Rosacea Flashcards
List the 4 types of rosacea
1
2
3
4
- erythema-totelangiectatic
- papulopustular
- phymatous
- ocular
The pathophysiology of rosacea has not been clearly elucidated. It is thought to involve _________, _________, neurovascular dysregulation and increased activation of the immune system
genetics, environment
Triggers that can worsen rosacea:
1.
2.
3.
4. Intense exercise
5. Emotional stress
6. Medications (vasodilators. ex. ccb, pde5-i, nitrates)
7. Cosmetics
- food and beverages (spicy food, vinegar, hot drinks, alcohol)
- Sun exposure (UV exacerbates rosacea)
- Temp extremities
Risk factors for rosacea:
1.
2.
3.
4. Increased parasite exposure
5. F»>M
6. Fair skinned
- genetics/fam hx
- Increased UV exposure
- age 30-50
Clinical presentation of rosacea subtypes:
Erythemato-telangiectactic:
Papulopustular:
Phymatous:
Ocular:
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
Non drug options for all rosacea types:
1.
2.
3.
4.
5.
- Avoid triggers
- laser treatment (can significantly improve telangiectasia)
- Skin care (non soap cleansers)
- Skin protection (SPF >30 sunscreen)
- Cosmetic camouflage (green tinted foundation is effective for hiding the redness of rosacea)
Topical _____________ gel appears to be safe and effective for treatment of the general facial redness associated with rosacea
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.
Topical ________ acid and ____________ are considered safe for use in pregnancy/breastfeeding
Azelaic acid and Metronidazole
Rosacea management: Erythemato-telangiectatic first line?
1.
2.
3.
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
If symptoms worsen after 4-6 weeks of topical treatment in erythemato or papulopustular rosacea you can try ?
Oral antibiotics
Doxycycline or Tetracycline (AVOID minocycline)
Rosacea management: Papulopustular
First line:
1
2
3
Start with topical
“AIM”
Azelaic acid
Ivermectin
Metronidazole
Inadequate response in 4-6 weeks ? Oral antibiotics
Rosacea management: Phymatous
First line:
1.
Oral antibiotics (Doxycycline or tetracycline)
Inadequate response? Add topical retinoid
Rosacea mangement:
Ocular
First line:
1.
Eyelid hygiene and artificial tears
Worsening ? Add oral antibiotics (doxy or tetra)
True or false: Topical therapies for rosacea need to be continued indefinitely due to relapse on discontinuation
True
This topical therapy for rosacea is only applied BID
Azelaic acid