Rosacea Flashcards

1
Q

List the 4 types of rosacea
1
2
3
4

A
  1. erythema-totelangiectatic
  2. papulopustular
  3. phymatous
  4. ocular
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2
Q

The pathophysiology of rosacea has not been clearly elucidated. It is thought to involve _________, _________, neurovascular dysregulation and increased activation of the immune system

A

genetics, environment

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3
Q

Triggers that can worsen rosacea:
1.
2.
3.
4. Intense exercise
5. Emotional stress
6. Medications (vasodilators. ex. ccb, pde5-i, nitrates)
7. Cosmetics

A
  1. food and beverages (spicy food, vinegar, hot drinks, alcohol)
  2. Sun exposure (UV exacerbates rosacea)
  3. Temp extremities
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4
Q

Risk factors for rosacea:
1.
2.
3.
4. Increased parasite exposure
5. F»>M
6. Fair skinned

A
  1. genetics/fam hx
  2. Increased UV exposure
  3. age 30-50
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5
Q

Clinical presentation of rosacea subtypes:

Erythemato-telangiectactic:

Papulopustular:

Phymatous:

Ocular:

A

Erythemato: Facial flushing and redness , spider veins

Papulopustular: persistent redness with papules or pustules (often mistaken for acne)

Phymatous: Affects the nose causing skin to thicken and become bumpy

Ocular: Affects eye; dryness, burning stinging, redness

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6
Q

Non drug options for all rosacea types:
1.
2.
3.
4.
5.

A
  1. Avoid triggers
  2. laser treatment (can significantly improve telangiectasia)
  3. Skin care (non soap cleansers)
  4. Skin protection (SPF >30 sunscreen)
  5. Cosmetic camouflage (green tinted foundation is effective for hiding the redness of rosacea)
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7
Q

Topical _____________ gel appears to be safe and effective​ for treatment of the general facial redness associated with rosacea

A

Brimonidine

presumably acting by constricting dilated blood vessels (it has no effect on telangiectatic blood vessels). It can be considered in those for whom erythema is a cosmetic concern. Onset of effect occurs 30 min after application and can last up to 12 h. Rebound erythema is a significant concern for some patients.

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8
Q

Topical ________ acid and ____________ are considered safe for use in pregnancy/breastfeeding

A

Azelaic acid and Metronidazole

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9
Q

Rosacea management: Erythemato-telangiectatic first line?
1.
2.
3.

A

Start with topical agents
“ABM”
Azelaic acid
Brimonidine
Metronidazole

Inadequate response 4-6 weeks? Try alternate or combination of above OR IPL / vascular laser are first lines if erythema due to telangiectasia

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10
Q

If symptoms worsen after 4-6 weeks of topical treatment in erythemato or papulopustular rosacea you can try ?

A

Oral antibiotics

Doxycycline or Tetracycline (AVOID minocycline)

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11
Q

Rosacea management: Papulopustular
First line:
1
2
3

A

Start with topical
“AIM”
Azelaic acid
Ivermectin
Metronidazole

Inadequate response in 4-6 weeks ? Oral antibiotics

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12
Q

Rosacea management: Phymatous
First line:
1.

A

Oral antibiotics (Doxycycline or tetracycline)

Inadequate response? Add topical retinoid

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13
Q

Rosacea mangement:
Ocular
First line:
1.

A

Eyelid hygiene and artificial tears

Worsening ? Add oral antibiotics (doxy or tetra)

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14
Q

True or false: Topical therapies for rosacea need to be continued indefinitely due to relapse on discontinuation

A

True

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15
Q

This topical therapy for rosacea is only applied BID

A

Azelaic acid

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16
Q

Common side effects for all topical therapies in rosacea?
1.
2.

A

Skin irritation
Local burning or stinging

17
Q

Brimonidine has an onset of ___ minutes, but its effects can last up to ___ hours

A

30 min

12 hr

18
Q

Biggest worry with brimonidine is this can occur of someone stops it?

A

Rebound erythema

19
Q

Oral tetracyclines are first line therapy in moderate to severe rosacea in combination with ________

A

topical agents !!! never use alone

20
Q

Avoid ____ and _____ in pregnancy / breastfeeding in rosacea

A

tetracyclines and isotretinoin