Chapter 38 - Rosacea and Related Disorders

Question 1

Which laser is used to recontour fibrotic rhinophyma?

Answer 1

CO2 laser; it’s the only established method of improving fibrotic rhinophyma

Question 2

Are the effects of isotretinoin on rosacea long lasting the way they are in acne patients?

Answer 2

No; most patients require longterm oral tetracyclines to maintain remission after treatment with isotretinoin

Question 3

Pediatric patients with childhood granulomatous periorificial dermatitis can’t be treated with tetracycline due to the risk of teeth staining. What oral antibiotic should be used instead?

Answer 3

Erythromycin

Question 4

Is topical tretnoin (a comedolytic) helpful in treating rosacea?

Answer 4

Yes, even though there are no comedones in rosacea. It may work through its effects on the elastolysis seen in chronic rosacea

Question 5

Is azelaic acid cream as effective as topical metronidazole for treating rosacea?

Answer 5

Yes, it appears to be as effective as topical metronidazole

Question 6

What’s the name for the eponymously named syndrome, presumed to be AD, where patients develop early-onset rosacea-like facial dermatosis, plus comedones, pitted atrophy, and small papules?

Answer 6

Haber syndrome

*In some patients there’s an overlap with Dowling-Degos disease

Question 7

What’s the name of the rosacea that often clinically overlaps with granulomatous rosacea, has a predilection for the periorbital region, and is characterized histologically by granulomas with central caseation necrosis?

Answer 7

Lupus miliaris disseminatus faciei

*Despite the granulomas with central caseation, there’s no relationship to Mycobacterium tuberculosis

Question 8

What is the other name for ulerythema ophryogenes?

Answer 8

Keratosis pilaris atrophicans faciei

*Follicular atrophy and scarring alopecia of the eyebrows is typical

Question 9

What is the pathogenesis of rosacea?

Answer 9

Multifactorial. Vasodilation, hyperirrtability, organisms (Demodex folliculorum, Propionibacterium acnes), neurologic diseases, drugs, ?UV light, ?photodamage, vasoactive tumors/disorders

Question 10

What are the 4 subtypes of rosacea?

Answer 10

1) erythematotelangiectatic, 2) papulopustular, 3) phymatous, 4) ocular

Question 11

What are the primary features of rosacea?

Answer 11

Flushing, non transient erythema, papules/pustules/ telangiectasia

Question 12

What is the diagnostic criteria for rosacea?

Answer 12

1 or more primary features

Question 13

What is the pathogenesis for ocular rosacea?

Answer 13

Meibomian gland impaction leads to decreased lipid in the tear film, greater tear evaporation, and subsequent irritability of the eye. ?Elevated epithelium-derived protease activity

Question 14

What are some ocular symptoms of rosacea?

Answer 14

Symptoms range from a sensation of dryness or tired eyes to edema, tearing, pain, blurry vision, styes, chalazia and corneal damage

Question 15

What might you see on physical examination of the eyes in a patient with ocular rosacea?

Answer 15

Blepharitis, conjunctivitis, chronic edema, meibomian impaction, styes, keratitis, corneal neovascularization, corneal ulceration, rupture, ectropion

Question 16

What are the first line treatment options for patients for rosacea?

Answer 16

Topical metronidazole, sodium sulfacetamide with sulfur, azelaic acid, benzoyl peroxide/clindamycin. Oral tetracycline, minocycline. All are of Level 1 evidence