Rosacea

Question 1

Clinical Feature. Lesion features

Answer 1

dome-shaped inflammatory papules ± pustules

• flushing, non-transient erythema, and telangiectasia

Question 2

Clinical Feature. distribution:

Answer 2

typically on central face including forehead, nose, cheeks, and chin; rarely on scalp, neck,
and upper body

Question 3

Clinical Feature exacerbating factors:

Answer 3

characterized by remissions and exacerbations.

exacerbating factors: heat, cold, wind, sun, stress, drinking hot liquids, alcohol, spices

Question 4

Course

Answer 4

all forms of rosacea can progress from mild to moderate to severe.
rarely in longstanding rosacea, signs of thickening, induration and lymphedema in the skin can develop

Question 5

phyma:

Answer 5

a distinct swelling caused by lymphedema and hypertrophy of subcutaneous tissue, particularly
affecting the nose (rhinophyma)

Question 6

ocular manifestations:

Answer 6

blepharoconjunctivitis, keratitis, iritis

Question 7

Pathophysiology

Answer 7

unknown

Question 8

Epidemiology

Answer 8

• although found in all skin types, highest prevalence in fair-skinned people
• 30-50 yr old; F>M

Question 9

Differential Diagnosis

Answer 9

acne vulgaris, seborrheic dermatitis, perioral dermatitis, contact dermatitis

Question 10

Management. Avoid. Telangiectasia. Phymas

Answer 10

trigger avoidance and daily sunscreen use for long-term management
• avoid topical corticosteroids
• telangiectasia: treated by physical ablation; electrical hyfrecators, vascular lasers, and intense pulsed
light therapies
• phymas: treated by physical ablation or removal; paring, electrosurgery, cryotherapy, laser therapy (CO2,
argon, Nd:YAG)

Question 11

Specific Rosacea Treatments

1st Line

Answer 11

Oral tetracyclines
Topical metronidazole
Oral erythromycin (250-500 mg PO bid)
Topical azelaic acid
Topical ivermectin

Question 12

Specific Rosacea Treatments 2nd Line

Answer 12

Topical clindamycin
Topical erythromycin 2% solution
Topical benzoyl peroxide
Oral metronidazole

Question 13

Specific Rosacea Treatments 3rd Line

Answer 13

Oral retinoids