4. EARLY ROSACEA (STAGE I)
•
•
•
•
“FLUSHER-BLUSHERS”
OFTEN < AGE 20
NOSE/CHEEKS
RECURRENT EPISODES
OF BLUSHING.
• ERYTHEMA PERSISTS
• FEW
TELANGIECTASIAS
12. 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?
22. 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.
31. 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
32. 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
33. TREATMENT – SEVERE
• ORAL METRONIDAZOLE
• CLONIDINE 0.1mg QD or BID FOR
FLUSHING HELPS
• PREDNISONE TAPER
• ISOTRETINOIN (ACCUTANE)
34. 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
35. A GOOD START….
• KLARON LOTION,
4oz., apply qAM to face
• NORITATE CREAM,
30g, apply qHS to face
36.
37.
38.
39. 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!!!!!!!!!!!!!!!!!!!!
