ROSACEA
Rosacea (also referred to as acne rosacea) = chronic skin disease of unknown
aetiology.
Clinical Features:
- Typically affects cheeks, nose & forehead
- First symptom is often flushing
- Telangiectasia are common
- Later develops into persistent erythema with papules and pustules
- Rhinophyma
- Ocular involvement (blepharitis)
- Sunlight may exacerbate symptoms
Management:
- Simple management = daily application of high SPF sun cream &
camouflage creams to conceal redness
, - For rosacea with predominant erythema/flushing but limited
telangiectasia = topical brimonidine gel (alpha-adrenergic agonist) PRN
to temporarily reduce redness
- For rosacea with mild/moderate papules/pustules = topical ivermectin
- For rosacea with moderate/severe papules/pustules = combination of
topical ivermectin and oral doxycycline
- If symptoms do not improve with optimal management, laser therapy
may be appropriate for prominent telangiectasia or rhinophyma
ACNE VULGARIS
Acne = disease of the pilosebaceous unit (collective name for hair follicle, hair
shaft, and sebaceous gland). Several different types of acne lesions are usually
seen in each patient such as:
- Comedones – due to dilated sebaceous follicle whereby if the top is
closed, a whitehead is seen, but if the top opens, a blackhead forms.
- Inflammatory lesions – due to the follicle bursting and releasing irritants,
forming papules and pustules
- Excessive inflammatory response can result in nodules or cysts
- This sequence of events can ultimately cause scarring such as ice-pick
scars or hypertrophic scars.
- Drug-induced acne is often monomorphic (pustules are characteristically
seen in steroid use)
- Acne fulminans is very severe acne associated with systemic upset e.g.,
fever and so hospital admission is often required and the condition
usually responds to oral steroids
Pathophysiology:
- Common skin disorder which usually peaks in adolescence and typically
affects the face neck and upper trunk/chest.
- Characterised by the obstruction of the pilosebaceous follicle with
keratin plugs which results in comedones, inflammation and pustules
- Pathophysiology is multifactorial:
Follicular epidermal hyperproliferation resulting in the formation of a
keratin plug, which causes obstruction of the pilosebaceous follicle.
Activity of sebaceous glands may be controlled by androgen (e.g.,
seen in PCOS), but patients with acne can often have normal
androgen levels
Colonisation by anaerobic bacterium called Propionibacterium acnes
Inflammation
, Classification of Acne:
- Mild acne = open and closed comedones with or without sparse
inflammatory lesions
- Moderate acne = widespread non-inflammatory lesions and numerous
papules and pustules
- Severe acne = extensive inflammatory lesions, which may include
nodules, pitting and scarring
Management:
Rosacea (also referred to as acne rosacea) = chronic skin disease of unknown
aetiology.
Clinical Features:
- Typically affects cheeks, nose & forehead
- First symptom is often flushing
- Telangiectasia are common
- Later develops into persistent erythema with papules and pustules
- Rhinophyma
- Ocular involvement (blepharitis)
- Sunlight may exacerbate symptoms
Management:
- Simple management = daily application of high SPF sun cream &
camouflage creams to conceal redness
, - For rosacea with predominant erythema/flushing but limited
telangiectasia = topical brimonidine gel (alpha-adrenergic agonist) PRN
to temporarily reduce redness
- For rosacea with mild/moderate papules/pustules = topical ivermectin
- For rosacea with moderate/severe papules/pustules = combination of
topical ivermectin and oral doxycycline
- If symptoms do not improve with optimal management, laser therapy
may be appropriate for prominent telangiectasia or rhinophyma
ACNE VULGARIS
Acne = disease of the pilosebaceous unit (collective name for hair follicle, hair
shaft, and sebaceous gland). Several different types of acne lesions are usually
seen in each patient such as:
- Comedones – due to dilated sebaceous follicle whereby if the top is
closed, a whitehead is seen, but if the top opens, a blackhead forms.
- Inflammatory lesions – due to the follicle bursting and releasing irritants,
forming papules and pustules
- Excessive inflammatory response can result in nodules or cysts
- This sequence of events can ultimately cause scarring such as ice-pick
scars or hypertrophic scars.
- Drug-induced acne is often monomorphic (pustules are characteristically
seen in steroid use)
- Acne fulminans is very severe acne associated with systemic upset e.g.,
fever and so hospital admission is often required and the condition
usually responds to oral steroids
Pathophysiology:
- Common skin disorder which usually peaks in adolescence and typically
affects the face neck and upper trunk/chest.
- Characterised by the obstruction of the pilosebaceous follicle with
keratin plugs which results in comedones, inflammation and pustules
- Pathophysiology is multifactorial:
Follicular epidermal hyperproliferation resulting in the formation of a
keratin plug, which causes obstruction of the pilosebaceous follicle.
Activity of sebaceous glands may be controlled by androgen (e.g.,
seen in PCOS), but patients with acne can often have normal
androgen levels
Colonisation by anaerobic bacterium called Propionibacterium acnes
Inflammation
, Classification of Acne:
- Mild acne = open and closed comedones with or without sparse
inflammatory lesions
- Moderate acne = widespread non-inflammatory lesions and numerous
papules and pustules
- Severe acne = extensive inflammatory lesions, which may include
nodules, pitting and scarring
Management:
