Dermatology

Question 1

Macule vs patch

Answer 1

Macule: flat, < 1 cm, change in skin colour only (e.g., freckle)

Patch: flat, > 1 cm (e.g., vitiligo)

Question 2

Papule vs Nodule vs Plaque

Answer 2

Papule: raised, solid, < 1 cm (e.g., insect bite)

Nodule: raised, solid, > 1 cm, deeper than papule (e.g., dermatofibroma)

Plaque: raised, flat-topped, > 1 cm, often formed by coalescence of papules (e.g., psoriasis)

Question 3

Vesicle vs Bulla vs Pustule

Answer 3

Vesicle: fluid-filled, < 1 cm (e.g., herpes simplex)

Bulla: fluid-filled, > 1 cm (e.g., bullous pemphigoid)

Pustule: pus-filled (e.g., acne)

Question 4

Wheal:

Answer 4

• transient,
• raised,
• itchy,
• often allergic (e.g., urticaria)

Question 5

Scale vs crust

Answer 5

Scale: flakes of stratum corneum (e.g., psoriasis)
Crust: dried serum/blood (e.g., impetigo)

Question 6

fissure vs Ulcer

Answer 6

Ulcer: full-thickness loss of epidermis and dermis (e.g., leg ulcer)
Fissure: linear crack (e.g., eczema)

Question 7

Impetigo features

Answer 7

1. Superficial bacterial infection, often Staph aureus or Strep pyogenes
2. Golden/crusted lesions, typically around nose/mouth
3. Non-bullous (more common) vs bullous (S. aureus toxin-mediated)
4. Contagious, especially in children
   Swab if widespread

Question 8

Impetigo mx

Answer 8

1. Localised: topical fusidic acid 2% (5–7 days)
2. Widespread/bullous: oral flucloxacillin (clarithromycin if pen-allergic)
3. Advise on school: no school until lesions crusted/dried or 48h after starting abx

Question 9

Folliculitis features + mx

Answer 9

1. Superficial pustules centered on hair follicles
2. Often due to S. aureus
3. Can be itchy or tender

• Mx

1. Mild: hygiene advice, antiseptic washes (e.g. chlorhexidine)
2. More severe: topical antibiotics (fusidic acid), or oral flucloxacillin if extensive

Question 10

Cellulitis features

Answer 10

1. Unilateral, red, hot, swollen area with poorly defined border
2. Fever, systemic symptoms
3. Often lower limbs, may involve lymphangitis
4. Important: bilateral leg redness is unlikely to be cellulitis

Question 11

Cellulitis invx

Answer 11

Consider FBC, CRP, blood cultures if unwell/systemic signs

Question 12

Cellulitis mx

Answer 12

Primary Care:
1. Oral flucloxacillin 500mg QDS (erythromycin/clarithro if allergic)
1. Safety-net re: spreading or systemic signs
1. Elevate limb

Inpatient:
1. Admit if: systemic symptoms, facial cellulitis, rapid progression
1. IV abx (e.g. flucloxacillin ± benzylpenicillin)
1. Rule out necrotising fasciitis if disproportionate pain/rapid progression

Question 13

Herpes simplex virus (HSV) features

Answer 13

1. Painful grouped vesicles on erythematous base, may ulcerate
2. Common on lips (HSV-1) or genitals (HSV-2)
3. Swab for PCR/Viral culture if uncertain
4. Primary episode: fever, malaise, lymphadenopathy
5. Reactivation: recurrent cold sores or genital ulcers
6. May cause eczema herpeticum if superimposed on eczema (emergency)

Question 14

HSV Mx

Answer 14

Primary Care:
1. Mild oral/labial: self-limiting, topical aciclovir 5% may help early
1. Genital/first episode: oral aciclovir 400mg TDS for 5 days
1. Give safety-netting for signs of bacterial superinfection or systemic illness

Specialist Dermatology/inpatient:
1. Eczema herpeticum: urgent referral – requires IV aciclovir
1. Severe, frequent recurrences: consider prophylactic oral antivirals

Question 15

VZV - chickenpox features

Answer 15

1. Crops of vesicles → pustules → crusted lesions
2. Fever, malaise, pruritus
3. More severe in adults, immunocompromised, and pregnanc

Question 16

VZV (chicken pox) Mx

Answer 16

Primary Care:

