Name
ACNE ROSACEA
DESCRIPTION
DETAIL
CAUSES : NO PROVEN CAUSE THOUGH * THYROID & GONADAL DISTURBANCE * ALCOHOL, COFFEE, TEA, SPICY FOODS * DEMODEX FOLLICULAR PARASITE * EXPOSURE TO HOT, COLD * HOT DRINKS * EMOTIONAL STRESS * GI DISTURBANCES * ENVIRONMENTAL TRIGGER FACTORS - SUN, WIND, COLD -------------------------------------------------------------------------- D.D. : - DRUG ERRUPTIONS - GRANULOMAS OF SKIN - CUTANEOUS LUPUS ERYTHEMATOOSUS - CARCINOID SYNDROME - DEEP FUNGAL INFECTION - ACNE VULGARIS - SEBORRHEIC DERMATITIS - STEROID ROSACEA( ABUSE)* PATHOLOGICAL FINDINGS - INFLAMMATION AROUND HYPERTROPHIED SEBACEOUS GLANDS, PRODUCING PAPULES, PUSTULES & CYSTS * Absence of comedones and blocked ducts * Vascular dilatation and dermal lymphocytic infi ltrate
TYPENOTES
GENERAL MEASURES β’ Reassurance β’ Treat psychological stress if present β’ Avoid oil based cosmetics. Others are acceptable and may help women tolerate the symptoms. β’ Electrodesiccation or chemical sclerosis of permanently dilated blood vessels β’ Possible evolving laser therapy SURGICAL MEASURES Surgical treatment of rhinophyma DRUG(S) OF CHOICE β’ Low dose oral tetracycline 500-1000 mg/day or doxycycline 20 mg bid (persistant), 50-150 mg/day or minocycline 75-200 mg/day β’ SULFUR CONTAINING LOCAL APPLICANTS β’ Azelaic acid (Finacea) β’ Topical metronidazole (MetroGel) 0.75% gel - apply each morning and at bedtime after cleansing skin; also available as a cream and lotion which may be better tolerated by some patients; or 1% cream formulation of metronidazole (Noritate) used in a once daily manner β’ Topical erythromycin β’ Topical clindamycin lotion preferred β’ Possible utility of calcineurin inhibitors (tacrolimus - 0.1%, pimecrolimus 0.1% β’ Topical steroids should not be used as they may aggravate rosacea Contraindications: β’ Tetracycline: not for use in pregnancy or children < 8 years β’ Isotretinoin: teratogenic; not for use in pregnancy or in women of reproductive age who are not using a reliable birth control method Precautions: β’ Tetracycline: may cause photosensitivity; sunscreen recommended Signifi cant possible interactions: β’ Tetracycline: avoid concurrent administration with antacids, dairy products, or iron β’ Broad-spectrum antibiotics: may reduce the effectiveness of oral contraceptives; barrier method Recommended ALTERNATIVE DRUGS * For severe cases, isotretinoin orally for 4 months POSSIBLE COMPLICATIONS β’ Rhinophyma (dilated follicles and thickened bulbous skin on nose), especially in men β’ Conjunctivitis β’ Blepharitis β’ Keratitis β’ Visual deterioration
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
TOTAL LEUCOCYTE COUNT, DIFF. LEUCOCYTE COUNT