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Dermatology > Rosacea > Flashcards

Rosacea Flashcards

1
Q

What is rosacea?

A

A chronic rash - relapsing and remitting disorder of blood vessels and pilosebaceous units in central facial areas

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2
Q

What age range does it typically affect?

A

30-60

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3
Q

Who is it common in?

A

Typically fair skinned people
Blue eyes
Celtic origin

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4
Q

Is it related to acne?

A

No

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5
Q

What pre-rosacea features can occur?

A

Flushing triggered by stress/ blushing, alcohol and spices

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6
Q

What features occur?

A

A central facial rash - cheeks, forehead, nose, chin with erythema
Telangiectasia
Papules and pustules (without comedones)
Inflammatory nodules
Facial oedema
Sensitive skin

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7
Q

What ocular involvement can occur?

A

Blepharitis / conjunctivitis
Episcleritis
Chalazion

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8
Q

What can occur in men?

A

Rhinophyma

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9
Q

What is rhinophyma?

A

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

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10
Q

What is often the first symptom?

A

Flushing

Then later develops into persistent erythema with papules and pustules

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11
Q

What can exacerbate symptoms?

A

Sunlight

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12
Q

Do blackheads, whiteheads or nodules occur?

A

No

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13
Q

Scaling can occur. What is this called?

A

Rosacea dermatitis

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14
Q

What is telangiectasia?

A

Prominent cutaneous blood vessels - red or purple in colour

Broken capillaries

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15
Q

How is rosacea diagnosed?

A

Mostly clinically

Occasionally a skin biopsy performed - chronic inflammation and vascular changes

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16
Q

What is the cause?

A

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

17
Q

What self care advice can be given?

A

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

18
Q

Why should you review a patient’s medication?

A

Some drugs can aggravate flushing e.g calcium channel blockers
Topical steroids can cause flare ups

19
Q

How should mild or moderate papulopustular rosacea (limited papules and pustules with no plaques) be managed?

A

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

20
Q

What side effects can azelaic acid cause?

A

Transient stinging, dryness, burning, itching

21
Q

How should moderate to severe rosacea be managed?

E.g extensive papules, pustules or plaques

A

An oral tetracycline or erythromycin
E.g tetracycline 500mg BD for 6-12 weeks

Erythromycin 500mg BD if pregnant or breastfeeding

22
Q

What should be considered if predominant flushing but limited telangiectasia?

A

Brimonidine 0.5% gel

Does not have any effect on papules, pustules or phymatous changes

23
Q

Prominent rhinophyma should be…

A

Referred to plastic surgeon

24
Q

What differentials are there?

A

Acne vulgaris
Seborrhoeic dermatitis
SLE

25
Q

How can telangiectasia be treated?

A

Laser treatment

26
Q

How can ocular rosacea be managed?

A

Eyelid hygiene
Ocular lubricants
Oral tetracycline if moderate to severe

27
Q

What areas of the face are sparred?

A

Perioral and periorbital skin

28
Q

What percentage have ocular involvement ?

A

50%

Dermatology (35 decks)

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