1. Supportive: antihistamines, calamine lotion, paracetamol
2. Oral aciclovir within 24h of rash onset in adults/high risk patients
3. Exclude from school until all lesions crusted

Inpatient:

1. Immunocompromised/pregnant/neonatal: oral aciclovir
2. Notify public health if outbreak in vulnerable setting

Question 17

Herpes zoster (Shingles) features

Answer 17

1. Unilateral dermatomal painful vesicular rash
2. Burning/tingling prodrome
3. Post-herpetic neuralgia common in elderly
4. Ophthalmic zoster (V1): can threaten sight (Hutchinson’s sign = tip of nose)

Question 18

Herpes zoster (Shingles) mx

Answer 18

Primary Care:

1. Oral aciclovir 800mg 5x/day for 7 days (within 72h ideally)
2. Analgesia ± amitriptyline for neuropathic pain
3. Refer if eye involved, immunosuppressed, or widespread rash

Specialist/Inpatient:

1. Ophthalmic involvement: urgent ophthalmology referral
2. IV antivirals if severe or immunocompromised

Question 19

Viral warts feat + mx

Answer 19

1. Rough, hyperkeratotic papules, often on hands and feet
2. May be flat or filiform
3. Spread via contact

mx:
1. Reassurance: often resolve within 2 years
1. Topical salicylic acid or cryotherapy if bothersome

Question 20

Molluscum contagiosum feat + mx

Answer 20

1. Umbilicated, skin-coloured papules, often grouped
2. Most common in children, sexually active adults, immunosuppressed
3. May be itchy or inflamed when resolving

mx:
1. Reassurance: self-limiting over 6–18 months
1. consider topical agents (e.g. benzoyl peroxide, imiquimod) or cryo if persistent

Question 21

Dermatophytosis (Tinea) features

Answer 21

“ring worm”

1. Annular, scaly plaques with central clearing
2. May be itchy
3. Locations: corporis (body), cruris (groin), pedis (feet), capitis (scalp), unguium (nails)

Question 22

Dermatophytosis (Tinea) mx

Answer 22

1. Topical clotrimazole or terbinafine for localized skin
2. Oral terbinafine or itraconazole for scalp/nails/extensive infection
3. Antifungal shampoo for scalp (ketoconazole)

Question 23

Candidiasis

Candida albicans features + RF

Answer 23

1. Moist, erythematous patches with satellite pustules
2. Common in skin folds (intertrigo), mouth (thrush), genitals
3. Risk factors: immunosuppression, diabetes, antibiotics

Question 24

Candidiasis

Invx + Mx

Answer 24

Investigations:

1. Swabs or scrapings for microscopy/culture
2. Oral candidiasis: check HIV, diabetes if unexplained

Management:

1. Topical clotrimazole, miconazole, or nystatin
2. Oral fluconazole if extensive/oral
3. Keep area dry, manage underlying causes

Question 25

Scabies feat + mx

Answer 25

1. Intensely itchy, worse at night 1. Burrows: thin grey lines on wrists, web spaces, genitals 1. Often affects family/contacts mx: 1. Permethrin 5% cream over whole body, repeat in 7 days 1. Treat all close contacts simultaneously 1. Wash bedding/clothing at 60°C 1. May need oral ivermectin under specialist supervision

Question 26

Head lice feat + mx

Answer 26

1. Itchy scalp 1. Lice visible 1. Can see with fine-tooth nit comb mx: 1. Dimeticone lotion, wet combing 1. Repeat treatment after 7 days 1. Treat close contacts

Question 27

Atopic dermatitis (eczema) features

Answer 27

1. Chronic itchy, inflamed skin (flexures in children) 1. Often family history of atopy 1. Dry skin, lichenification, flare-ups

Question 28

Atopic dermatitis (eczema) - primary care Mx

Answer 28

1. Emollients: frequent use, including soap substitutes 1. Topical corticosteroids: lowest potency for shortest time needed 1. Mild: hydrocortisone 1% 1. Moderate: clobetasone butyrate (Eumovate) 1. Identify and avoid triggers (irritants, allergens) 1. Antihistamines for itch (esp. at night) 1. Treat infection if signs of impetiginisation (flucloxacillin, swab if MRSA likely)

