Rosacea And Acne

Question 1

Rosacea is not _____________ (but may exist with acne which may be).

Answer 1

comedonal

Question 2

_________________ is licensed for the treatment of facial erythema in rosacea

Answer 2

Brimonidine tartrate

Question 3

What is the mechanism of action of brimonidine?

Answer 3

Alpha-2 AGONIST; causes cutaneous vasoconstriction

(Also used to reduce aqueous humor formation and increase uveoscleral outflow to lower intra-ocular pressure in open-angle glaucoma)

Question 4

The pustules and papules of rosacea respond to topical ________________, topical _____________ or to topical ________________.

Answer 4

azelaic acid

ivermectin

metronidazole

Question 5

Alternative to topical treatment, oral administration of _____________ or ______________, or ________________, can be used in the treatment of rosacea

Answer 5

oxytetracycline

tetracycline

erythromycin

• courses usually last 6–12 weeks and are repeated intermittently

Question 6

If oral oxytetracycline or tetracycline are inappropriate (e.g. in renal impairment) in the treatment of facial rosacea, _______________ can be used instead

Answer 6

Doxycycline; modified-release in low daily doses

*camouflagers may be required for the redness

Question 7

What are the important side effects of systemic brimonidine? (2)

Answer 7

1. CV effects (bradycardia, hypotension, dizziness) *alpha-2 agonist!
2. Risk of exacerbation of rosacea

Question 8

To minimise the possibility of systemic absorption of brimonidine gel, it is important to _______________

Answer 8

avoid application to irritated or damaged skin, including after laser therapy

Question 9

To minimize the risk of exacerbating rosacea with bimonidine gel, patients should be counseled to…? (2)

Answer 9

1. Not exceed the maximum daily dose
2. Stop treatment if symptoms worsen

*treatment should be initiated with a small amount (less then the max dose) for at least 1 week, then gradually increased

Question 10

Brimonidine should be used with caution in which patients? (7)

Answer 10

1. Cerebral insufficiency
2. Coronary insufficiency
3. Depression (vs mirtazipine, an alpha-2 antagonist)
4. Postural hypotension
5. Raynaud’s syndrome
6. Severe CVD
7. Thromboangiitis obliterans

**causes cutaneous vasoconstriction and systemic vasodilation, may exacerbate listed conditions

Question 11

What are the common side effects of brimonidine? (8)

Answer 11

1. Dizziness, orthostatic hypotension
2. Dry mouth, dry eye and vision disorders
3. Headache
4. Asthenia
5. GI disorder
6. Pulmonary reaction
7. Flushing
8. Drowsiness

Question 12

Is brimonidine safe to use in hepatic and/or renal impairment?

Answer 12

Caution in both

Question 13

Patients and carers should be advised regarding brimonidine and ____________

Answer 13

Performance of skilled tasks eg driving due to drowsiness and blurred vision

Question 14

What is the drug class/mechanism of action of azelaic acid?

Answer 14

acts as an antibacterial by inhibiting synthesis of cellular protein in anaerobic and aerobic bacteria, especially staph epidermis is and priopionibacterium acnes

Question 15

What are the indications of azelaic acid? (2)

Answer 15

1. Acne vulgaris

2. Papulopustular rosacea

Question 16

What patient and carer advice should be given regarding azelaic acid?

Answer 16

1. If severe skin irritation occurs, the amount of preparation applied or frequency of application should be reduced, or treatment temporarily discontinued.
2. In patients with sensitive skin, treatment may be started with once-daily application (in the evening) and progressed to twice-daily application if tolerated.

Question 17

What are the indications of ivermectin? (4)

Answer 17

1. Papulopustular rosacea
2. Chronic strongyloides infection
3. Onchocerciasis
4. scabies

Question 18

What is the main side effect of ivermectin?

Answer 18

Skin reactions

Question 19

Is ivermectin safe to use in pregnancy and breast feeding?

Answer 19

Avoid; toxicity following oral use in animal studies; present in breast milk

Question 20

What patient and carer advice should be given regarding topical ivermectin? (2)

Answer 20

1. Avoid intact with eyes, lips, and mucosa

2. Wash hands immediately after use

Question 21

How is ivermectin administered? (2)

Answer 21

1. Topically (rosacea)

2. Orally (strongyloides, onchocerciasis)