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ROSACEA

ROSACEA. By Dan Ladd, D.O. Texas/KCOM Dermatology Residency Program Program Director Bill V. Way, D.O. CC: ITCHY RASH ON FACE. “STINGS” “BURNS” ONSET 2 DAYS TOPICAL CREAMS NOT HELPFUL PMX: NONE NO NEW MEDS NO NEW SOAPS OR PERFUMES. WHAT IS ROSACEA?. VARIABLE DEGRESS OF…..

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ROSACEA

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  1. ROSACEA By Dan Ladd, D.O. Texas/KCOM Dermatology Residency Program Program Director Bill V. Way, D.O.

  2. CC: ITCHY RASH ON FACE • “STINGS” • “BURNS” • ONSET 2 DAYS • TOPICAL CREAMS NOT HELPFUL • PMX: NONE • NO NEW MEDS • NO NEW SOAPS OR PERFUMES

  3. WHAT IS ROSACEA? • VARIABLE DEGRESS OF….. • CENTROFACIAL ERYTHEMA • TELANGIECTASIAS • PAPULES • PUSTULES • NODULES • EDEMATOUS PLAQUES

  4. EARLY ROSACEA (STAGE I) • “FLUSHER-BLUSHERS” • OFTEN < AGE 20 • NOSE/CHEEKS • RECURRENT EPISODES OF BLUSHING. • ERYTHEMA PERSISTS • FEW TELANGIECTASIAS

  5. STAGE I - TELANGIECTASIAS

  6. STAGE I • TELANGIECTASIAS BECOME PROGRESSIVELY PROMINENT, FORMING SPRAYS ON THE NOSE, NASOLABIAL FOLDS, CHEEKS AND GLABELLA

  7. STAGE II PAPULES & PUSTULES BEGIN, INCREASED ERYTHEMA AND TELANGIECTASIAS

  8. STAGE III DENSE ERYTHEMA PAPULES, PUSTULES, NODULES. TELANGIECTASIAS SEVERE, DIFFUSE VARIABLE PLAQUE-LIKE EDEMA

  9. ADULTS PAPULES PUSTULES NO COMEDONES ERYTHEMA TELANGIECTASIAS TEENS PAPULES PUSTULES COMEDONES NO ERYTHEMA NO TELANGIECTASIAS ROSACEA VS. ACNE

  10. WHAT CAUSES ROSACEA? • “VIRTUALLY NOTHING IS KNOWN ABOUT CAUSATION……….THE INFLUENCE OF HEREDITY IS MOOT, AS IS ALMOST EVERYTHING THAT HAS BEEN WRITTEN ABOUT ETIOLOGY” --A. Kligman • Vasomotor lability? Hypertension? • Demodex mite infestation? • Solar damage? Heat? Caffiene? • Lymphatic obstruction? Emotional stress?

  11. Found within follicular infundibula & sebaceous ducts…

  12. Commensal organisms….

  13. NOT Pathogenic organisms….

  14. TRIGGERS • HOT LIQUID BEVERAGES, SOUPS • ALCOHOL / CAFFEINE • SPICY FOODS • SUN EXPOSURE • IRRITATING COSMETICS/OTC • HEAT – EXERCISE IN COOL AREAS.

  15. COMPLICATIONS • COMPLICATIONS: • RHINOPHYMA – DISFIGURING, NOSE • OPHTHALMIC ROSACEA • LESS COMMON VARIANTS: GRANULOMATOUS, STEROID, GRAM-NEGATIVE, CONGLOBATA, FULMINANS

  16. RHINOPHYMA - EARLY

  17. RHINOPHYMAMODERATE

  18. SEVERE

  19. RHINOPHYMA • OCCURS EXCLUSIVELY IN MEN. • PROGRESSIVE INCREASE IN CONNECTIVE TISSUE, SEBACEOUS GLAND HYPERPLASIA, ECTATIC VEINS AND CHRONIC DEEP INFLAMMATION. • MAY OCCUE WITH STAGE III ROSACEA, BUT SURPRISINGLY, PATIENTS WITH RHINOPHYMA MAY ONLY HAVE MILD ROSACEA.

  20. Treatment – Cosmetic Repair

  21. OCULAR ROSACEA

  22. OCULAR ROSACEA

  23. COMMON, MAY BE FIRST SIGN OF ROSACEAVARIABLE PRESENTATION

  24. OCULAR ROSACEA • BLEPHARITIS • CONJUNCTIVITIS • PAIN, PHOTOPHOBIA • IRITIS, IRIDOCYLITIS, KERATITIS • MAY NEED OPHTHALMOLOGY CONS • KERATITIS MAY LEAD TO BLINDNESS

  25. TREATMENT - MILD • SUNSCREENS • TOPICAL SULFACETAMIDE/SULFUR • TOPICAL METRONIDAZOLE • ORAL TETRACYCLINE, DOXYCYCLINE, MINOCYCLINE

  26. Topicals- Sulfacetamide/Sulfur • Klaron 10% Lotion • Rosula Lotion (with Urea) • Sulfacet R • Rosanil Cleanser • Ovace Cleanser • Plexion Cleanser, Suspension and SCT

  27. Topical Metronidazoles • Noritate 1% cream, Once a Day • Metrocream 0.75% BID • Metrolotion 0.75% BID • Metrogel 0.75% BID

  28. Tetracyclines • Tetracycline 250-500mg QD or BID • Very cheap, but must take 1 hour before or 2 hours after meals, less compliance • Doxycycline 50-75-100mg QD or BID • Generic, Doryx Pellets, Adoxa. • Minocycline 50-75-100mg QD or BID • Generic, Vectrin, Dynacin, Minocin

  29. Tetracyclines • Not for children due to teeth discoloration, may cause hyperpigmetation at sites of trauma in adults, stop medication if worsening headache occurs (pseudotumor cerebri) • Photosensitivity reactions rare if patients on sunscreens

  30. TREATMENT – SEVERE • ORAL METRONIDAZOLE • CLONIDINE 0.1mg QD or BID FOR FLUSHING HELPS • PREDNISONE TAPER • ISOTRETINOIN (ACCUTANE)

  31. A SIMPLE REGIMEN FOR THE VAST MAJORITY OF ROSACEA PATIENTS • WASH FACE GENTLY WITH CETAPHIL DAILY FACIAL CLEANSER • APPLY KLARON LOTION QAM • APPLY SUNSCREEN • WASH FACE AGAIN AT NIGHT • APPLY NORITATE CREAM QHS

  32. A GOOD START…. • KLARON LOTION, 4oz., apply qAM to face • NORITATE CREAM, 30g, apply qHS to face

  33. EXPECTATIONS • TELL THEM TO EXPECT IMPROVEMENT IN 4-6 WEEKS • TELL THEM TO CONTINUE REGIMEN UNTIL NEXT VISIT • MAY GIVE ORAL TETRACYCLINES FOR FLARES • INFORM THEM THERE IS NO CURE FOR ROSACEA!!!!!!!!!!!!!!!!!!!!

  34. QUESTIONS

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