Question 29

Atopic dermatitis (eczema) - secondary care Mx

Answer 29

Topical anti-inflammatories: 1. calcineurin inhibitors (e.g. tacrolimus) 2. JAK inhibitors physical therapies: 1. Phototherapy (ultraviolet B and PUVA) Systemic treatments: 1. ciclosporin 2. methotrexate 3. biologic injections - dupilumab 4. oral JAK inhib - upadacitinib

Question 30

Contact dermatitis features + mx

Answer 30

1. Itchy rash in contact with irritants/allergens 1. Irritant: exposed to an irritant at sufficient concentration for long enough, non-immune mediated 1. Allergic: individual allergen, even at low concentration. delayed hypersensitivity (type IV) mx: 1. Avoid trigger 1. mild-mod topical steroid 1. Barrier creams

Question 31

Acne vulgaris feat

Answer 31

1. Inflammatory skin condition affecting pilosebaceous units 1. Common in adolescents and young adults 1. Comedones (open = blackheads, closed = whiteheads) 1. Papules, pustules, nodules, cysts 1. Face, chest, back (seborrhoeic areas) 1. May cause post-inflammatory hyperpigmentation or scarring 1. Can impact mental health significantly

Question 32

Acne vulgaris - mild/mod mx

Answer 32

Primary Care Management: First-line: 12 week course of one of: * topical **adapalene** (retinoid) + topical **benzoyl peroxide** * topical **tretinoin** (retinoid - more potent) + topical **clindamycin** * topical **benzoyl peroxide** + topical **clindamycin**

Question 33

Acne vulgaris - mod/severe mx

Answer 33

12 week course of: - topical **adapalene** (retinoid) + topical **benzoyl peroxide** - topical **tretinoin** (retinoid - more potent) + topical **clindamycin** - topical **adapalene** + topical **benzoyl peroxide** + **oral lymecycline/ doxycycline** - topical **azelaic acid** + **oral lymecycline/doxycycline** consider COCP in women

Question 34

Acne vulagaris Mx considerations

Answer 34

DO NOT use: - monotherapy with topical abx - monotherapy with oral abx - combination of topical + oral abx - tetracycline - avoid in pregnant, breastfeeding or <12 - use erythromycin in pregnancy - pregnancy contraindication to topical and oral retinoid

Question 35

Acne vulgaris - when to refer, secondary care Mx

Answer 35

when to refer: - acne congloblate - nodulo-cystic - not responded to 2 courses of treatment or treatment with oral abx - scarring - pigmentary changes - psychological distress Severe nodulocystic acne or scarring: **oral isotretinoin** (requires specialist prescribing, contraception monitoring)

Question 36

Psoriasis feat

Answer 36

1. Chronic, erythematous plaques with silvery scale 1. Extensor surfaces, scalp, umbilicus, sacrum 1. Assess severity (PASI score), DLQI

Question 37

Psoriasis types

Answer 37

1. Chronic plaque psoriasis (most common): well-demarcated red plaques with silvery scale, often on extensor surfaces, scalp, sacrum 1. Guttate psoriasis: small drop-like lesions, often post-streptococcal infection 1. Flexural (inverse): shiny red plaques in skin folds with little/no scale 1. Pustular psoriasis: sterile pustules on palms/soles (localised) or widespread (emergency)

Question 38

Other manifestations of psoriasis

Answer 38

1. Nail changes: pitting, onycholysis, subungual hyperkeratosis 1. Psoriatic arthritis in up to 30%: dactylitis, enthesitis, oligoarthritis

Question 39

Psoriasis: metabolic syndrome

Answer 39

- obesity - hypertension - dyslipidaemia - insulin resistance

Question 40

Psoriasis mx

Answer 40

**Primary Care Management:** 1. smoking cessation, alcohol and diet advice Topical therapy (first-line): 1. Emollients 1. Vitamin D analogues (calcipotriol, once/twice daily) 2. coal tar 3. salicylic acid 1. Topical corticosteroids (short courses; mild/moderate potency) **Specialist Management:** 1. Phototherapy: Narrowband UVB for widespread/resistant disease Systemic therapy: 1. Methotrexate (monitor FBC/LFTs) 1. Ciclosporin, acitretin 1. Biologics (e.g. adalimumab, secukinumab) for severe disease — screen for TB, hepatitis Psoriatic arthritis → refer to rheumatology

