Rosacea Flashcards
What is rosacea?
A chronic rash - relapsing and remitting disorder of blood vessels and pilosebaceous units in central facial areas
What age range does it typically affect?
30-60
Who is it common in?
Typically fair skinned people
Blue eyes
Celtic origin
Is it related to acne?
No
What pre-rosacea features can occur?
Flushing triggered by stress/ blushing, alcohol and spices
What features occur?
A central facial rash - cheeks, forehead, nose, chin with erythema
Telangiectasia
Papules and pustules (without comedones)
Inflammatory nodules
Facial oedema
Sensitive skin
What ocular involvement can occur?
Blepharitis / conjunctivitis
Episcleritis
Chalazion
What can occur in men?
Rhinophyma
What is rhinophyma?
Swelling and soft tissue overgrowth of nose
Skin thickened and sebaceous oil glands enlarged
Often prominent vessels - thin and red or large and purple
May be bulbous, pitted (due to prominent pores) and scarred
What is often the first symptom?
Flushing
Then later develops into persistent erythema with papules and pustules
What can exacerbate symptoms?
Sunlight
Do blackheads, whiteheads or nodules occur?
No
Scaling can occur. What is this called?
Rosacea dermatitis
What is telangiectasia?
Prominent cutaneous blood vessels - red or purple in colour
Broken capillaries
How is rosacea diagnosed?
Mostly clinically
Occasionally a skin biopsy performed - chronic inflammation and vascular changes
What is the cause?
Several theories - genetic, environmental, vascular and inflammatory factors. Skin damage due to chronic UV exposure plays a part
High conc of antimicrobial peptides e.g cathelicidines have been observed - promote infiltration of neutrophils in dermis and dilation of vessels - fluid leaks out causing swelling and pro inflammatory cytokines leak into dermis increasing inflammation
MMPs play a role - contribute to thickened skin
What self care advice can be given?
Reassure person about its benign nature, progression to severe disease e.g rhinophyma especially in women is uncommon
Not related to poor hygiene
Chronic condition - can be improved but flare ups may occur
Frequent application of high factor SPF to face
If skin is dry - hypoallergenic emollients
Avoid oil based creams
If flushing an issue, avoid triggers - stress, spicy food, caffeine, cheese, alcohol
Why should you review a patient’s medication?
Some drugs can aggravate flushing e.g calcium channel blockers
Topical steroids can cause flare ups
How should mild or moderate papulopustular rosacea (limited papules and pustules with no plaques) be managed?
Topical metronidazole - BD for 6-9 weeks
- generally well tolerated
OR
Azelaic acid 15% BD - may be more effective if do not have sensitive skin
What side effects can azelaic acid cause?
Transient stinging, dryness, burning, itching
How should moderate to severe rosacea be managed?
E.g extensive papules, pustules or plaques
An oral tetracycline or erythromycin
E.g tetracycline 500mg BD for 6-12 weeks
Erythromycin 500mg BD if pregnant or breastfeeding
What should be considered if predominant flushing but limited telangiectasia?
Brimonidine 0.5% gel
Does not have any effect on papules, pustules or phymatous changes
Prominent rhinophyma should be…
Referred to plastic surgeon
What differentials are there?
Acne vulgaris
Seborrhoeic dermatitis
SLE
