Rosacea

Question 1

What is rosacea?

Answer 1

It is defined as a condition in which there is chronic inflammation of cutaneous vasculature, resulting in blood vessels becoming visible in the face

Question 2

What three regions of the body tend to be affected by rosacea?

Answer 2

Nose

Cheeks

Forehead

Question 3

What are the six risk factors associated with rosacea?

Answer 3

Middle Aged, 30 – 50 Years Old

Female Gender

White Race

Pregnancy

Alcohol

Sunlight Exposure

Question 4

What are the nine clincial features of rosacea?

Answer 4

Facial Flushing

Telangiectasia

Erythematous Skin

Papules

Pustules

Rhinophyma

Blepharitis

Keratitis

Conjunctivitis

Question 5

What is telangiectasia?

Answer 5

They are small, widened blood vessels on the skin

Question 6

What are papules?

Answer 6

They are defined as < 1cm, erythematous, solid inflammatory lesions

Question 7

What are pustules?

Answer 7

They are defined as < 1cm, well-circumscribed, erythematous epidermal lesions filled with pus

Question 8

What is rhinophyma?

Answer 8

It a disfiguring nasal deformity due to the proliferation of sebaceous glands and underlying connective tissue

Question 9

What is blepharitis?

Answer 9

It is inflammation of the eyelid

Question 10

What is the first clinical feature of rosacea?

Answer 10

Facial Flushing

Question 11

How is rosacea diagnosed?

Answer 11

Clinically

Question 12

What are the two conservative management options of rosacea?

Answer 12

Daily High Factor Sunscreen Application

Camouflage Creams To Conceal Redness

Question 13

What are the five pharmacological management options of rosacea?

Answer 13

Topical Brimonidine Gel

Topical Ivermectin

Topical Metronidazole

Topical Azelaic Acid

Oral Doxycycline

Question 14

When is topical brimonidine used to manage rosacea?

Answer 14

It is recommended to manage mild rosacea, which is characterised by predominant flushing and limited telangiectasia

Question 15

What is the mechanism of action of bromonidine?

Answer 15

It is an alpha-adrenergic agonist, which is used to cause vasoconstriction

Question 16

How is topical brominidine gel administered?

Answer 16

It should be applied on an ‘as required basis’ to temporarily reduce redness

Question 17

How soon does topical brominidine take to reduce redness? How long does this effect last for?

Answer 17

30 minutes

It reaches peak action at 3 – 6 hours, after which the redness returns to the baseline

Question 18

When is topical ivermectin used to manage rosacea?

Answer 18

It is the first line management option used to manage mild to moderate rosacea, which is characterised by papules and/or pustules

Question 19

When is topical metronidazole used to manage rosacea?

Answer 19

It is the second line management option used to manage mild to moderate rosacea, which is characterised by papules and/or pustules

Question 20

When is topical azelaic acid used to manage rosacea?

Answer 20

It is the second line management option used to manage mild to moderate rosacea, which is characterised by papules and/or pustules

Question 21

When is oral doxycyline used to manage rosacea?

Answer 21

It is the first line management option used to manage severe rosacea, which is characterised by widespread papules and/or pustules

Question 22

What should oral doxycycline be administered with?

Answer 22

Topical Ivermectin

Question 23

When is laser therapy used to manage rosacea?

Answer 23

It is used to manage rosacea which is characterised by prominent and persistent telangiectasia

Question 24

In which two circumstances is dermatology referral of rosacea recommended?

Answer 24

When clinical features have not improved with optimal management in primary care

OR

In those who present with rhinophyma

Question 25

In which circumstance is an urgent dermatology referral of rosacea recommended? Why?

Answer 25

There is presentation of red, inflammed eyes and eyelids

This indicates ocular involvement, which requires promt escalation to prevent corneal scarring