Rosacea Flashcards
What is rosacea?
Chronic condition characterised by central facial erythema, visible blood vessels, and inflammatory papules, pustules and nodules.
Not comedones.
Cause unknown.
Starts with prolonged flushing (feels hot or burns).
Rosacea populations
Most common in fair-skinned people 30-50 years.
More common in females.
Rosacea pathogenesis
Multi-factorial, not well understood.
Genetic susceptibility:
- family history may increase risk
Compromised/impaired skin barrier:
- allow microorganisms to penetrate and stimulate inflammatory response
Altered immune response (alterations to skin and gut microbiome)
- chronic inflammation
Vascular hyper-reactivity:
- Extreme temps/spice may result in dysregulation in vascular response
Rosacea signs and symptoms
Transient and recurrent flushing of skin.
Telangiectasia (little broken capillaries under skin).
Pustules and papules.
Thickening of skin (nose and men).
Persistent facial swelling (eyelids and cheeks).
Describe Erythematotelangiectatic rosacea (ETR)
Frequent/recurrent blushing or flushing of central face, nose and medical cheeks.
Red face due to persistent redness and/or prominent blood vessels.
Describe papulopustular rosacea (PPR)
Inflammatory papules and pustules common feature, no comedones present.
Red papules and pustules on nose, forehead, cheeks, chin.
Describe phymatous rosacea
Enlarged unshaped nose w/ prominent pores (sebaceous hyperplasia) and fibrous thickening
Firm swelling of eyelids too.
Persistent redness and swelling or solid oedema of upper face due to lymphatic obstruction.
Ocular rosacea
Eye irritation and blepharitis present in 20% of rosacea patients.
Red, sore, gritty eyelid margins include papules and styes (posterior blepharitis).
Sore and tired eyes (conjunctivitis, keratitis, episcleritis).
Rosacea differential diagnosis
Acne differs due to open/closed comedones.
Perioral dermatitis differs due to eruption of small papules and pustules around mouth.
Seborrheic dermatitis differs due to no papules and pustules, itchy, yellow, scales.
Treatment management of rosacea
Minimise flushing factors/irritation of skin
Avoid emotional stress, alcohol, spicy foods, exercise, wind, hot baths, temperature extremes, hot drinks, and irritating/stinging skin care.
Sun protection and sun avoidance.
Emollient soap-free cleanser, with low irritant sunscreen and foundation to reduce irritation and mask erythrotelangiectic features.
Avoid topical corticosteroids, hydrocortisone withdrawal can cause severe flare.
Factors and conditions associated w/ flushing
Menopause
Stress
Temperature changes and extremes
Alcohol
Exercise
Wind
CCB, sildenafil, nicotinic acid, tamoxifen, cyproterone, systemic corticosteroids, cyclosporin, vancomycin, opioids, optical corticosteroids long-term.
Less common:
Food additives (nitrates in meats and sulfites)
Neurological disorders
Explain use of metronidazole in rosacea
0.75% gel or cream
Has antimicrobial and anti-inflammatory effects
Mild-moderate rosacea (severe too)
Od or bd for 6-12 weeks
Improve within 2-4 weeks
Long-term may be required
Generally well tolerated, local reactions (dry, red, burn, sting)
Explain use of azelaic acid in rosacea
15% gel
Mild or papulopustular rosacea
Od or bd (morning and night) for 6-12 weeks
Less effective than metronidazole
Explain use of topical ivermectin in rosacea
Anti-parasitic agent w/ anti-inflammatory effect
Mild-moderate and papulopustular rosacea
new product, for unresponsive/intolerant to metronidazole or azelaic acid
benefits after 2-4 weeks
Explain the use of oral antibiotics +/- topical therapy
Use if topical therapy is unsuccessful
First line - doxycycline, erythromycin
Second line - minocycline
More severe rosacea
Use for up to 8 weeks, change if not tolerated or no response after 4 weeks.
If ineffective - low dose isotretinoin
