Rosacea Flashcards
Clinical features of rosacea include
ETTR (Erythematotelangiectatic) rosacea has what symptoms
transient erythema, persistent centrofacial erythema, telangiectasias and flushing
Constant burning/ stinging possibly due to heightened transient receptor potential vanilloid TRPV cation channels (normally triggered by spicy food, heat, alcohol)
Histopathologic inflammatory changes were noted to be most pronounced near the
bulge region of the pilosebaceous follicle
site of stem cells
Rosacea is seen in higher % of ____ skin types
What does this implicate?
type 1 and 2
increases the liklihood of it being related to UVB light exposure
HOWEVER → only ETTR, not papulopustular rosacea
Proposed pathogenesis of UVB light in rosacea?
UVB exposure → angiogenesis via VEGF released from keratinocytes
What two overlaps which are seen in Eczema do rosacea patients have?
Use of what medication improves these issues in Rosacea
Increased transepidermal water loss
Disruption of fatty acid
Minocycline
Increased numbers of ___ is seen in rosacea patients, where are these located?
Demodex mites -→ seen in pilosebcaeous follicles
Onset of Rosacea is seen when
Men vs. women?
Which type of rosacea is seen here?
Middle age
Women are affected at younger age than men
This is ERythematotelangiectatic rosacea (ETTR)
Which type of Rosacea is seen here>?
Papulopustular rosacea
Characterized by centralofacial eruption of multiple, small dome-shaped ,erythematous papules that appear alone or in crops
Some may have central pustule
Individual papules or pustules last about two weeks and are then replaced by blotchy postinflammatory erythema which gradually fades over ~10 days. Residual scarring is not a feature of PPR.
What type of rosacea is this?
Rosacea dermatitis → a halo of erythema may surround larger inflammatory lesions/ tiny telangiectatic vessels
some patients will have some degree of persistent erythema of the cheeks that may represent a combination of postinflammatory erythema, telangiectasias, and vasodilation.
Which subtype
Phymatous rosacea (subtype 3)
sebaceous gland hypertrophy + fibrosis + dilated pores at the end of the nose + telangiectatic vessels at the end
rhinophyma is the most common presentation, primarily seen in men
lots of times you see this with mild-mod PPR
What subtype
Which other rosacea’s is this commonly seen in?
Occular rosacea’
Dryness/ gritty sensation, inability to wear contacts, tearing, crusting of eyelids, frequent Styes, pruritus
Seen in patients with ETTR and PPR more frequently
Lupus miliaris disseminatus faciei is thought to be a form of _______
talk about the clinical presentation of this condition
granulomatous rosacea
- monomorphic, persistent, skin-colored to dull red-brown papules that are dome shaped, favor central face, 1-3 mm → histologically show non-caseating epithelioid granulomas
What is this and talk about hwat you see
Vascular enlargement
Mild edema
this is Erythematotelangiectatic rosacea
What do you see here
Papulopustular subtype rosacea
dense dermal infiltrate of lymphocytes, predominantly surrounding hair follicle
What do you see here
Nodular granulomatous infiltrate composed of histiocytes, histiocytioc giant cells and admixed lymphocytes in upper interfollicular dermis
Talk about some of the facial skin care for rosacea patients
Lukewarm water/ soap free cleansers (pH balanced)
sunscreen >30 spf (zinc or titanium dioxide containing)
green pigmented facial powders neutralizes erythema
Moisturizers containing humectants
avoid abrasive exfoliants, cleanser applicators
avoid waterproof cosmetics/ heavy foundations
avoid glycolic peels/ dermabrasion
Topical treatments for PP rosacea
Treatments for ETR rosacea
Systemic treatments + specific treatments for Phymatous rosacea and Occular rosacea!
The treatment course with antibiotics for rosacea is typically shorter or longer than acne?
Shorter ( 4-8 weeks versus 4-6 months)
Do topical or systemic antibiotics work for Erythrotelangiectatic rosacea?
No, they may irritate the skin’
The problem is the vasodilation of the capillaries and treating the erythema
Think of topical Brimonidine or oxymetazoline
SUNSCREEN → Cosmetic care → lasers
Main type of treatment for PPR →
Topical/ systemic antibiotics
Treatments for this?
4-8 week course of oral Abx (Doxy, erythro, tetracyclines), alt. abx include Azithromycin 500 3x/week for 4-8 weeks
If topical corticosteroids are implicated in causing this, discontinue them - though tapering is better than stopping abruptly
What is steroid rosacea
Facial eruption in which erythema, papules/ pustules and sometimes atrophic changes such as telangiectasia develop from repeated application of mod-high potency topical steroids
reduce strength and frequency of steroids rather than abrupt discontinuation
may also need systemic antibiotics (tetracyclines) for 4-8 weeks
What is Morbihan disease?
A rare facial disorder characterized by progressive/ persistent asymptomatic non pitting swelling of the central upper face and fixed facial erythema
Histologically indistinguishable from from other forms of rosacea but with granulomatous features + Lymphedema
MAYbe treat with antihistamines and low dose isotretinoin
