Rosacea

Question 1

List the 4 types of rosacea
1
2
3
4

Answer 1

1. erythema-totelangiectatic
2. papulopustular
3. phymatous
4. ocular

Question 2

The pathophysiology of rosacea has not been clearly elucidated. It is thought to involve _________, _________, neurovascular dysregulation and increased activation of the immune system

Answer 2

genetics, environment

Question 3

Triggers that can worsen rosacea:
1.
2.
3.
4. Intense exercise
5. Emotional stress
6. Medications (vasodilators. ex. ccb, pde5-i, nitrates)
7. Cosmetics

Answer 3

1. food and beverages (spicy food, vinegar, hot drinks, alcohol)
2. Sun exposure (UV exacerbates rosacea)
3. Temp extremities

Question 4

Risk factors for rosacea:
1.
2.
3.
4. Increased parasite exposure
5. F»>M
6. Fair skinned

Answer 4

1. genetics/fam hx
2. Increased UV exposure
3. age 30-50

Question 5

Clinical presentation of rosacea subtypes:

Erythemato-telangiectactic:

Papulopustular:

Phymatous:

Ocular:

Answer 5

Erythemato: Facial flushing and redness , spider veins

Papulopustular: persistent redness with papules or pustules (often mistaken for acne)

Phymatous: Affects the nose causing skin to thicken and become bumpy

Ocular: Affects eye; dryness, burning stinging, redness

Question 6

Non drug options for all rosacea types:
1.
2.
3.
4.
5.

Answer 6

1. Avoid triggers
2. laser treatment (can significantly improve telangiectasia)
3. Skin care (non soap cleansers)
4. Skin protection (SPF >30 sunscreen)
5. Cosmetic camouflage (green tinted foundation is effective for hiding the redness of rosacea)

Question 7

Topical _____________ gel appears to be safe and effective​ for treatment of the general facial redness associated with rosacea

Answer 7

Brimonidine

presumably acting by constricting dilated blood vessels (it has no effect on telangiectatic blood vessels). It can be considered in those for whom erythema is a cosmetic concern. Onset of effect occurs 30 min after application and can last up to 12 h. Rebound erythema is a significant concern for some patients.

Question 8

Topical ________ acid and ____________ are considered safe for use in pregnancy/breastfeeding

Answer 8

Azelaic acid and Metronidazole

Question 9

Rosacea management: Erythemato-telangiectatic first line?
1.
2.
3.

Answer 9

Start with topical agents
“ABM”
Azelaic acid
Brimonidine
Metronidazole

Inadequate response 4-6 weeks? Try alternate or combination of above OR IPL / vascular laser are first lines if erythema due to telangiectasia

Question 10

If symptoms worsen after 4-6 weeks of topical treatment in erythemato or papulopustular rosacea you can try ?

Answer 10

Oral antibiotics

Doxycycline or Tetracycline (AVOID minocycline)

Question 11

Rosacea management: Papulopustular
First line:
1
2
3

Answer 11

Start with topical
“AIM”
Azelaic acid
Ivermectin
Metronidazole

Inadequate response in 4-6 weeks ? Oral antibiotics

Question 12

Rosacea management: Phymatous
First line:
1.

Answer 12

Oral antibiotics (Doxycycline or tetracycline)

Inadequate response? Add topical retinoid

Question 13

Rosacea mangement:
Ocular
First line:
1.

Answer 13

Eyelid hygiene and artificial tears

Worsening ? Add oral antibiotics (doxy or tetra)

Question 14

True or false: Topical therapies for rosacea need to be continued indefinitely due to relapse on discontinuation

Answer 14

True

Question 15

This topical therapy for rosacea is only applied BID

Answer 15

Azelaic acid

Question 16

Common side effects for all topical therapies in rosacea?
1.
2.

Answer 16

Skin irritation
Local burning or stinging

Question 17

Brimonidine has an onset of ___ minutes, but its effects can last up to ___ hours

Answer 17

30 min

12 hr

Question 18

Biggest worry with brimonidine is this can occur of someone stops it?

Answer 18

Rebound erythema

Question 19

Oral tetracyclines are first line therapy in moderate to severe rosacea in combination with ________

Answer 19

topical agents !!! never use alone

Question 20

Avoid ____ and _____ in pregnancy / breastfeeding in rosacea

Answer 20

tetracyclines and isotretinoin