8.0 - Acne Rosacea

Front 1

Rosacea
- aetiology
- pathophysiology
- appearance

Back 1

1. aetiology unknown
2. pathophysiology: disturbance of vasomotor control
3. Age of onset is in 30-50 year olds!!!
(A) early: flushing and blushing, often with uncomfortable stinging
(B) Facial redness, edema, telangiectasis
(C) inflammatory phase: sterile papules and pustules
(D) tissue hyperplasia of cheeks and nose (rhinophyma), partially due to hyperplasia of sebaceous glands

**Ocular rosacea often accompanies facial rosacea and manifests as some combination of blepharoconjunctivitis, iritis, scleritis, and keratitis, causing itching, foreign body sensation, erythema, and edema of the eye.

Front 2

Rosacea
- triggers to be controlled (primary treatment)

Back 2

Common reported triggers for these flares include:
- sun exposure (wear sunblock!)
- emotional stress
- cold or hot weather, wind
- exercise
- cosmetics
- alcohol
- spicy foods
- hot baths or hot drinks

Front 3

Rosacea
- topical drug treatment

Back 3

Therapeutic Guidelines
- metrnoidazole gel/cream bd
- clindamycin solution bd
2. erythromycin gel bd
** Merck advises that Azelaic acid 20% (Finacea is 15%) is equally effective as metronidazole

Metronidazole often used long term to prolong remission

Front 4

Rosacea
- systemic drug treatment, for severe cases or when topical treatment alone is inadequat

Back 4

Doxycycline 50-100mg d
Or Tetracycline 500-1000mg d (or 2dd)

If inadequate after 4 weeks consider instead
- minocycline 50-100mg d
- or erythromycin 250mg bd

8 week courses are often used and repeated prn; sometimes a low dose suppressive regimen is used

Lastly: 10mg isotretinoin three times a week

Ocular rosacea: systemic ABX usually works, + artifial tears, else refer

Front 5

Rosecea
- surgical treatments?

Back 5

Anecdotal reports of benefit from vascular laser therapy

Front 6

Other random treatments for rosacea?

Back 6

Benxoyl peroxide 2.5% d-bd, added to topical metronidazole or azelaic acid.

Front 7

Treatment of rhinophyma?

Back 7

In rhinophyma, tissue hypertrophy produces a swelling of the nose that may become disfiguring. Although it is popularly believed that rhinophyma is caused by excess alcohol intake, there is no association between the two. It is more common in men over the age of 45 years.

Specialist referral for surgical correction is advisable. The treatment of choice is carbon dioxide laser therapy. Shave excision is also effective. Good control of inflammatory rosacea may reduce risk of rhinophyma and its recurrence after laser or other physical therapy.
(tg)