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CCFP 105 Topics > Skin Disorders > Flashcards

Skin Disorders Flashcards

1
Q

Describe the classic presentation of Rosacea.

A

Erythema, telangiectasia, inflammatory papules and pustules that involves the central face, and may include hyperplasia of connective tissue.

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2
Q

What is the time course of flushing and erythema that is associated with Rosacea?

A

Typically <5 minutes.

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3
Q

What are some less common, but still possible features of rosacea?

A

Erythematous plaques
Scaling
Edema
Phymatous changes

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4
Q

What does Phymatous Rosacea refer to?

A

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).

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5
Q

What should be in the differential diagnosis for Rosacea? (4)

A

Acne Vulgaris
Seborrhoeic Dermatitis
SLE
Carcinoid Syndrome

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6
Q

What are the 4 subtypes of rosacea?

A

Erythematotelangiectatic
Papulopustular
Phymatous
Ocular

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7
Q

What are common lifestyle triggers for rosacea?

A

EtOH
Sun Exposure
Hot Drinks
Spicy Food

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8
Q

What skin care treatments are recommended for all types of rosacea?

A

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

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9
Q

Beyond skin care and trigger avoidance, what is the first line treatment for erythematotelangiectatic rosacea?

A

Topical Metronidazole, Azelaic acid, or brimonidine.

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10
Q

Assuming no response after 8-12 weeks of first line therapy, what other treatments may be trialled for erythematotelangiectatic rosacea?

A
  1. laser or Light therapy
  2. Oral doxycycline
  3. Oral propranolol —> for transient facial erythema
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11
Q

Aside from trigger avoidance and skin care, what are the first line treatments for Papulopustular rosacea?

A

Topical Metronidazole
Topical Ivermectin
Topical Azelaic Acid

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12
Q

Which treatment for Papulopustular rosacea is the least expensive?

A

Metronidazole - may be slightly less effective than Azelaic Acid or Ivermectin.

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13
Q

What treatment should be added alongside first line treatment for moderate to severe Papulopustular rosacea?

A

Oral Doxycycline or Oral Tetracycline

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14
Q

What criteria are used to grade the severity of Papulopustular rosacea?

A

Number of pustules (few, several, many)
Absence or Presence of Plaques (mild and moderate, are absent; severe, present)

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15
Q

Beyond trigger avoidance and skin care, what is the first line treatment for Phymatous rosacea?

A

Topical Retinoids, or,
Oral Doxycycline, or
Oral tetracycline

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16
Q

If first line treatments are unsuccessful, what is the next step in management of Phymatous rosacea?

A

Combine topical retinoids with oral doxy- or tetra-cycline

17
Q

What is 3rd line treatment for Phymatous rosacea?

A

Accutane (aka isotretinoin)

18
Q

What treatment can be used in Phymatous rosacea to assist with debunking of scar tissue?

A

Laser or light-based therapies.

19
Q

What is the first line treatment for ocular rosacea?

A

Lid Hygiene
warm compresses and eyelid massage
Artificial tears

20
Q

What is 2nd line treatment for ocular rosacea?

A

Lid care and artificial tears, with addition of oral doxycycline or tetracycline.

21
Q

What is the next step in management of ocular rosacea that has failed both first line and second line treatments?

A

referral to ocular specialist for consideration of topical cyclosporine.

22
Q

What medications (and their classes) can be used to help with rosacea-associated flushing?

A

Propranolol- non-selective beta blocker
Cervedilol - non-selective beta blocker
Clonidine - centrally acting alpha agonist

23
Q

What are th e four primary features of rosacea?

A

Flushing (transient erythema)
Non-transient erythema
Papules and Pustules
Telangiectasia

24
Q

What are secondary features of rosacea that may or may not be present?

A

Burning/Stinging
Plaque
Dry appearance
Edema
Ocular Manifestations
Peripheral Location
Phymatous changes

25
Q

How can we distinguish between comedones and pustules?

A

Comedones- whitehead or blackhead that are flesh-coloured or whitish lesions, 1-3 mm in diameter.
Pustules- elevated, yellow-topped lesions that contain pus.

26
Q

What are the contraindications to isotretinoin (accutane)?

A

Pregnancy
Breastfeeding
Hepatic (acute hepatitis) or Renal Insufficiency
Hypervitaminosis A
Excessive Hyperlipidemia
Concurrent tetracycline therapy

CCFP 105 Topics (5 decks)

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