Rosacea

Question 1

What are treatment options for Rosacea

Answer 1

1) Topical antibiotics
a) metronidazole
b) clindamycin
2) Oral antibiotics
a) Clindamycin
b) tetracyclines

Question 2

Non-Pharm

Answer 2

1) Avoid excessive exposure to sunlight

Question 3

Mild Symptoms

Answer 3

Rash, itch on face and some papules

Question 4

Moderate-Severe symptoms

Answer 4

-inflammation of nose and eyes

Question 5

4 types of Rosacea

Answer 5

1) Erthemato+ telangiectatic
- -Flushing and erythema and spider veins
- Could occur on nose, ears, neck, chest and back.
2) Paulopustular:
- - papules, pustules, erythema.
3) Phymatous:
- - nasal swelling, nodules on nose, hypertrophy of sebaceous glands
4) Ocular:
- - crusting, itchiness of lid margins, conjunctivitis, chlazion, severe conditions could cause blurred vision, loss of lashes, potential loss of vision.

Question 6

Pathophysiologic Causes

Answer 6

• possibly
  1) sunlight causes DAMAGE to dermis
  2) inflammatory proteins (i.e. cathelicidin and SCTE)
  3) face mite (Demodex folliculoriium)

Question 7

Disease course

Answer 7

Chronic, progressive disorder witth flare ups that often misdiagnosed as adult acne

Question 8

Triggers

Answer 8

1) Sun or cold/ harsh winds
2) Hot beverages,
3) alcohol,
4) vinegar and spicy foods can increase flushing.
5) Stress
6) Application of corticosteroids on face (further causing atrophy of skin)
7) Use of astringents

Question 9

Treatment for erythemato-telangiectatic

Answer 9

1) Topical:
a) metronidazole
b) azelaic acid
2) Systemic:
a) Tetracyclines (mino & doxy)
b) erythromycin
c) Isotretinoin
3) Physical:
a) lasers
b) intense pulsed light

Question 10

Treatment for paupopustular

Answer 10

1) Topical
a) clindamycin
b) erythromycin
c) metronidazole
d) Azelaic acid
e) sulfacetamide
2) Systemic:
a) tetracyclines

Question 11

Phymatous

Answer 11

1) To decrease swollen lymph glands can
a) Prednisone
b) isotretinoin
2) For nasal nodules, need to shave it

Question 12

Ocular

Answer 12

1) Topical
a) fusidic acid eye drops
b) Artificial tears

2) Systemic:
a) Tetracyclines

3_ Physical: lasers and pulsed lights

Question 13

First line drugs for mild to moderate

Answer 13

1) metronidazole (i.e. Metrogel) or azelaic acid topical

2) may need to continue indefinitely

Question 14

For moderate to severe

Answer 14

Topical + Systemic agent (Similar treatment algorithm as acne)

Question 15

Treatment resistant rosacea

Answer 15

Isotretinoin

Question 16

Isotretinoin side effects

Answer 16

• teratogenic (2 methods of birth control_
• -CONCERN only in females, not males.
• Dry skin, lips, mouth
• myalgia
• psychiatric effects