Question 41

Acute urticaria feat

Answer 41

1. Sudden, itchy, raised wheals lasting less than 24 hours each (new ones appear over days) 1. Blanch with pressure, often with swelling (angioedema) 1. Triggered by infection, allergens, insect bites, or idiopathic 1. No systemic illness signs (if present, think anaphylaxis or other)

Question 42

Acute urticaria mx

Answer 42

1. Non-sedating antihistamines (e.g., cetirizine), 1. short course oral steroids if severe 1. Refer if symptoms persist >6 weeks (chronic urticaria)

Question 43

Chronic urticaria feat

Answer 43

1. Recurrent itchy wheals and/or angioedema lasting >6 weeks 1. Lesions similar to acute urticaria but persist or recur frequently 1. Often idiopathic, can be autoimmune 1. No systemic symptoms usually

Question 44

chronic urticaria mx

Answer 44

1. Primary care: Increase non-sedating antihistamines up to 4x standard dose 1. Specialist: If symptoms persist despite high-dose antihistamines, consider omalizumab or immunosuppressants

Question 45

Erythema Multiforme feat

Answer 45

1. Acute, immune-mediated hypersensitivity reaction 1. Target lesions: concentric rings with central dusky area 1. Usually on extremities, sometimes mucosal involvement (mild) 1. Common triggers: infections (especially HSV), drugs

Question 46

Erythema Multiforme mx

Answer 46

Primary care: 1. Supportive care, 1. treat underlying infection (e.g., antivirals for HSV) Specialist: 1. Systemic corticosteroids in severe cases, 1. recurrent EM may require long-term antivirals

Question 47

Steven- johnsons syndrome (SJS)/Toxic Epidermal necrolysis (TEN) feat

Answer 47

1. Severe mucocutaneous reaction, usually drug-induced 1. Painful red/purple skin, blistering, epidermal detachment (like burns) 1. Nikolsky’s sign positive (skin sloughs off with slight pressure) 1. Mucous membranes involved (mouth, eyes, genitals) 1. SJS under 10% body surface area, TEN >30% BSA 1. Systemic symptoms: fever, malaise, organ involvement

Question 48

Steven- johnsons syndrome (SJS)/Toxic Epidermal necrolysis (TEN) mx

Answer 48

1. Urgent hospital admission, ideally burns or ICU unit 1. Stop offending drug immediately 1. Supportive care: fluids, wound care, pain management 1. Consider immunomodulatory treatments (IVIG, ciclosporin)

Question 49

Eczema herpeticum feat

Answer 49

1. Acute, widespread vesicular eruption over areas of atopic eczema 1. Painful, punched-out erosions, sometimes with fever and malaise 1. Caused by herpes simplex virus infection (usually HSV-1) 1. Can spread rapidly and become severe if untreated

Question 50

Eczema herpeticum mx

Answer 50

1. Urgent referral to hospital 1. Systemic antivirals (e.g., aciclovir), 1. supportive care, 1. manage eczema concurrently

Question 51

Necrotising Fasciitis feat

Answer 51

1. Rapidly progressing infection of deep fascia and subcutaneous tissue 1. Severe pain out of proportion to skin findings 1. Swelling, erythema, blistering, skin necrosis 1. Systemic toxicity: fever, shock, organ failure

Question 52

Necrotising fasciitis invx

Answer 52

1. Clinical diagnosis (emergency) 1. Blood tests: raised CRP, WCC, lactate 1. Imaging (CT or MRI) can help but should NOT delay treatment 1. Surgical exploration is definitive

Question 53

Necrotising fasciitis mx

Answer 53

1. Emergency surgical debridement (specialist care) 1. Broad-spectrum IV antibiotics immediately 1. Supportive intensive care

Question 54

Erythroderma feat

Answer 54

1. Generalised redness and scaling affecting >90% of body surface 1. May be due to eczema, psoriasis, drug reactions, or malignancy (e.g. CTCL) 1. Skin feels hot, dry, and itchy; may have oedema, lymphadenopathy 1. Systemic symptoms: fever, malaise, fluid/electrolyte imbalance

Question 55

Erythroderma mx

Answer 55

1. Admit to hospital for monitoring and supportive care 1. Emollients, fluid balance, temperature regulation 1. Treat underlying cause (e.g., stop culprit drug, manage eczema/psoriasis) 1. Specialist dermatology involvement essential

