Skin Disorders Flashcards
Describe the classic presentation of Rosacea.
Erythema, telangiectasia, inflammatory papules and pustules that involves the central face, and may include hyperplasia of connective tissue.
What is the time course of flushing and erythema that is associated with Rosacea?
Typically <5 minutes.
What are some less common, but still possible features of rosacea?
Erythematous plaques
Scaling
Edema
Phymatous changes
What does Phymatous Rosacea refer to?
A variant of rosace in which skin thickens and scars, leading to irregular, swollen and at time discoloured skin. (Rhinophyma-bulbous nose being the most common example).
What should be in the differential diagnosis for Rosacea? (4)
Acne Vulgaris
Seborrhoeic Dermatitis
SLE
Carcinoid Syndrome
What are the 4 subtypes of rosacea?
Erythematotelangiectatic
Papulopustular
Phymatous
Ocular
What are common lifestyle triggers for rosacea?
EtOH
Sun Exposure
Hot Drinks
Spicy Food
What skin care treatments are recommended for all types of rosacea?
Mild cleansing agents (avoid typical soaps) - advise daily use with only hands (no rough exfoliants)
Emollients and Moisturizers
UV protection via sunscreen, hats or protective clothing
Beyond skin care and trigger avoidance, what is the first line treatment for erythematotelangiectatic rosacea?
Topical Metronidazole, Azelaic acid, or brimonidine.
Assuming no response after 8-12 weeks of first line therapy, what other treatments may be trialled for erythematotelangiectatic rosacea?
- laser or Light therapy
- Oral doxycycline
- Oral propranolol —> for transient facial erythema
Aside from trigger avoidance and skin care, what are the first line treatments for Papulopustular rosacea?
Topical Metronidazole
Topical Ivermectin
Topical Azelaic Acid
Which treatment for Papulopustular rosacea is the least expensive?
Metronidazole - may be slightly less effective than Azelaic Acid or Ivermectin.
What treatment should be added alongside first line treatment for moderate to severe Papulopustular rosacea?
Oral Doxycycline or Oral Tetracycline
What criteria are used to grade the severity of Papulopustular rosacea?
Number of pustules (few, several, many)
Absence or Presence of Plaques (mild and moderate, are absent; severe, present)
Beyond trigger avoidance and skin care, what is the first line treatment for Phymatous rosacea?
Topical Retinoids, or,
Oral Doxycycline, or
Oral tetracycline
If first line treatments are unsuccessful, what is the next step in management of Phymatous rosacea?
Combine topical retinoids with oral doxy- or tetra-cycline
What is 3rd line treatment for Phymatous rosacea?
Accutane (aka isotretinoin)
What treatment can be used in Phymatous rosacea to assist with debunking of scar tissue?
Laser or light-based therapies.
What is the first line treatment for ocular rosacea?
Lid Hygiene
warm compresses and eyelid massage
Artificial tears
What is 2nd line treatment for ocular rosacea?
Lid care and artificial tears, with addition of oral doxycycline or tetracycline.
What is the next step in management of ocular rosacea that has failed both first line and second line treatments?
referral to ocular specialist for consideration of topical cyclosporine.
What medications (and their classes) can be used to help with rosacea-associated flushing?
Propranolol- non-selective beta blocker
Cervedilol - non-selective beta blocker
Clonidine - centrally acting alpha agonist
What are th e four primary features of rosacea?
Flushing (transient erythema)
Non-transient erythema
Papules and Pustules
Telangiectasia
What are secondary features of rosacea that may or may not be present?
Burning/Stinging
Plaque
Dry appearance
Edema
Ocular Manifestations
Peripheral Location
Phymatous changes
