onset of papulopustules and erythem and how do you treat it?
Pyoderma Faciale (a.k.a. Rosacea Fulminans)
Treat with oral steroids, antibiotics and istretinoin.
What is the treatment protocol for Papulopustular Rosacea?
- Doxycycline 40mg OD for 3+months.
- Metronidazole in the morning and Azelaic acid 15% at night.
- Soolantra (Topical Ivermectin) is useful.
- Sunscreen
What is the treatment protocol for Erythemotelangiectatic Rosacea?
- Treat papulopustular element as previous protocol.
- Treat flushing and telangiectasia with IPL or Topical Brimonidine.
- Cosmetic Camouflage.
What is the treatment protocol for phymatous rosacea?
Surgical treatment with cutting diathermy.
What is the treatment protocol for ocular rosacea?
- Doxycycline or cyclosporine eye drops.
- Daily morning massage around the orbit and periorbit.
Where can we obtain advise on cosmetic camouflage?
Changing Faces
changingfaces.org.uk
What is the theoretical cause for perioral dermatitis?
Middle aged women using too many facial creams.
(Note the vermillion border is spared)
What is the treatment for perioral dermatitis?
- Doxycycline 100mg OD.
- +/- Topical retinoids.
- Topical Erythromycin is useful if needed because it is gentle.
- If resistant - use either Azithromycin orally or Clarithromycin.
