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Rosacea
(acne rosacea) (Epidemiology (Onset 30-50y, 10% UK, Caucasians,…
Rosacea
(acne rosacea)
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Epidemiology
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F>M, but more severe in M
Pathophysiology
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Types
- Erythematelangiectatic
- Papulopustular
- Phymatous
- Ocular
- Granulomatous
Triggers
Food and drink (alcohol, hot drinks, caffiene, cheese, spice)
Heat, sunlight, humidity
Vasodilatators e.g. CCBs
Topical steroids
Emotional stress
Clinical
presentation
Sensitive skin
Burining, stinging, dry, oedematous
Flushing
Red flush, transient or permenant
Facial rash
Pre-rosacea: flushing, transient erythema
Erythematelangietatic: persistent erythema, telangiectasia
Papulopustular: papules and pustules, non-tender
Phymatous: e.g. rhinophyma
Ocular: red, gritty, dry, irritated eyes, conjunctival telanciectasia, periocular erythema
Diagnosis
History
DH
Current meds, allergies
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PMH
Acne, skin disorders,
systemic disease
SH
Occupation, stress,
alcohol, smoking
PC/HPC
Erythematous facial rash, persistent/not,
papules/pustules, eye symptoms,
systemic signs, red flags,
medications/creams tried
Examination
Dermatological
Widespread facial erythema,
may have papules/pustules, phymatous change
Ophthalmoscopy
Conjunctival erythema, periocular erythema
Severity
classification
Moderate
Erythema, limited papules/pustules, no plaques
Severe
Erythema, extensive papules/pustules, plaques
Mild
Erythema, no papules/pustules
Management
Medical
Topical antibiotic
Indication: mild-mod disease
E.g. topical metronidazole, azelaic acid cream for 6-9wk
MOA: kills bacteria/mites reducing inflammation
SEs: skin irritation (burning, itching), dry skin
Oral antibiotics
Indication: mod-severe disease, ocular disease
E.g. PO tetracycline, erythromycin, doxycycline for 6-12w
Artificial tears
Indication: ocular disease
MOA: lubricates eye, reducing irritation and inflammation
Topical vasoconstrictor
Indication: erythema only
E.g. brimonidine gel
MOA: vasoconstriction, reducing erythema
SEs: can make telangiectasia worse
Conservative
Lifestyle - avoid aggrevators, reduce stress, eye hygeine
Medication review - CCBs, topical steroids
Referral - persistent, unresponsive
disease (dermatology), rhinopyma (plastics)
Complications
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Rosacea fulminans
Multiple erythematous papules, pustules, nodules,
purulent cysts; can scar if untreated
May have systemic features
Psychosocial
Reduced confidence/self-esteem
Stigma (attribute erythema to alcohol)
Depression and anxiety
Prognosis
Chronic, can be managed
but not cured
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