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Rosacea

Rosacea. Maryam Ghasemi Daneshjooye Pezeshki Daneshgah Esfahan 901111521 DR Fatemi. epidemiology. relatively common disease fair-skinned people rarer in dark-skinned people women are more often affected than men in earlier stages Men more rhynophima importance of sun-damaged skin .

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Rosacea

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  1. Rosacea

  2. Maryam GhasemiDaneshjooye Pezeshki Daneshgah Esfahan901111521DR Fatemi

  3. epidemiology • relatively common disease • fair-skinned people • rarer in dark-skinned people • women are more often affected than men in earlier stages • Men more rhynophima • importance of sun-damaged skin

  4. pathogenesis • precise etiology of rosacea remains a mystery • hypothesis :degenerative changes of the perivascular, and possibly vascular, collagen and elastic tissues in inherently susceptible individuals exposed to climatic factors. • lead to small vessel dilatation resulting in flushing, telangiectases, and erythema. • the dilated vessels become incompetent with perivascular leakage of potentially inflammatory substances.

  5. CLINICAL FINDINGS • centrofacial disease • principally localized on the nose, cheeks, chin, forehead, and glabella • rosacea is classified into stages : 1- Episodic Erythema 2-Stage I 3-Stage II 4-Stage III

  6. Episodic erythema • predisposed to flushing and blushing, evoked by numerous nonspecific stimuli such as ultraviolet radiation, heat, cold, chemical irritation, strong emotions, alcoholic beverages, hot drinks, and spices. • Eventually flushing and blushing lead to permanent erythema

  7. Stage 1 • erythema persists for hours and days • Telangiectases become progressively more prominent • complain of sensitive skin that stings and burns after application of a variety of cosmetics, fragrances, and certain sunscreen

  8. Stage 2 • inflammatory papules less than 0.5 to 1.0 mm in size, with or without pustules • persist for weeks • Some papules show a small pustule at the apex, justifying the term papulopustular. • lesions are always follicular in origin vellus and sebaceous follicles are involved • deeper inflammatory lesions may heal with scarring, but scars are small and tend to be shallow • pores become more prominent • papulopustular attacks become increasingly frequent

  9. Stage 3 • A small proportion of the patients • particularly on the cheeks and nose, less often on the chin, forehead, or ears • large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. • Finally, the patient shows inflamed and thickened edematous skin with large pores, resembling the surface of an orange ( peau d'orange). • features are caused by inflammatory infiltration, connective tissue hypertrophy with masses of collagen deposition, diffuse sebaceous gland hyperplasia, and overgrowth of individual sebaceous glands • Ultimate deformity is rhinophyma

  10. treatment • Treatment schedules are determined by the stage and severity of the disease • 1. Control of inflammation: Topical products: 1. Metronidazole 2. Sodium sulfacetamide-sulfur 3. Azelaic acid 4. Benzoyl peroxide 5. Erythromycin/ clindamycin 6. Tacrolimus 7. Tretinoin Oral medications: 1. Tetracyclines 2. Macrolides 3. Metronidazole 4. Isotretinoin

  11. treatment • 2. Repair of structural damage: 1-Laser 2-Intense pulsed light 3-surgical techniques (rhinophyma) • 3. Prevention of further damage: 1- Sunscreens 2- Cosmetics 3-Avoidanceof triggerfactors(flushing)

  12. treatment • Box 13-6 Treatment of rosacea by subset • 1. All subsets: Daily sunscreen Sun avoidance strategies Cosmetic coverage Avoidance of specific factors that trigger flushing Laser and intense pulsed light • 2. Erythrotelangiectatic subset: Morning:sodium sulfacetamide-sulfur cleanser followed by a moisturizing sunscreen and/or camouflaging cosmetic with sunscreen Night: leave on metronidazole, azelaic acid or sodium sulfacetamide-sulfur product

  13. treatment • 3. Papulopustular subset: Morning:Topical metronidazole, azelaic acid, sodium sulfacetamide-sulfur or benzoyl peroxide-antibiotic combination + suncreens Nightly:sodium sulfacetamide-sulfur cleanser + different one of the above topical products forAM usage Oral antibiotics or isotretinoin depending on severity • 4. Glandular subset: 1-Benzoyl peroxide-antibiotic combination most effective, other topicals less so 2-Oral antibiotics or isotretinoin depending on severity 3-Surgical intervention as needed for phymatous changes

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