Derma - Rosacea + perioral dermatitis

Question 1

Chronic and recurrent inflammatory disorder of the pilosebaceous units and vasculature of the face
It also involves erythema of the central face that has persisted for months or more. - Red face

Answer 1

Rosacea

Question 2

Rosacea common among what populations

Answer 2

Caucasians
Men and women affected
After 30 y/o onset usually

Question 3

Onset of rosacea age

Answer 3

30y/o

Question 4

Flushing, persistent erythema, papules and pustules, telangiectasia

Answer 4

Primary rosacea

Question 5

Burning/ stinging, dry appearance, edema/plaques, ocular signs, phyma

Answer 5

Secondary rosacea

Question 6

Are there comedones present in rosacea

Answer 6

None

Question 7

Triggers of rosacea

Answer 7

Heat/cold
Hot drinks
Spicy foods
Exercise
Alcohol
Strong emotions
Topical irritants
Medications
Menopausal flushing

Question 8

What diagnostic modality?
Rosacea

Exclude other cutaenous diseases such as lupus

Answer 8

Skin biopsy

Question 9

Rosacea tx

Answer 9

Identification and avoidance of triggers
Photoprotection
Gentle cleanser and emollient
Topical antibiotics
Systemic: antibiotics, isotretinoin, anti-androgen

Question 10

Topical antibiotics rosacea

Answer 10

Metronidazole cream
Azelaic acid
Clindamycin, erythromycin
Sodium sulfacetamide

Question 11

Systemic antibiotics rosacea

Answer 11

Tetracycline
Minocycline
Doxycycline
Lymecycline

Erythromycin
Metronidazole

Question 12

Chronic facial dermatitis characterized by small discrete erythematous papules and/or pustules that often become confluent on perioral and periorbital skin

Answer 12

Perioral dermatitis

Question 13

Initial lesions of perioral dermatitis

Site

Answer 13

On nasolabial folds with rum of sparing around the vermillion border of lips

Question 14

Usual population affected by perioral dermatitis

Answer 14

Women and children

Question 15

Perioral dermatitis related to use of

Answer 15

Potent topical steroids

Highly fluorinated toothpaste

Question 16

Tx perioral dermatitis

Answer 16

Topical antibiotics:
Metronidazole cream/gel
Azelaic acid
Clindamycin, erythromycin
Sodium sulfacetamide

Systemic antibiotics
Tetracycline, minocycline, doxycline, lymecycline
Erythromycin

Question 17

Circumscribed areas of raised erythema and edema of superficial dermis

Answer 17

Urticaria

Question 18

Acute urticatia

Answer 18

< 6 weeks

Question 19

Chronic urticaria

Answer 19

> 6 weeks

Question 20

Acute urticaria

Gender

Answer 20

Men = women

Question 21

Chronic urticatia

Answer 21

Women > men

Question 22

Age group

Acute urticaria

Answer 22

Any

Question 23

Chronic urticaria

Age group

Answer 23

4th-5th decade

Question 24

Signals associated with urticaria

Answer 24

Histamine, bradykinin, kallikrein, acetylcholine

Question 25

Central swelling of variable size, surrounded by a reflex erythema Associated with itching or sometimes burning Transient

Answer 25

Wheal

Question 26

Sudden pronounced swelling of lower dermis and subcutis Sometimes pain than itching Frequent involvement of the mucous membranes

Answer 26

Angioedema

Question 27

Resolution | Wheal

Answer 27

1-24 hr

Question 28

Resolution angioedema

Answer 28

Within 72 hours

Question 29

New classification of urticaria based on its duration, frequency and cause

Answer 29

Spontaneous urticaria Physical urticaria Special types of urticaria Disorders related to urticaria

Question 30

New guidelines for routine diagnosis of urticaria

Answer 30

Thorough history - possible trigger factors, characteristic of urticaria Physical examination - dermatographism test Specific challenge and lab tests - on basis of suspected cause

Question 31

Key questions urticaria

Answer 31

Time of onset of disease Frequency and duration of whealing Associated angio-oedema Associated subjective symptoms (e.g. pain) Family history (urticaria, atopy) Previous or current allergies, infections, internal diseases Induction by physical agents or exercise Use of drugs (NSAIDs, injections, immunisations, hormones, laxatives) Food, smoking habits Occupation, hobbies

Question 32

Tx urticaria

Answer 32

H1 antihistamines H2 antihistamines Glucocorticoids Epinephrine

Question 33

Receptor that mediates wheal and flare reactions, bronchal constriction, mucus secretion, smooth muscle contraction, edema, hypotension, CNS depression, cardiac arrhythmias

Answer 33

H1 receptor

Question 34

Antihistamines | May cause drowsiness

Answer 34

First gen antihistamines

Question 35

Less of nonsedating antihistamines

Answer 35

Second gen H1 antihistamines

Question 36

First gen antihistamines | Enumerate

Answer 36

Hydroxyzine hydrochloride Diphenhydramine Chlorpheniramine

Question 37

Second gen antihistamines | Enumerate

Answer 37

``` Loratadine Cetirizine Desloratadine Levocetirizine Fexofenadine Bilastine ```

Question 38

H2 antihistamines | Enumerate

Answer 38

Cimetidine Ranitidine Famotidine

Question 39

Stabilize mast cell membranes and inhibit further histamine release Reduce inflammatory effect of histamine and other mediators

Answer 39

Glucocorticoids

Question 40

Glucocorticoids | How to prescribe for urticaria

Answer 40

40 mg prednisone in a short Children: 1 mg/kg/d for 5 days

Question 41

– alpha-adrenergic effects result in vasoconstriction of the superficial cutaneous vessels and directly oppose the vasodilatory effect of histamine – has no effect on pruritus

Answer 41

Epinephrine