Transcript 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 •
pathogenesis
precise etiology of rosacea remains a mystery •
degenerative changes of the :hypothesis •
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.
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
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
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
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
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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
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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
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)
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
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