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Dermatology Board Prep > DERM (05) Diseases of Cutaneous Adnexa > Rosacea > Flashcards

Rosacea Flashcards

1
Q

2 main abnormalities in rosacea?

A

Neurovascular dysregulation: heightened TRPV activity within skin.

Aberrant innate immune response: vasodilation, plasma extravasation of protein and recruitment of inflammatory cells and regulation of IL-37

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2
Q

Morphology of rosascea?

A

It is normally on the central face

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3
Q

Types of rosacea?

A

erythematotelangiectatic (vascular), papulopustular, phymatous, ocular rosacea

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4
Q

Difference between papulopustular rosacea and acne?

A

deeper red color and no comedones unlike acne.

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5
Q

What is the difference between acne and rosacea fulminans (also called pyoderma faciale)?

A

Usually in women (vs adolescent men), associated with IBD, RAPID onset of intensely inflamed coalescent fluctuant nodules and cysts on the background of dark red erythema.

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6
Q

What two things can cause caseating histiocytic granulomas?

A

Tuberculosis, and lupus miliarias desseminata faciale

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7
Q

Epidemiology of rosacea?

A

Peaks at 30-40 y/o, F>M, 20% have a family hx of rosacea, skin types I and II most commonly affected.

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8
Q

What are the two major abnormalities seen in rosacea?

A

Neurovascular dysregulation: heightened TRPV activity within the skin. Aberrant innate immune response: causes vasodilation, plasma extravasation of protein, and recruitment of inflammatory cells. (upregulation of LL-37)

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9
Q

Clinical presentation of erythematotelangietatic rosacea?

A

Usually is on the central face. With the vascular variant, you get central face w/ recurrent blush that eventually becomes permanent flushing. They also can have a burning, stinging sensation; easily irritated w/ roughness and scaling. Can also have edema and telangiectasias

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10
Q

Clinical feature of papulopustular rosacea?

A

Similar to acne vulgaris, but lesions may have a deeper red color and no comedones.

  • Persistent central facial erythema w/ transient papules/ pustules
  • Pustules are small <3mm, dome-shaped, erythematous papules with varying stages of evolution
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11
Q

What bacteria is associated with demodex and can stimulate inflammation in rosacea?

A

Bacillus oleronius

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12
Q

What is the cause of phymatous rosacea?

A

Thickening of the skin occurs due to the overgrowth of sebaceous glands.

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13
Q

How common is ocular rosacea?

A

About 50% of rosacea patients are affected

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14
Q

Presentation of ocular rosacea?

A

Dryness foreign body sensation, photosensitivity, burning/stinging, blepharitis, recurrent chalazion, conjunctivitis, keratitis, iritis, scleritis

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15
Q

Types of rosacea that can cause facial edema?

A

Morbihan disease and rosacea lymphedema

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16
Q

Presentation of morbihan disease and rosacea lymphedema?

A

Hard nonpitting swelling of forehead, glabella, nose, cheeks. Can be more pronounced during the morning hours, spontaneous resolution does not occur.

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17
Q

Treatment for morbihan’s disease or rosacea lymphedema

A

Isotretinoin plus/minus ketotifen (antihistamine). You can also try systemic steroids, antibiotics, and lymphatic drainage/compression therapy.

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18
Q

What is pyoderma faciale?

A

Another name for rosacea fulminans. The Key is that there are no comedones which is a big difference between this and acne fulminans.

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19
Q

What systemic sx’s can be presetn in rosacea fulminans?

A

Can have low grade fever, myalgias, increased WBC, increased ESR.

20
Q

What is the treatment for rosacea fulminans?

A

Prednisone (slow taper) and isotretinoin

21
Q

What is granulomatous rosacea?

A

Granulomatous rosacea: discrete yellow/brown-red firm monomorphic papules or nodules on background of diffusely reddened thickened skin no butterfly region. Can also be distributed around periphery of face and perioral areas. On histology, non-caseating epithelioid granulomas; resembles sarcoidosis.

22
Q

Treatment for granulomatous rosacea?

A

Tetracyclines and isotretinoin.

23
Q

What is this? 25 y/o woman, presenting w/ smooth, firm, yellow-brown to red 1-3mm monomophous papules.

A

Lupus miliaris disseminatus faciei

The involvement of the eyelid is especially characteristic. It heals with scarring.

Tx is difficult and you can consider isotretinoin adn tetracyclines.

24
Q

Histologic findings of rosacea?

