Rosacea

Question 1

Clinical features of Erythematotelangiectatic Rosacea (ETR)?

Answer 1

Chronic/persistent Facial redness and visible blood vessels. Burning and stinging, Sensitive skin

Question 2

Cause of Erythematotelangiectatic?

Answer 2

Genetics
Environmental factors - Spicy foods, alcohol, stress, UV exposure

Question 3

Pathophysiology of Erythematotelangiectatic Rosacea?

Answer 3

Constant
UV radiation can damage the walls of blood vessels = blood vessel dilation.
Other environmental triggers can: heat, alcohol or stress = triggers dilation of superficial blood vessel

Question 4

Treatment plan for Erythematotelangiectatic Rosacea?

Answer 4

First line
Maintain skin barrier: gentle cleanser, SPF 50+, moisturiser and avoid triggers e.g. sun, spicy food, alcohol

Topical: Azelaic acid - anti-inflammatory properties and assist redness reduction

PDL (585nm/595nm)
Long pulse Nd:YAG (1064nm)
KTP (532nm)

Question 5

Clinical features of Papulopustular Rosacea?

Answer 5

Papules and pustules
Constant erythema
Sensitive skin
Swelling

Question 6

Cause of Papulopustular Rosacea?

Answer 6

Genetics
dysregulation immune response: inflammatory cells activates = papules and pustules
Demodex mite overgrowth
Vascular instability: constant blood vessel dilation
Triggers: UV radiation, stress, alcohol, heat

Question 7

Pathophysiology of Papulopustular Rosacea?

Answer 7

Triggers from sun exposure, spicy food, alcohol = weaken the blood vessel walls = prevents them to function normally as constant dilation of blood vessel
High density of Demodex mites - trigger abnormal immune response

Question 8

Treatment plan for Papulopustular Rosacea?

Answer 8

Maintain skin barrier, spf, cleanse and moisturiser (mild and no fragrance) niacinamide or ceramide for barrier repair, avoid triggers if possible

Topical and orals
Mild: Retinol, and azelaic acid
Moderate: Topical and oral (tetracyclines)
Severe: Topical and oral (high dose Tetracyclines or low isotretinoin)

PDL: target persistent redness i.e telangiectasia and inflmmation
IPL: Reduce blood vessels (flushing), redness pustules, papules (bumps)
Long pulse Nd:YAG (1064nm): decrease papules and pustule activity, improve redness and itchiness and deeper blood vessels