Rosascea

Question 1

What is rosascea.

Answer 1

chronic skin disease characterized by episodic or persistent facial flushing, with a notable predisposition towards women aged between 30 and 60 who have fair skin.

Question 2

What is the cause of rosascea?

Answer 2

Multi factorial and unknown

*The immune response to the commensal Demodex mite, a component of the normal human microbiome involved in inflammatory response

*Helicobacter pylori link

Question 3

What is the pathophysiology of rosascea?

Answer 3

*Vasodilation of lymphatic vessels, with overespression of TRPV1 and TRPA1 receptor

• dysregulation of immune response of overactivation of TLR-2 for innate and adaptive immune response,

Question 4

Which area is affected in rosascea?

Answer 4

typically affects nose, cheeks and forehead
flushing is often first symptom

Question 5

What are the general features of rosascea?

Answer 5

*flushing
*telangiectasia which later develops into persistent erythema with papules and pustules
*rhinophyma
*ocular involvement

Question 6

What are the triggers for rosascea?

Answer 6

*UV rays from sunlight
* wind
*Spicy food
*Caffeine and alcohol
*Hot liquids
*Stress
* extreme temperature changes

Question 7

What are the general features of rosascea?

Answer 7

*Flushing
*Tingling, burning and pruiritus

*telangiectasia are common later develops into -> persistent erythema with papules and pustules
*rhinophyma
*ocular involvement

Question 8

What ocular involvement occurs in rosascea?

Answer 8

Blepharitis is the most common, causing crusting of the eyelid. There may be dryness, blurred vision, light sensitivity and tearing.

Also associated with conductivities, keratitis and iritis.

Question 9

What is rhinophyma?

Answer 9

Subtype of rosascea with rough waxy surface, more common in men. this subtype leads to a swollen, bulbous nose with enlarged sebaceous glands and prominent hair follicles

Question 10

What is the Erythemato-telangiectatic subtype?

Answer 10

Characterised by facial flushing, which can be transient, recurrent, or persistent.
Telangiectasia may develop over time, and redness becomes more persistent.

Question 11

What is papulo-pustular rosascea?

Answer 11

Features include red bumps (papules) and some pus-filled pimples (pustules).

Question 12

How is rosascea diagnosed?

Answer 12

Diagnosis is primarily clinical, based on the patient’s history and physical examination. When necessary, a skin biopsy can be used to rule out other differential diagnoses.

Question 13

What is the conservative management of rosascea?

Answer 13

daily application of a high-factor sunscreen
camouflage creams may help conceal redness

Gentle cleansers and moisturisers

Question 14

How to manage the erythema/flushing subtype of rosascea?

Answer 14

PRN topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia

Question 15

What is the moa of brimonidine?

Answer 15

it typically reduces redness within 30 minutes, reaching peak action at 3-6 hours, after which the redness returns to the baseline. It’s used to t,EPO RSR illy reduce redness

Question 16

What is the first line managmeent of rosascea with mild papules or pustules?

Answer 16

First line is topical ivermectin

Question 17

What is the second line management of rosascea with mild papules or pustules?

Answer 17

topical metronidazole or topical azelaic acid

Question 18

What is the management of moderate papules and/or pustules?

Answer 18

topical metronidazole or topical azelaic acid

For more severe subtype, combination of topical ivermectin + oral doxycycline

Question 19

When to refer for rosascea?

Answer 19

symptoms have not improved with optimal management in primary care

patients with a rhinophyma

Question 20

How to manage prominent telangiectasia?

Answer 20

laser therapy may be appropriate for patients with prominent telangiectasia

Question 21

What is telangiectasia?

Answer 21

permanent widening of small blood vessels (capillaries, arterioles, or venules) near the surface of the skin or mucous membranes, appearing as tiny red, blue, or purple thread-like lines

Question 22

What is given for persistent erythema?

Answer 22

Topical bromiodine, alpha adrenergic agonist

Question 23

What to give for mild to moderate rosascea?

Answer 23

Topical ivermectin
or
Metronidazole
or
azelaic acid

Question 24

What to give for severe rosascea?

Answer 24

Topical ivermectin and oral doxycycline

Question 25

What is the moa of ivermectin?

Answer 25

antiparasitic by binding selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing increased membrane permeability to chloride ions

Question 26

What worsens the flushing in rosascea?

Answer 26

Alcohol

Question 27

What is first line for severe rosascea?

Answer 27

combination of topical ivermectin + oral doxycycline

Question 28

How to manage rosascea with predominant flushing!

Answer 28

Topical bifid one gel

Question 29

When to give topical ivermectin in rosascea?

Answer 29

topical ivermectin may be utilised where there is more of an inflammatory component to rosacea, especially if there are papules and pustules present

Question 30

What to give for prominent telangiectasia in rosascea?

Answer 30

Laser therapy

Question 31

What to give patients with rosacea with predominant flushing but limited telangiectasia?

Answer 31

Briminodine gel

Question 32

How to differentiate rosascea and periorifical dermatitis?

Answer 32

Periorifical dermatitis causes will have papules and pustules around the nose, eyes and mouth, sparing skin where the lips transition to the face. Rosascea will have papules and pustules primarily on the cheeks

Question 33

When to suspect Periorifical dermatitis!

Answer 33

Steroids worsen symptoms

Question 34

How to manage Periorifical dermatitis?

Answer 34

Emollients Topical or oral antibiotics like doxycycline