Let's look back and revisit the case, looking for
clues that may help us to look at acne rosacea.
Alright, so we're told
she's a 41-year old EMT,
well that's pretty typical age group for
rosacea and also it's more common in women.
Next stop, we look at some of the
triggers that she was describing.
Now, she does drink alcohol but in particular
she said that on very hot days, it gets worse
and when she eats spicy food.
Well folks, what acne rosacea will tell you there's a number of
common episodic triggers that may bring on significant flares.
Exercising, drinking alcohol, spicy food and hot
drinks, exposure to the sun and even emotional stress.
So that all seems to go
along with acne rosacea.
Next stop, it turns out that yes, acne rosacea is commonly
associated with blepharitis, conjunctivitis or even iritis.
So that supports our diagnosis too.
Next stop, the risk factors.
Someone who has a fair complexion,
is more likely to get this
and it's also been found to be associated
with obesity and alcohol consumption.
Finally, looking at the rash itself, evidence of flushing,
papules, telangiectasias and even occasionally pustules
is typical of acne rosacea and what
you're not seeing here is comedones.
Acne rosacea compared with acne
vulgaris should never have comedones
and the absence of that in our
case is a clue to the diagnosis.
Alright, so our final
diagnosis is acne rosacea.
Let's review a few more key
features of acne rosacea.
First off, this is considered an
inflammatory disease of pilosebaceous units
associated with capillary hyperreactivity that
ultimately looks like flushing and telangiectasis.
It's idiopathic, there are a number of things
that have been associated with bringing it on
but we don't know exactly what's
causing it in the first place.
Sun exposure's a factor, there may be
some issues with immune dysregulation
or maybe it's just an inflammatory response
to some as yet unidentified skin flora.
Topical corticosteroids have also
been shown to worsen the disease.
In men, oftentimes, we see this much more
disfiguring presentation called rhinophyma,
which you can see here on the right.
Next stop, we wanna talk about how to
manage our patient's acne rosacea.
First off we want to tell her to identify and
avoid pertinent triggers, including the sunlight.
She also mentioned that eating spicy foods may be a
contributor and the alcohol's probably not helping either.
Patients can oftentimes use topical
emollients to help to soothe the skin.
And next stop, medications that we would start with would
be topical brimonidine and commonly, metronidazole.
Patients with more advanced disease or more significant symptoms
are often prescribed oral antibiotics particularly tetracyclines
and you can even consider laser therapy
under the care of a dermatologist.
So, a few key points about acne rosacea.
First off, it's characterized by repeated eruptions of
facial flushing and these erythematous papular lesions.
It's more common in women and more
common in those over the age of 30.
It's idiopathic but there are typical risk factors that
we look for - obesity, alcohol and fair complexion.
Lastly, it's characterized by
papules, pustules and telangiectasias
and importantly, you
should not see comedones.
We're gonna treat it by avoiding triggers and potentially
starting with topical brimonidine and topical metronidazole.