Rosacea and Sunscreen

Question 1

Metronidazole

Answer 1

Topical
IND: Treat inflammatory lesions and erythema of rosacea
MOA: Destroys bacterial DNA structure
BOX: n/a
CON: n/a
ADR: Topical reactions. NO disulfiram reactions when topical

Question 2

Ivermectin

Answer 2

IND: Rosacea and head lice
MOA: unknown
BOX: n/a
CON: Not for oral, ophthalmic or vaginal use in topical cream formulation
ADR: Local reactions

Question 3

Brimonidine

Answer 3

IND: Persistent, non-transient erythema of rosacea
MOA: Alpha 2 agonist; when applied topically, decreases erythema via vasoconstriction
BOX: n/a
CON: n/a
ADR: Local reactions. Depression or worsening thereof. Slight risk of decreased Blood pressure

Question 4

Oxymetazonline

Answer 4

IND: Persistent erythema of rosacea
MOA: Alpha 1a agonist; vasoconstriction
BOX: n/a
CON: n/a
ADR: Worsening glaucoma. Slight risk of increased blood pressure. Local reaction. Depression or worsening thereof

Question 5

Chemical sunscreens

Answer 5

Chemical: ABSORBS the sun’s UV rays.
UVB: Homosalate, Otocrylene, Octisalate, PABA
UVA1: Avobenzone
UVA1 and UVB: Oxybenzone

Question 6

Physical sunscreen

Answer 6

Physical: REFLECTS Sun’s UV rays.
Covers all UV rays but application is more difficult
Zinc Oxide 21.6% and Titanium Dioxide 2.4%

Question 7

SPF

Answer 7

Time comparison for onset of erythema (Sunburn) between protected and unprotected skin.
SPF 15: 93%
30: 96.7%
40: 97.5%
NOT linear

Question 8

Sunscreen Recommendations

Answer 8

Under 6 m/o: Avoid if possible. Keep in shade, loose clothes, wide hats. PHYSICAL sunscreen if necessary
Older: Physical is still preferred but not convenient d/t children behaviors. Test a small area first to ensure tolerability.
Continue non-pharm methods.

Question 9

Hyperhidrosis

Answer 9

Antiperspirants: decrease flow of sweat, production, and occludes glands partially

Question 10

Onabotulinumtoxin A

Answer 10

IND: Axillary Hyperhidrosis
MOA: Neurotoxin that affects the presynaptic membrane. Produces a state of denervation by preventing ACh release. Persists until new fibrils grow (6 months)
BOX: Risk of spread of Toxin effect; hours to weeks after injection
CON: Infection at proposed injection sites
ADR: Local reactions