Question 56

Staphylococcal scalded skin syndrome (SSSS) feat

Answer 56

1. Caused by exfoliative toxins from Staph. aureus 1. Mainly affects infants and young children 1. Widespread painful erythema, blistering, and skin peeling 1. Nikolsky’s sign positive (skin sloughs off with gentle pressure) 1. No mucosal involvement (unlike SJS/TEN)

Question 57

Staphylococcal scalded skin syndrome (SSSS) mx

Answer 57

1. Admit to hospital (paediatrics or burns unit) 1. IV antibiotics (e.g., flucloxacillin) 1. Supportive care: fluids, skin care, analgesia 1. Specialist dermatology or paediatric infectious diseases involvement

Question 58

Bites and stings feat + mx

Answer 58

Features: 1. Local pain, swelling, urticaria 1. Infection (cellulitis) or allergic reaction possible 1. Watch for anaphylaxis (esp. bee/wasp stings) 1. Tick bites → Lyme disease (erythema migrans) Management: 1. Mild: cold compress, antihistamines, analgesia 1. Infected: flucloxacillin 1. Anaphylaxis: IM adrenaline, emergency referral 1. Lyme suspicion: doxycycline if erythema migrans

Question 59

Burns feat

Answer 59

Classified by depth: 1. Superficial (1st degree): red, painful, no blister 1. Partial thickness (2nd degree): blistered, painful 1. Full thickness (3rd degree): white/charred, painless 1. Assess % Total Body Surface Area (TBSA) burned 1. Watch for signs of airway involvement, shock

Question 60

Burns mx

Answer 60

1. Cool burn (cool water ≤20 mins), analgesia 1. Cover with cling film (not cotton), keep warm Refer to burns unit if: 1. 10% TBSA, full thickness, face/hands/genitals 1. Inhalation injury, chemical/electrical burns 1. Fluids if >15% TBSA in adults (Parkland formula)

Question 61

Actinic Keratosis feat

Answer 61

1. Rough, scaly patches on sun-exposed areas (face, scalp, forearms, backs of hands) 1. May be pink, red, or skin-coloured 1. Common in older, fair-skinned individuals with long-term sun exposure 1. Premalignant: small risk (~1%) of progressing to squamous cell carcinoma (SCC) 1. Biopsy if lesion is atypical, thickened, ulcerated, or rapidly changing

Question 62

Actinic Keratosis mx

Answer 62

1. Sun protection advice 1. Emollients ± topical treatments: 1. 5-fluorouracil (Efudix) 1. Imiquimod 1. Diclofenac gel 1. Cryotherapy for isolated lesions

Question 63

Bowen's disease features

Answer 63

1. Well-demarcated, scaly, red plaque 1. Often on sun-exposed skin (e.g., lower legs in elderly women) 1. Slowly enlarging, may mimic psoriasis or eczema 1. Premalignant: ~3–5% risk of progression to invasive SCC

Question 64

Bowen's disease mx

Answer 64

1. Sun protection 1. Topical 5-fluorouracil or imiquimod 1. Cryotherapy 1. Excision if high-risk site or non-responsive

Question 65

BCC feat

Answer 65

1. Most common skin cancer 1. Pearly, translucent nodule with telangiectasia 1. May ulcerate (“rodent ulcer”) 1. Slow-growing, locally invasive, rarely metastasises 1. Typically on sun-exposed areas (face, neck)

Question 66

BCC mx

Answer 66

1. Routine dermatology referral 1. Surgical excision (first-line) with 4mm margin 1. Mohs micrographic surgery for high-risk or facial lesions 1. Alternative: curettage + cautery, cryotherapy, topical imiquimod or 5-FU for superficial BCCs

Question 67

SCC feat

Answer 67

1. Firm, scaly or crusted nodule or plaque 1. May ulcerate or bleed; often tender 1. Arises on sun-exposed skin or sites of chronic inflammation (e.g., ulcers, scars) 1. Can metastasise (unlike BCC) — especially high-risk lesions

Question 68

SCC mx

Answer 68

1. Urgent skin biopsy or excision (2WW/FDS referral) 1. Surgical excision with ≥4 mm margin (≥6 mm for high-risk SCC) 1. Consider wider excision or lymph node assessment if invasive 1. Radiotherapy if surgery not possible 1. Follow-up for high-risk lesions due to recurrence/metastasis risk

Question 69

Benign melanocytic naevi (moles)

