ROSACEA

By Dan Ladd, D.O.

Texas/KCOM Dermatology Residency Program
Program Director
Bill V. Way, D.O.

CC: ITCHY RASH ON FACE

STINGS
BURNS
ONSET 2 DAYS
TOPICAL CREAMS
NOT HELPFUL
PMX: NONE
NO NEW MEDS
NO NEW SOAPS OR
PERFUMES

WHAT IS ROSACEA?

VARIABLE DEGRESS OF..

CENTROFACIAL ERYTHEMA
TELANGIECTASIAS
PAPULES
PUSTULES
NODULES
EDEMATOUS PLAQUES

EARLY ROSACEA (STAGE I)

FLUSHER-BLUSHERS
OFTEN < AGE 20
NOSE/CHEEKS
RECURRENT EPISODES
OF BLUSHING.
ERYTHEMA PERSISTS
FEW TELANGIECTASIAS

STAGE I - TELANGIECTASIAS

STAGE I
TELANGIECTASIAS
BECOME
PROGRESSIVELY
PROMINENT,
FORMING SPRAYS
ON THE NOSE,
NASOLABIAL
FOLDS, CHEEKS
AND GLABELLA

STAGE II
PAPULES & PUSTULES BEGIN, INCREASED
ERYTHEMA AND TELANGIECTASIAS

STAGE III
DENSE ERYTHEMA
PAPULES,
PUSTULES,
NODULES.
TELANGIECTASIAS
SEVERE, DIFFUSE
VARIABLE
PLAQUE-LIKE
EDEMA

ROSACEA VS. ACNE

ADULTS
PAPULES
PUSTULES
NO COMEDONES
ERYTHEMA
TELANGIECTASIAS

TEENS
PAPULES
PUSTULES
COMEDONES
NO ERYTHEMA
NO
TELANGIECTASIAS

WHAT CAUSES ROSACEA?

VIRTUALLY NOTHING IS KNOWN ABOUT

CAUSATION.THE INFLUENCE OF
HEREDITY IS MOOT, AS IS ALMOST
EVERYTHING THAT HAS BEEN WRITTEN
ABOUT ETIOLOGY --A. Kligman
Vasomotor lability? Hypertension?
Demodex mite infestation?
Solar damage? Heat? Caffiene?
Lymphatic obstruction? Emotional stress?

Found within follicular

infundibula & sebaceous ducts

Commensal organisms.

NOT Pathogenic organisms.

TRIGGERS

HOT LIQUID BEVERAGES, SOUPS

ALCOHOL / CAFFEINE
SPICY FOODS
SUN EXPOSURE
IRRITATING COSMETICS/OTC
HEAT EXERCISE IN COOL AREAS.

COMPLICATIONS

COMPLICATIONS:
RHINOPHYMA DISFIGURING, NOSE
OPHTHALMIC ROSACEA
LESS COMMON VARIANTS:
GRANULOMATOUS, STEROID, GRAMNEGATIVE, CONGLOBATA,
FULMINANS

RHINOPHYMA - EARLY

RHINOPHYMA
MODERATE

SEVERE

RHINOPHYMA
OCCURS EXCLUSIVELY IN MEN.
PROGRESSIVE INCREASE IN CONNECTIVE
TISSUE, SEBACEOUS GLAND
HYPERPLASIA, ECTATIC VEINS AND
CHRONIC DEEP INFLAMMATION.
MAY OCCUE WITH STAGE III ROSACEA,
BUT SURPRISINGLY, PATIENTS WITH
RHINOPHYMA MAY ONLY HAVE MILD
ROSACEA.

Treatment Cosmetic Repair

OCULAR ROSACEA

OCULAR ROSACEA

COMMON, MAY BE FIRST

SIGN OF ROSACEA
VARIABLE PRESENTATION

OCULAR ROSACEA

BLEPHARITIS
CONJUNCTIVITIS
PAIN, PHOTOPHOBIA
IRITIS, IRIDOCYLITIS, KERATITIS
MAY NEED OPHTHALMOLOGY CONS
KERATITIS MAY LEAD TO BLINDNESS

TREATMENT - MILD

SUNSCREENS
TOPICAL SULFACETAMIDE/SULFUR
TOPICAL METRONIDAZOLE
ORAL TETRACYCLINE,
DOXYCYCLINE, MINOCYCLINE

Topicals- Sulfacetamide/Sulfur

Klaron 10% Lotion

Rosula Lotion (with Urea)
Sulfacet R
Rosanil Cleanser
Ovace Cleanser
Plexion Cleanser, Suspension and SCT

Topical Metronidazoles

Noritate 1% cream, Once a Day

Metrocream 0.75% BID
Metrolotion 0.75% BID
Metrogel 0.75% BID

Tetracyclines
Tetracycline 250-500mg QD or BID
Very cheap, but must take 1 hour before or

2 hours after meals, less compliance

Doxycycline 50-75-100mg QD or BID
Generic, Doryx Pellets, Adoxa.
Minocycline 50-75-100mg QD or BID
Generic, Vectrin, Dynacin, Minocin

Tetracyclines
Not for children due to teeth discoloration,
may cause hyperpigmetation at sites of
trauma in adults, stop medication if
worsening headache occurs (pseudotumor
cerebri)
Photosensitivity reactions rare if patients on
sunscreens

TREATMENT SEVERE
ORAL METRONIDAZOLE
CLONIDINE 0.1mg QD or BID FOR
FLUSHING HELPS
PREDNISONE TAPER
ISOTRETINOIN (ACCUTANE)

A SIMPLE REGIMEN FOR

THE VAST MAJORITY OF
ROSACEA PATIENTS
WASH FACE GENTLY WITH CETAPHIL

DAILY FACIAL CLEANSER

APPLY KLARON LOTION QAM
APPLY SUNSCREEN
WASH FACE AGAIN AT NIGHT
APPLY NORITATE CREAM QHS

A GOOD START.

KLARON LOTION,
4oz., apply qAM to face
NORITATE CREAM,
30g, apply qHS to face

EXPECTATIONS
TELL THEM TO EXPECT

IMPROVEMENT IN 4-6 WEEKS

TELL THEM TO CONTINUE REGIMEN
UNTIL NEXT VISIT
MAY GIVE ORAL TETRACYCLINES
FOR FLARES
INFORM THEM THERE IS NO CURE
FOR ROSACEA!!!!!!!!!!!!!!!!!!!!

QUESTIONS