What is Medicine – Acne Rosacea ACNE ROSACEA Rosacea is a chronic condition that causes recurrent bouts of facial flushing, erythema (caused by dilated small blood vessels in the face), papules, pustules, and telangiectasia (caused by increased reactivity of capillaries) in a symmetric, central facial distribution. There are four subtypes: - Phymatous rosacea - Erythematotelangiectatic rosacea (ETR) - Papulopustular rosacea (PPR) - Ocular rosacea Skin/exocrine system(s) impacted; rosacea as synonym Aspects of Geriatrics Chronic inflammatory dermatosis with middle-aged onset: Aging-related effects may worsen the side effects of oral isotretinoin therapy (at this time, data are limited due to the dearth of clinical research in senior patients over 65 years old). EPIDEMIOLOGY Prevalence Females are more likely than men to develop the condition in people between the ages of 30 and 50. However, males are more likely to advance to subsequent stages. Fitzpatrick skin types I and II are more prevalent. No known cause. Possible aetiologies and pathophysiologies include the following: - Disturbance of the thyroid and sex hormones - Excessive consumption of alcohol, coffee, tea, and spicy foods (unproven) - Suspected Demodex follicular parasite - Exposure to heat and cold - Emotional stress - GI tract dysfunction (potential link to Helicobacter pylori) Genetics Commonly affects people of Northern European and Celtic ancestry Linked to three human leukocyte antigen (HLA) alleles: (MHC class II) HLA-DRB1, HLA-DQB1, and HLA-DQA1 RISK ELEMENTS Consumption of spicy foods and hot beverages Environmental elements: heat, cold, wind, and sunlight GENERAL PREVENTION No known preventive measures COMMONLY ASSOCIATED CONDITIONS include seborrheic dermatitis of the scalp and eyelids, keratitis with photophobia and lacrimation, and uveitis. DISEASE HISTORY Are typically episodically flushed with an increase in skin temperature in reaction to heat stimuli in the mouth (hot liquids), spicy foods, alcohol, and sun exposure. The main presenting symptoms of rosacea are excessive facial warmth and redness. Although acne may have developed years before the start of rosacea, this is not always the case. In most cases, itching is nonexistent. MEDICAL ANALYSIS Four subtypes of rosacea exist: - Episodic erythema and "flushing and blushing" are symptoms of the rosacea diathesis. ETR is an acronym for persistent erythema with telangiectases. - PPR: papules, pustules, telangiectases, persistent erythema - Phymatous: long-lasting deep erythema, dense telangiectases, papules, pustules, and nodules; in rare cases, long-lasting "solid" edoema of the centre area of the face. It is speculative to assume that one subtype will progress to another. Erythema on the face, especially on the cheekbones, chin, and nose. Sometimes the entire face could be affected. Pustules and telangiectasia may be present, and inflammatory papules are predominant. In contrast to acne vulgaris, comedones are not present. Women typically have lesions on their chins and cheeks, whereas men typically have them on their noses. 50% of patients have ocular signs, which include mild dryness and irritation with blepharitis, conjunctival injection, burning, stinging, and tears, as well as inflammation, swelling, and redness of the eyelids. Differential diagnoses include granulomas of the skin, drug eruptions (iodides and bromides), carcinoid syndrome, acne vulgaris, seborrheic dermatitis, steroid-induced rosacea, systemic lupus erythematosus, and lupus pernio (sarcoidosis). DETECTION & INTERPRETATION OF DIAGNOSIS Physical exam results are used to make the diagnosis. ● In order to better focus treatment options that are intended to address the primary clinical presentation, a categorization modification has recently been proposed based on the phenotype that reflects the clinical presentation (1). Interpretation of Tests Histology of the affected skin may show: Papules, pustules, and cysts produced by inflammation around hypertrophied sebaceous glands; Absence of comedones and clogged ducts; Vascular dilatation and dermal lymphocytic infiltrate; Granulomatous inflammation. GENERAL