Rosacea

Question 1

Define rosacea [1]

Answer 1

Rosacea is a chronic, inflammatory skin condition that primarily affects the face, causing redness, flushing, and visible blood vessels

It typically begins between the ages of 30 and 50.

Rosacea is characterized by periods of exacerbation and remission

Question 2

Describe the pathophysiology of rosacea [3]

Answer 2

Vascular dysregulation:
- Increased reactivity of capillaries to heat, results in flushing and telangiectasia

Inflammation

Ultraviolet radiation:
- Sun exposure may exacerbate rosacea by causing oxidative stress and inducing inflammation.

Question 3

What are the 4 subtypes of rosacea? [4]

Answer 3

Erythematotelangiectatic rosacea (ETR):
- Characterized by facial redness, flushing, and visible blood vessels (telangiectasias).

Papulopustular rosacea:
- Presents with acne-like breakouts, including papules and pustules, along with facial redness and swelling.

Phymatous rosacea:
- Associated with skin thickening, especially around the nose (rhinophyma), and can also affect the chin, forehead, cheeks, and ears.

Ocular rosacea:
- Involves the eyes, causing redness, burning, itching, and the sensation of a foreign body. It can lead to complications such as blepharitis, conjunctivitis, and keratitis if not treated promptly.

Question 4

Which subtype of rosacea is shown? [1]

Answer 4

Phymatous rosacea: Associated with skin thickening, especially around the nose (rhinophyma), and can also affect the chin, forehead, cheeks, and ears.

Question 5

Which subtype of rosacea is shown? [1]

Answer 5

Ocular rosacea

Question 6

Describe the clinical presentation of rosacea [+]

Answer 6

• Symmetrical
• Papulopustules
• Red face
• Telangiectasia
• Marked sebaceous hyperplasia
• Unlike acne no comedones, cysts or nodules
• Often over nose
• NO comodones

Question 7

Name and describe this association of rosacea [1]

Answer 7

Rhinophyma
* Men
* Nose enlarges, reddens and becomes rugose

Question 9

Describe the investigations you would perform for rosacea

Answer 9

Clinical diagnosis normally enough

Consider:
- ANA to test for SLE

Answer 10

blephiritis

Question 11

Describe the tx for rosacea
- simple measures
- for predominant erythema or flushing? [2]
- Mild/moderate papules [2]
- Moderate/severe papules [2]
- Telangiectasia that hasn’t resolved despite treatment [1]

Answer 11

Simple:
- recommend daily application of a high-factor sunscreen
- camouflage creams may help conceal redness

Flushing:
- Topical brimonidine gel (alpha adrenergic agonist) - as required basis’ to temporarily reduce redness’

Mild/moderate papules:
- topical ivermectin is first-line (CKS)
- alternatives include: topical metronidazole or topical azelaic acid

Moderate / severe papules:
- combination of topical ivermectin + oral doxycycline
- isotretinoin

refractory, prominent telangiectasia:
- laser therapy

NB: steroids not used in rosacea

Question 12

NICE guideline 198 (June 2021) advises considering oral isotretinoin use in those over the age of 12 who have failed treatment with topical therapies and systemic antibiotics.

Examples include [4]

Answer 12

Nodulocystic acne
Acne conglobata
Acne fulminans
Acne at risk of permanent scarring

Question 13

How do you differentiate rosacea to seborrhoeic dermatitis? [1]

Answer 13

Yellow greasy scales on an erythematous base in a seborrhoeic distribution (peri-orificial and on the scalp). Usually scaly.

Question 14

Answer 14

topical ivermectin

Question 15

Answer 15

Epistaxis

Question 16

Answer 16

topical brimonidine

Question 17

Answer 17

topical ivermectin + oral doxycycline