Rosacea Flashcards
True or False
The highest denisty of eccrine glands is found on the palms and soles
T
True or False
There are no eccrine glands on the vermillion lips, labia minora clitoris, glans penis, external auditory canal.
True
What are the subtypes of Rosacea?
- Erythematotelangectatic (ETTR)
- Papular-pustular
- Ocular
- Granulomatous
- Morbihans Rhinophymatous
- Pyoderma Facialae
Who does rosacea affect?
Commonly affects 3 - 10% of the population.
Onset in 30s.
More common in females than males
(Rhinophymatous more common in men).
Skin phototypes 1 and 2, but all phototypes possible.
Family history and North European descent are also factors.
What is the pathogenesis of rosacea?
Environmental trigger + genetic predisposition results in vascular dysfunction, dysregulated immune response, epidermal barrier dysfunction, and inflammation.
What are common triggers for rosacea?
- Extremes of temperature
- UV (sun exposure)
- Spicy foods
- Alcohol
- Exercise
- Acute stress
- Some medications
- Menopausal hot flashes
- Pregnancy
What are the common symptoms for rosacea?
- Neurogenic: Stinging, burning, sensitive skin
- Transient Erythema and flushing
- Persistent Erythema - centrofacial
- Prominent blood vessels (Telangiectasias)
- Papules
- Pustules
- Dryness
- Ocular manifestations
- Thickened skin (Phymatous change)
- Swelling / Oedema (morbihans)
What are the diagnostic / major phenotypes for rosacea?
Diagnostic Phenotypes:
1. Fixed centrofacial erythema that periodically intensifies
2. Phymatous change.
In the absence of a diagnostic phenotype, 2 or more of the following major phenotypes can be diagnostic:
1. Papules and pustules
2. Telangiectasias
3. Flushing
4. Ocular manifestations
What are the key differential diagnoses for fixed centro-facial erythema?
- Actinic damage: Favours the lateral face, less transient erythema.
- KP: Onset in adolescents, lateral cheeks.
- Seb Derm: Favour nasolabial folds, eyebrows, eyelid creases.
- SLE: Absence of inflammatory papulopustules.
- DM: Eyelid oedema prominent.
- Flushing: No fixed erythema.
What are the key differential diagnoses for papular pustular rosacea?
- Acne: Occurs at a younger age, presence of comedones.
- POD: History of steroid use.
- Tinea Incognito: Unilateral.
- Acneiform eruption: Abrupt onset, may involve the scalp.
- Follicular mucinosis: Multiple papules, not pustules.
What is phymatous change?
Sebaceous gland hypertrophy, patulous follicles, a bulbous appearance on the distal portion of the nose, eventual fibrosis.
What are the symptoms of ocular rosacea?
Dryness, grittiness, tearing, pruritis, eyelid margin telangiectasias.
What are the signs of ocular rosacea?
Interpalpebral conjunctival injection, corneal spade-shaped infiltrates, scleritis, and sclerokeratitis on slit lamp examination.
What are the clinical features of granulomatous rosacea?
Monomorphic, persistent, skin-colored to dull red–brown facial papules that are dome-shaped, favour the central face, and usually measure 1–3mm in diameter.
What is the approach to management of rosacea?
Explain the diagnosis:
- Common (3 - 10%)
- Benign condition, but chronic with exacerbations
- Aim for control not cure)
- Caused by a number of factors - environmental and genetic predisposition
Identify and avoid triggers:
- Keep a diary of flushing episodes
General measures:
Simplify the skin care regime
- Wash with lukewarm water
- Use soap free cleaners (applied gently - avoid scrubbing) that are PH balanced
- Avoid astringents, toners, abrasive exfoliators
- Avoid cosmetics that contain alcohols, menthol, camphor, fragrance
- Avoid waterproof or heavy cosmetics
- Avoid any abrasive procedures
- Moisturise
UV protection:
- SPF 50+ broad spectrum (zinc and titanium dioxide are often well tolerated)
- Aim for a cream or lotion with protective silicones (over alcohol based)
- Sunprotection and avoidance
Cosmetic camouflage
- Facial foundation with green pigment
- Use cosmetics that contain protective silicones
Specific treatment:
Erythematotelangectatatic
- Topical: Azelaic acid, metronidazole
- Topical Brimonidine Tartate (0.33%) - Selective α2-adrenergic agonist that improves erythema; effects are temporary and possible rebound erythema
- Laser - PDL 595nm
Papular pustular
- Topical ivermectin (1% once daily) Nocte
- Metronidazole (0.75% gel /cream / lotion or 1 % gel / cream) OD or BD
- Azelaic acid (15% gel /foam) BD
- Minocycline 1.5% foam
- Clindamycin 1% lotion
- Benzyl Peroxide (5%) cream
- Tretinoin (0.025% or 0.05% or 0.01%)
- Permethrin
- Pimecrolimus / tacrolimus
- Systemic:
○ Doxycylcine 100mg OD for 4 - 8 weeks
○ Minocylcine 100mg OD
○ Tetracylcine
○ Erythromycin 500mg OD or BD
○ Azithromycin
○ Metronidazole
○ Isotretinoin
Phymatous:
- Isotretinoin
- Electrosurgery
- C02 laser
Surgical excision
True or false
Apocrine glands open directly onto the skin surface. Eccrine glands open into hair follicles.
False - the other way around
Label
What is the function of sweat secretion?
- Thermoregulation - evaporative heat loss
- Maintenance of electrolyte balance
- Keeping the stratum croneum moist to ensure fine tactile skils
The excretory function of the sweat gland can be instrumental in the delivery of systemically administered drugs to
the stratum corneum (e.g., fluconazole, griseofulvin), and it provides an explanation for cutaneous side effects of certain chemotherapeutic drugs.
