Rosacea Flashcards
What is rosacea, and what are its key clinical features?
Rosacea is a chronic inflammatory skin condition affecting the central face. It is characterized by persistent facial erythema, telangiectasias, papulopustular lesions, and sensitivity to triggers such as heat, alcohol, and sun exposure. It lacks comedones, distinguishing it from acne vulgaris.
How do you diagnose rosacea?
Clinical diagnosis based on characteristic facial erythema, flushing, telangiectasias, and papulopustular lesions. Skin scrapings may reveal Demodex folliculorum overgrowth in some cases.
What are the differential diagnoses of rosacea?
Acne vulgaris (has comedones), seborrheic dermatitis (scaly patches on eyebrows and nasolabial folds), SLE (malar rash), carcinoid syndrome (episodic flushing), and dermatomyositis (heliotrope rash, Gottron papules).
How is rosacea differentiated from acne vulgaris?
Rosacea lacks comedones, which are characteristic of acne vulgaris. It is also exacerbated by triggers such as heat, alcohol, and sun exposure, whereas acne is more related to sebum production and bacterial colonization (Cutibacterium acnes).
What is Demodex folliculorum, and what is its role in rosacea?
Demodex folliculorum is a microscopic mite found in hair follicles, particularly in the face. It is a normal commensal but is found in higher densities in rosacea patients. It may contribute to the inflammatory response and skin barrier dysfunction seen in rosacea.
What are the four subtypes of rosacea?
- Erythematotelangiectatic rosacea (ETR): Persistent erythema, flushing, and telangiectasias.
- Papulopustular rosacea: Acneiform papules and pustules without comedones.
- Phymatous rosacea: Thickened skin, nodular growths (e.g., rhinophyma).
- Ocular rosacea: Conjunctivitis, blepharitis, dry eyes, and photophobia.
Which form of rosacea has persistent facial erythema, flushing, and telangiectasias?
Erythematotelangiectatic rosacea (ETR) is a chronic form of rosacea primarily characterized by persistent facial erythema, flushing, and telangiectasias.
What is the first-line treatment for erythematotelangiectatic rosacea?
Avoidance of triggers, sun protection, and laser therapy for persistent telangiectasias. After first-line treatment, medical management with brimonidine or oxymetazoline (vasoconstrictors for transient redness) is provided followed by laser therapy (vascular laser or intense pulsed light [IPL]) for telangiectasias.
What is the recommended treatment for refractory rosacea with persistent redness and telangiectasias?
Laser therapy is the preferred treatment for refractory erythema and telangiectasias.
What form of rosacea has acneiform papules and pustules but without comedones?
Papulopustular rosacea is characterized by inflammatory papules and pustules, similar to acne but without
comedones.
What is the first-line treatment for papulopustular rosacea?
Lifestyle modifications are first with sun protection (broad-spectrum SPF 30+ sunscreen), avoidance of triggers (alcohol, spicy foods, heat, stress), and gentle skin care (fragrance-free, non-comedogenic products). Medical management can then be given with topical metronidazole, ivermectin, or azelaic acid (alternatively topical clindamycin or erythromycin). For moderate to severe cases, oral doxycycline or minocycline (low-dose for anti-inflammatory effects), with give Isotretinoin for refractory cases.
What form of rosacea has thickened skin, nodular growths (e.g., rhinophyma)?
Phymatous rosacea is a subtype of rosacea characterized by thickened skin, nodular growths, and sebaceous gland hypertrophy, most commonly affecting the nose (rhinophyma).
What is rhinophyma, and which rosacea subtype is it associated with?
Rhinophyma is a thickened, nodular enlargement of the nose due to sebaceous gland hypertrophy. It is associated with phymatous rosacea and is more common in men. Early-stage treatment (mild cases) is treated initially with lifestyle modifications such as limiting sun exposure and decreasing alcohol consumption (alcohol doesn’t cause it but can worsen disease). Then treatment involves medication such as topical retinoids, metronidazole, or azelaic acid (may help slow progression). Oral doxycycline for associated inflammatory lesions. and for moderate to severe cases (thickened nodular skin), give isotretinoin (may reduce sebaceous hyperplasia), laser therapy (CO2 laser, erbium:YAG laser) for debulking or surgical excision or dermabrasion for rhinophyma.
What type of rosacea is associated with conjunctivitis, blepharitis, dry eyes, and photophobia?
Ocular rosacea is a subtype of rosacea that primarily affects the eyes and eyelids, often accompanying cutaneous rosacea but sometimes occurring independently. It is chronic and inflammatory, involving the eyelids, conjunctiva, and cornea, leading to irritation and potential vision complications if untreated.
How is ocular rosacea managed?
Artificial tears, lid hygiene, and oral doxycycline. Severe cases require ophthalmology referral.
What is the most common subtype of rosacea?
Erythematotelangiectatic rosacea (ETR)
What are common triggers for rosacea flares?
Heat, sun exposure, alcohol, spicy foods, hot beverages, emotional stress, and certain skin products.
What role do antibiotics play in rosacea treatment?
Antibiotics like doxycycline or minocycline are used for moderate to severe rosacea due to their anti-inflammatory properties. They are not used for their antibacterial effects.
Why should patients with rosacea avoid topical steroids?
Topical steroids can worsen rosacea by causing rebound vasodilation and perioral dermatitis.
What lifestyle modifications can help manage rosacea?
Avoid known triggers (heat, alcohol, spicy foods), use sunscreen daily, gentle skincare routine, and avoid harsh facial products.