A
  • perivascular and perifollicular lymphohistocytic infiltrate, vascular ectsia, mild edema, sebaceous hyperplasia (eyrethematotelangetatic)
  • Papulopustular: dense dermal infiltrate of lymphs, predominatly surrounding an involved hair follicle - marked solar elastosis
  • granulomatous subtype histocytes, giant cells, admixed lymphs filling upper interfollicular derms
25
Q

What stains/histologic markers are increased in rosacea?

A

VEGF, CD31 (also vascular), D2-40 (lymphatic endothelial marker, podoplanin)

26
Q

Topical tx options for rosacea?

A

Metronidazole, sodium sulfacetamide/sulfur, azelaic acid, benzoyl peroxide, clindamycin, green-tinted makeup

27
Q

What genodermatosis is associated w/ a rosacea-like eruption and verrucous lesions?

A

Cutaneous disorder of hyperpigmentation characterized by reticulated pigmentation of the person’s skin.

  • Key features: rosacea-like facial eruption reticulated hyperpigmentation of major flexures, comedones on the back and neck, and pitted facial scars
28
Q

What is rosaceiform dermatitis?

A
  • Cutaneous reaction to a drug that resembles rosacea
  • Usually topical or systemic corticosteroids and topical calcineurin inhibitors
  • Facial erythema plus small papules and pustules
  • Widespread distribution on face
29
Q

Clinical presentation of steroid-induced rosacea?

A

Facial eruption erythema, papules and pustules 2/2 repeated application of mod-high potency steroids.

30
Q

What is idiopathic facial aseptic granuloma?

A

Single erythematous nodule on the cheek of a child (several months, then resolves)

31
Q

What is the clinical presentation of pityriasis folliculorum?

A

Women 20-40 y/o who rarely allow water on their face and instead use moisturizing and cleansing creams

Roughened whitish scaling skin surface (frosty) and some scattered fine papules and pustules

Tx: topical sulfur or permethrin 5% cream

32
Q

What skin types are most commonly affected by rosacea?

A

Types I and II

33
Q

What part of the face is most commonly affected by rosacea?

A

Central face distribtuion

34
Q

What is the histology seen in rosacea?

A

Perivascular and perifollicular lymphohistiocytic infiltrate, vascular ectasia, mild edema, and sebaceous hyperplasia

35
Q

What are the general treamtent principles of rosacea?

A
  • Avoid triggers: sunlight, heat/cold, stress, strong emotions, EtOH, hot beverages, spicy foods, and chemical irritation
  • Topicals: metronidazole, sodium sulfacetamide/sulfur, azelaic acid, BP, clindamycin, and green-tinted makeup
  • Systemic: Doxy/minocycline, isotretinoin if severe
  • Can use laser for vascular changes/redness: IPL and PDL
36
Q

What is Haber’s syndrome?

A

Genodermatosis w/ rosacea-like eruption and verrucous lesions

37
Q

What is the treatment for ocular rosacea?

A

Doxycycline/minocycline

38
Q

What times of the day is Morbihan’s disease and rosacea lymphedema worse?

A

Tends to be worse in the early morning

39
Q

Does solid facial edema in rosacea spontaneously resolve?

A

NO!

Needs to be treated

40
Q

What is the clinical presentation of lupus miliaris disseminatus faciei?

A

Smooth, firm, yellow-brown to red 1-3 mm monomorphous papules

  • Occurs in the typical distribution of rosacea (central butterfly of the face)
  • Eyelid skin involvement is characteristic
41
Q

What is the most common attributed cause of perioral/periorificial dermatitis?

A

Topical fluorinated corticosteroids

42
Q

What are the topical fluorinated corticosteroids?

A

Triamcinolone acetonide, betamethasone and beclomethasone

43
Q

The clinical description of perioral/periorificial dermatitis?

A

Clusters of small, pink, discrete scaly papules/pustules in personal region

  • Has clear zone around the vermillion border
  • Can also involve nasolabial folds and cheeks
44
Q

What are the typical sx’s of perioral/periorificial dermatitis?

A

Burning sensation

  • Not much itching
45
Q

Treatment of perioral/periorificial dermatitis?

A

Self-limited usually (months-years)

  • Doxy/minocycline, or erythromycin if in the pediatric population for 6-8 weeks then taper
  • Can also try topical calcineurin inhibitors, topical antibiotics, topical metronidazole

DERM (05) Diseases of Cutaneous Adnexa (5 decks)

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