TREATMENT MEASURES Adequate sun protection and skin care are crucial elements of management plan (1)[B]. Local skin irritants should be avoided; moderate, nondrying soap is advised. Steer clear of triggers Reassurance that rosacea has absolutely nothing to do with bad hygiene; treatment of any psychological stress that may be present. Topical steroids shouldn't be applied since they might make rosacea worse. Avoid using cosmetics with oil bases; other products are acceptable and may help women cope with discomfort. Support for physical fitness; electrodesiccation or chemical sclerosis of permanently dilated blood arteries; potential future laser therapy. First Line: MEDICATION Patients with moderate to severe rosacea responded considerably better to topical metronidazole preparations given once (1% formulation) or twice (0.75% formulations) daily for 7 to 12 weeks compared to placebo. Compared to metronidazole, a rosacea treatment system (cleanser, metronidazole 0.75% gel, moisturising complexion corrector, and sunscreen SPF 30) may be more effective and tolerable. Finacea, which contains azelaic acid, is particularly successful as an initial treatment; azelaic acid topical alone is excellent as a maintenance treatment. Topical ivermectin 1% cream has recently been found to treat PPR more effectively than metronidazole. Topical brimonidine tartrate 0.5% gel works well to lessen the erythema brought on by ETR. Oxymetazoline 1% cream, a potent 1A-adrenergic receptor agonist, was recently approved for the treatment of persistent erythema associated with rosacea in adults. Doxycycline 40 mg dose is at least as effective as 100 mg dose and costs much more, but it also carries a lower risk of side effects. Tetracyclines may cause photosensitivity; wearing sunscreen is advised. ● Important potential interactions - Tetracyclines: Steer clear of taking them at the same time as iron, dairy products, or antacids. - Broad-spectrum antibiotics: may lessen the efficacy of oral contraceptives; nevertheless, rifampin is the only antibiotic where this finding has been verified; think about incorporating barrier technique. Next Line Topical clindamycin (lotion preferable) - Can be used in conjunction with benzoyl peroxide; commercial topical combinations are available. Topical erythromycin, topical timolol maleate 0.5%, and topical clindamycin. The potential usage of pimecrolimus and tacrolimus, two calcineurin inhibitors. Inflammatory rosacea can be effectively treated with 1% pimecrolimus. Permethrin 5% cream, which has equal effectiveness to metronidazole for severe cases and isotretinoin oral solution at 0.3 mg/kg for at least three months. Pediatric Considerations Tetracyclines: not to be used in children under the age of 8 pregnant women's issues Tetracyclines should not be used during pregnancy. Isotretinoin is teratogenic and should not be used by women of reproductive age who are not taking effective contraception. It is also necessary to register with the iPLEDGE programme. ADVANCED THERAPIES For ocular rosacea, cyclosporine 0.05% ophthalmic emulsion might be superior to artificial tears. SURGICAL AND OTHER PROCEDURE Progression of rhinophyma or telangiectasias may be treated with laser therapy. Telangiectases and erythema can be effectively treated with pulsed dye laser (585 or 595 nm). Rhinophyma can be treated with a CO2 fractional ablative laser. CONTINUING CARE /AFTER CARE /RECOMMENDATIONS Outpatient therapy patient observation According to the prescribing guidelines and the iPLEDGE program's advice, patients using isotretinoin occasionally and as needed should have close follow-up and laboratory assessments. Consider having patients with eye complaints evaluated by an ophthalmologist. Avoid drinking alcohol and any form of hot beverage. PROGNOSIS: Slowly progressing; occasionally subsides on its own COMPLICATIONS Rhinophyma (dilated follicles and enlarged bulbous skin on nose), particularly in men, is a problem. Conjunctivitis, blepharitis, keratitis, and a decline in vision
0 Comments
Leave a Reply. |
Kembara's Health SolutionsDiscovering the world of health and medicine. Archives
June 2023
Categories
All
|