Psoriasis and Rosacea Seborrhea (Bellanger)

Question 1

A skin disease that affects the middle third of the face, causing persistent redness over the areas of the face and nose. There is no confirmatory lab test and no cure.

Answer 1

rosacea

Question 2

Rosacea usually occurs in those __ to __ years of age and is more common in ____. Etiology is unknown and the major pathogenic components are inflammatory, vascular and neural/hormonal.

Answer 2

30; 50; women

Question 3

The clinical presentation of subtype 1 rosacea

Answer 3

erythematotelangiectatic:
persistent erythema of central face
easily irritated facial skin

Question 4

The clinical presentation of subtype 2 rosacea

Answer 4

papulopustular:
subtype 1 +
dome-shaped erythematous papules and some pustules

Question 5

The clinical presentation of subtype 3 rosacea

Answer 5

phymatous (Rhinophyma):
thickened skin with prominent pores
+/- subtype 1 & 2

Question 6

The clinical presentation of subtype 4 rosacea

Answer 6

ocular rosacea:
both eyes are usually affected
conjunctivitis
blepharitis
styes
keratitis

Question 7

Rosacea aggravating factors:

• ____ sun exposures
• stress/anxiety
• humidity/extremes of weather/wind
• exercise
• ____ beverages
• smoking
• ____ and ____ foods
• medications (?)

Answer 7

• prolonged
• alcoholic
• hot; spicy
• eg., vasodilative drugs, calcium channel blockers, opiates

Question 8

Rosacea non-pharmacologic basic skin care:

• avoid potentially exacerbating factors
• gently ____ free skin cleanser (avoid ____, ____ and ____ cosmetics)
• moisturizer
• ____ daily (>SPF 15; broad spectrum

Answer 8

• soap; astringents, toners, waterproof

- photoprotection

Question 9

Ocular rosacea treatment:

• ____ water soaks towel compress
• ____ daily cleaning of base of lashes with baby shampoo or lid cleanser
• artificial tear replacement
• topical ____ gel
• oral ____ or ____
• refer severe cases to ophthalmologist

Answer 9

• warm
• twice
• metronidazole
• doxycycline; tetracycline

Question 10

Rosacea topical agents (6)

Answer 10

• metronidazole cream/gel
• azelaic acid gel
• brimonidine gel (reduces redness only)
• benzoyl peroxide & clindamycin (papulopustular)
• salfacetamide & sulfur (erythematotelangectatic)
• topical retinoids (use with or without oral antibiotics in refractory rosacea)

Question 11

Topical metronidazole

• ____ line
• ____ and ____ agent
• inhibits growth of ____
• side effects: burning, stinging, ____, ____
• face should be clean before application
• cosmetics may be used ___ minutes after application

Answer 11

• first
• anti-inflammatory; antimicrobial
• Demodex brevis (mites)
• dryness, itching
• 5

Question 12

Azelaic acid 15% gel

• ____ and ____ agent
• for ____ to ____ papulopustular rosacea
• face should be clean before application
• cosmetics may be used after application
• side effects: burning, stinging, itching, dryness, ____
• reassess if it has not improved after 12 weeks

Answer 12

• anti-inflammatory; antibacterial
• mild; moderate
• scaling

Question 13

Brimodine topical gel

Answer 13

alpha2 adrenergic agonist vasoconstricts, reducing redness in face

Question 14

doxycycline (Oracea)

• ____ dose
• used only for ____ therapy for up to __ ___

Answer 14

• anti-inflammatory

- systemic; 12 months

Question 15

Antibiotic/anti-inflammatory oral agents:

• doxycycline
• tetracycline
• minocycline
• erythormycin
• metronidazole

Answer 15

• 50-100 mg/day for 6-12 weeks
• 250-500 mg BID for 6-12 weeks
• 50-100 mg BID for 6-12 weeks
• 250-500 mg once or twice daily for 4-6 weeks
• 200 mg once or twice daily for 4-6 weeks

Question 16

Scaly dermatoses (3)

Answer 16

dandruff, seborrhea, psoriasis

Question 17

OTC ingredients for treatment of scaly dermatoses

Answer 17

coal tar
ketoconazole
pyrithione zinc (rinse of vs. residual)
salycilic acid
selenium sulfide
sulfur
hydrocortisone

Question 18

A chronic, non-inflammatory hyperproliferative epidermal scalp condition (pruritus is common). Peak occurance is in adulthood with no gender preference.

Answer 18

dandruff

Question 19

Dandruff treatment goals:

• reduce epidermal ____ rate of scalp skin
• minimize the cosmetic embarrassement
• minimize ____

Answer 19

• turnover

- itching

Question 20

Dandruff general treatment approach

• for mild presentation?
• for moderate to severe presentation?