Answer 69

1. Symmetrical, smooth-edged pigmented lesions 1. Even colour, < 6 mm diameter 1. May be flat or raised 1. Can darken or enlarge during adolescence, pregnancy 1. Monitor for changes using ABCDE rule

Question 70

Malignant Melanoma feat

Answer 70

**Irregular pigmented lesion** — assess with ABCDE: 1. Asymmetry 1. Border irregularity 1. Colour variation 1. Diameter >6 mm 1. Evolving (change in size/shape/colour) 1. May bleed, itch, or ulcerate

Question 71

Malignant melanoma invx

Answer 71

1. Urgent excisional biopsy with 2 mm margin (never shave/punch) 1. Histology: subtype + Breslow thickness (guides prognosis) 1. Staging: sentinel lymph node biopsy, imaging if invasive

Question 72

Malignant melanoma mx

Answer 72

1. Urgent 2WW referral if melanoma suspected 1. Wide local excision based on Breslow thickness 1. Consider lymph node mapping, immunotherapy for advanced disease 1. Long-term follow-up (risk of recurrence and second melanoma)

Question 73

Seborrhoeic Keratosis feat

Answer 73

1. Common benign epidermal tumour, usually in older adults 1. Well-demarcated, “stuck-on” appearance 1. Variable colour: tan, brown, black 1. Rough, warty surface, can be slightly raised or flat 1. Usually multiple, on trunk, face, neck

Question 74

Seborrhoeic Keratosis mx

Answer 74

1. Usually none needed (benign, asymptomatic) 1. Removal for cosmetic reasons or if irritated: cryotherapy, curettage, laser, or excision

Question 75

Seborrhoeic Dermatitis feat

Answer 75

1. Chronic inflammatory condition affecting seborrhoeic (oil-rich) areas: scalp, face (especially nasolabial folds), eyebrows, chest 1. Red, flaky, greasy-scaly patches with mild itch 1. Often worse in winter or stress 1. Can overlap with dandruff (scalp variant) 1. Common in infants (cradle cap) and adults

Question 76

Seborrhoeic Dermatitis Mx | Primary care + dermatologist

Answer 76

Primary care: 1. Antifungal shampoos (e.g., ketoconazole), 1. mild topical corticosteroids for flare-ups, 1. emollients Dermatologist: 1. Stronger topical corticosteroids, 1. topical calcineurin inhibitors (e.g., tacrolimus), 1. consider antifungal oral therapy in resistant cases

Question 77

Dermatitis Herpetiformis feat

Answer 77

1. Chronic, intensely itchy, symmetrical vesicular rash 1. Common sites: elbows, knees, buttocks, scalp, back 1. Small grouped vesicles and papules, often excoriated 1. Associated with gluten-sensitive enteropathy (coeliac disease) 1. May have gastrointestinal symptoms or be asymptomatic

Question 78

Dermatitis Herpetiformis invx

Answer 78

1. Skin biopsy with direct immunofluorescence: granular IgA deposits at dermal-epidermal junction (pathognomonic) 1. Serology: anti-tissue transglutaminase (tTG) antibodies 1. Consider small bowel biopsy for coeliac confirmation

Question 79

Dermatitis Herpetiformis mx | Primary care + dermatologist

Answer 79

Primary care: 1. Support diagnosis, 1. start gluten-free diet (coordination with dietitian) Specialist: 1. Dapsone to rapidly control symptoms (requires G6PD testing before) Long-term management: 1. strict gluten-free diet for remission and to prevent complications

Question 80

Rosacea feat

Answer 80

1. Chronic inflammatory facial skin condition 1. Central facial redness (erythema), flushing, telangiectasia 1. Papules and pustules, usually no comedones (helps distinguish from acne) 1. Commonly affects cheeks, nose, forehead, chin 1. May have ocular involvement (dry, irritated eyes)

Question 81

Rosacea triggers

Answer 81

1. sun exposure, 1. heat, 1. alcohol, 1. spicy food, 1. stress

Question 82

Rosacea mx | Primary care + specialist

Answer 82

Primary care: 1. Avoid triggers, 1. gentle skin care, 1. topical metronidazole or azelaic acid Specialist: 1. Oral antibiotics (e.g., doxycycline) for inflammatory lesions, 1. laser therapy for telangiectasia, 1. management of ocular rosacea with ophthalmology input