Acne Rosacea

by Stephen Holt, MD, MS

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    00:01 Let's look back and revisit the case, looking for clues that may help us to look at acne rosacea.

    00:07 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.

    00:16 Next stop, we look at some of the triggers that she was describing.

    00:19 Now, she does drink alcohol but in particular she said that on very hot days, it gets worse and when she eats spicy food.

    00:25 Well folks, what acne rosacea will tell you there's a number of common episodic triggers that may bring on significant flares.

    00:32 Exercising, drinking alcohol, spicy food and hot drinks, exposure to the sun and even emotional stress.

    00:39 So that all seems to go along with acne rosacea.

    00:42 Next stop, it turns out that yes, acne rosacea is commonly associated with blepharitis, conjunctivitis or even iritis.

    00:49 So that supports our diagnosis too.

    00:52 Next stop, the risk factors.

    00:54 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.

    01:02 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.

    01:14 Acne rosacea compared with acne vulgaris should never have comedones and the absence of that in our case is a clue to the diagnosis.

    01:23 Alright, so our final diagnosis is acne rosacea.

    01:27 Let's review a few more key features of acne rosacea.

    01:31 First off, this is considered an inflammatory disease of pilosebaceous units associated with capillary hyperreactivity that ultimately looks like flushing and telangiectasis.

    01:42 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.

    01:49 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.

    01:58 Topical corticosteroids have also been shown to worsen the disease.

    02:02 In men, oftentimes, we see this much more disfiguring presentation called rhinophyma, which you can see here on the right.

    02:09 Next stop, we wanna talk about how to manage our patient's acne rosacea.

    02:13 First off we want to tell her to identify and avoid pertinent triggers, including the sunlight.

    02:18 She also mentioned that eating spicy foods may be a contributor and the alcohol's probably not helping either.

    02:24 Patients can oftentimes use topical emollients to help to soothe the skin.

    02:28 And next stop, medications that we would start with would be topical brimonidine and commonly, metronidazole.

    02:35 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.

    02:47 So, a few key points about acne rosacea.

    02:50 First off, it's characterized by repeated eruptions of facial flushing and these erythematous papular lesions.

    02:57 It's more common in women and more common in those over the age of 30.

    03:01 It's idiopathic but there are typical risk factors that we look for - obesity, alcohol and fair complexion.

    03:08 Lastly, it's characterized by papules, pustules and telangiectasias and importantly, you should not see comedones.

    03:16 We're gonna treat it by avoiding triggers and potentially starting with topical brimonidine and topical metronidazole.

    About the Lecture

    The lecture Acne Rosacea by Stephen Holt, MD, MS is from the course Miscellaneous Skin Disorders.

    Included Quiz Questions

    1. It can be triggered by alcohol, spicy food, and sun exposure.
    2. It presents as flushing, papules, telangiectasia, and comedones.
    3. Its etiology has been associated with Malassezia infection.
    4. Rhinophyma variant is more common in females.
    5. It is caused by a defect in the heme synthesis pathway.
    1. Topical brimonidine
    2. Topical mupirocin
    3. Topical corticosteroids
    4. Cryotherapy
    5. Oral tacrolimus

    Author of lecture Acne Rosacea

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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