Answer 20

• use non-medicated shampoo, wash hair daily or every other day; leave in for 3-5 minutes; rinse thoroughly
• use OTC medicated shampoos; wash hair 2-3 times weekly for 2-3 weeks, then once weekly for control; leave in for 3-5 minutes; rinse thoroughly

Question 21

A chronic, inflammatory disorder occurring in areas of sebaceous gland activity; does not have a specific cure; neither harmful or contagious

Answer 21

seborrheic dermatitis

Question 22

Seborrheic dermatitis affected skin areas: (7)

Answer 22

scalp
eyelids (blepharitis)
face
ears/ear canals
mid-upper chest and back
buttock crease/genital area
armpits

Question 23

Seborrhea triggers

Answer 23

HIV infection

Parkinsonism

Question 24

Seborrhea causes:

• Malassezia (yeast) grows in the ____ along with bacteria
• hormones
• physical stress, fatigue, travel
• ____ deficiency
• obesity
• change of season (worsens when ____)

Answer 24

• sebum
• zinc
• cold

Question 25

Seborrhea physical characteristics: - ____ or dry scaling of scalp; "cradle cap" - mildly scaling eczematous patches on face at typical locations, often with itch and ____ - itch and ____ of ear canal - blepharitis - well-demarcated eczematous patches on mid-upper ____ - intertrigo (webs of fingers)

Answer 25

- greasy - stinging - inflammation - trunk

Question 26

Seborrhea goals of treatment

Answer 26

-reduce inflammation and epidermal turnover rate and minimize/eliminate visible erythema and scaling

Question 27

Seborrhea general treatment approach/management strategies: - ____ or remove scales and crusts - inhibit ____ colonization - reduce erythema and itching - avoid ____, aftershave, ____, soaps - control secondary infections

Answer 27

- loosen - yeast (Malassezia) - perfumes; ointments

Question 28

Seborrheic scales can be softened with a cream containing ____ acid and ____ or by ____/washing. Seborrheic skin should be ____ more often than usual.

Answer 28

salicylic; sulfur; wetting | washed

Question 29

To decrease fungal growth in seborrhea, wash the ____ with ____ shampoo (first line) or ____ ____shampoo (second line). May suggest topical cream treatments, such as ____ derivatives. Sometimes ____ light therapy.

Answer 29

ketoconazole; selenium sulfide imidazole ultraviolet

Question 30

Reduce seborrheic erythema and itching with corticosteroid ____ for the scalp, corticosteroid ____ for other parts of the body, and moisturizing ____ after washing. ____ shampoo and corticosteriod ____ must often be combined in therapy-resistant cases.

Answer 30

lotion; creams; emollients; ketoconazole; lotion

Question 31

Seborrheic treatment for infants: - remove scaling on scalp by massaging scalp with ____ ____, use a non-medicated shampoo (for severe cases, use ____ ____ 3-5% in olive oil or a water soluble base), use a soft bristle brush. - if they are over 2 y.o., use low potency ____ - if on the face, wash with mild soap or cleanser, apply facial emollient - NO ____

Answer 31

- baby oil; salicylic acid - hydrocortisone (0.5-1%) - steroids

Question 32

___ quantifies the extent and severity of skin involvement in different body regions as score. 0 means ___ ___, 72 means ___ ___

Answer 32

PASI (psoriasis area and severity index); no lesions; severe disease

Question 33

Psoriasis goals of treatment: - minimize/eliminate signs of psoriasis (____ and ____) - alleviate pruritus and minimize ____ - reduce frequency of flare-ups - ensure appropriate treatment of associated conditions such as PsA, HTN, dyslipidemia, diabetes, clinical depression, or ____ - avoid/minimize ____ ____ from topical or systemic treatments used - provide cost-effective therapy - provide guidance or counseling ____ ____ - maintaining/improving ____ of ____

Answer 33

- plaques; scales - excoriations - itching - adverse effects - as needed - quality; life

Question 34

Psoriasis lifestyle recommendations (5)

Answer 34

- reduce stress - regular exercise - weight management - moderation of alcohol consumption - cessation of smoking

Question 35

Psoriasis non-pharmacologic treatments (3)

Answer 35

- moisturizers/emollients - oatmeal baths - sunscreen

Question 36

Photochemotherapy: - PUVA (____+ ultraviolet A light) - MOA? - for patients with ____, ____ psoriasis - need skin ____ of lesion to confirm ____ - ___% effective

Answer 36

- psoralen - psoralen cross-links with DNA in presence of UVA light, effects immune response in skin and lymphocytes - severe; refractory - biopsy; diagnosis - 90

Question 37

Photochemotherapy - dosing? - side effects? (6)

Answer 37

- 0.6-0.8 mg/kg PO Q2h before UVA exposure | - serious burns, increased risk of melanoma & non-melanoma skin CA, blistering, peeling, itching, nausea