DOCSLIB.ORG

The Great Mimickers of Rosacea

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Great Mimickers of Rosacea The Great Mimickers of Rosacea Jeannette Olazagasti, BS; Peter Lynch, MD; Nasim Fazel, MD, DDS Practice Points Rosacea is characterized by frequent flushing; persistent erythema (ie, lasting for at least 3 months); telangiectasia; and interspersed episodes of inflammation with swelling, papules, and pustules. Rosacea is most commonly seen in adults older than 30 years and is considered to have a strong hereditary component, as it is more commonly seen in individuals of Celtic and Northern European descent as well as those with fair skin. Although rosacea is one of the most common Rosacea Characteristics conditions treated by dermatologists, it also is Rosacea is a chroniccopy disorder affecting the central one of the most misunderstood. It is a chronic dis- parts of the face that is characterized by frequent order affecting the central parts of the face and flushing; persistent erythema (ie, lasting for at least is characterized by frequent flushing; persistent 3 months); telangiectasia; and interspersed epi- erythema (ie, lasting for at least 3 months); tel- sodes of inflammation with swelling, papules, and angiectasia; and interspersed episodes of inflam- pustules.not2 It is most commonly seen in adults older mation with swelling, papules, and pustules. than 30 years and is considered to have a strong Understanding the clinical variants and disease hereditary component, as it is more commonly seen course of rosacea is important to differentiateDo in individuals of Celtic and Northern European this entity from other conditions that can mimic descent as well as those with fair skin. Furthermore, rosacea. Herein we present several mimickers of approximately 30% to 40% of patients report a fam- rosacea that physicians should consider when ily member with the condition.2 diagnosing this condition. Rosacea Subtypes—In a 2002 meeting held to Cutis. 2014;94:39-45. standardize the diagnostic criteria for rosacea, the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea described lthough rosacea is oneCUTIS of the most common 4 broad clinical subtypes of rosacea: erythematotel- conditions treated by dermatologists, it also is angiectatic, papulopustular, phymatous, and ocular.3 Aone of the most misunderstood. Historically, More than 1 subtype may present in the same patient. large noses due to rhinomegaly were associated with A progression from one subtype to another can occur indulgence in wine and wealth.1 The term rosacea is in cases of severe papulopustular or glandular rosacea derived from the Latin adjective meaning “like roses.” that eventuate into the phymatous form.2 Moreover, Rosacea was first medically described in French as not all of the disease features are present in every goutterose (pink droplet) and pustule de vin (pimples patient. Secondary features of rosacea include burn- of wine).1 This article reviews the characteristics of ing or stinging, edema, plaques, dry appearance rosacea compared to several mimickers of rosacea that of the skin, ocular manifestations, peripheral site physicians should consider. involvement, and phymatous changes. In erythematotelangiectatic rosacea, epi- Ms. Olazagasti is from the University of Puerto Rico School of sodic flushing occurs, which can last longer than Medicine, San Juan. Drs. Lynch and Fazel are from the University of 10 minutes with the central face exhibiting the most California, Davis School of Medicine, Sacramento. intense color. The redness also may involve the The authors report no conflict of interest. Correspondence: Nasim Fazel, MD, DDS, Department of Dermatology, peripheral portion of the face as well as extrafacial University of California, Davis School of Medicine, 3301 C St, #1300, areas (eg, ears, scalp, neck, chest). Periocular skin Sacramento, CA 95816 ([email protected]). is spared. The stimuli that may bring on flushing WWW.CUTIS.COM VOLUME 94, JULY 2014 39 Copyright Cutis 2014. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Mimickers of Rosacea include short-term emotional stress, hot drinks, or simply an inhabitant of follicles in rosacea-prone alcohol, spicy foods, exercise, cold or hot weather, skin remains a subject for future investigation. and hot water.3 Demodicosis occurs mainly in immunosuppressed Patients with papulopustular rosacea generally patients because immunosuppression influences present with redness of the central portion of the face the number of Demodex mites and the treatment along with persistent or intermittent flares character- response. Multiple patients with AIDS and/or those ized by small papules and pinpoint pustules. There with a CD4 lymphocyte count below 200/mm3 have also is an almost universal sparing of the periocular been reported to have demodicosis.5-11 In immuno- skin, and a history of flushing often is present; how- competent patients, pruritic papular, papulopustu- ever, flushing usually is milder than in the erythema- lar, and nodular lesions occur on the face, but in totelangiectatic subtype. The constant inflammation immunocompromised patients, the eruption may be may lead to chronic edema and phymatous changes, more diffuse, affecting the back, presternal area, and which occur more commonly in men than in women.3 upper limbs.6 A correct diagnosis relies on suggestive Phymatous rosacea is characterized by marked clinical signs, the presence of numerous parasites on skin thickening and irregular surface nodularities, direct examination, and a good clinical response to most commonly involving the nose (rhinophyma), acaricide treatment. though the chin (gnathophyma), forehead (meto- Helicobacter pylori seropositivity has been associ- phyma), ears (otophyma), and eyelids (blepharo- ated with various dermatologic disorders, includ- phyma) also are occasionally affected. There are ing rosacea.12 However, robust support for a causal 4 variants of rhinophyma with distinct histopatho- association between H pylori and rosacea does logic features: glandular, fibrous, fibroangiomatous, not exist. Several studies have demonstrated high and actinic.3 The glandular variant is most often seen prevalence rates of H pylori in rosacea patients, some in men who have thick sebaceous skin. Edematous even in comparisoncopy with age- and sex-matched papules and pustules often are large and may be controls.13,14 Moreover, treatments aimed at eradicat- accompanied by nodulocystic lesions. Frequently, ing H pylori also beneficially influence the clinical affected patients will have a history of adolescent outcome of rosacea; for instance, metronidazole, a acne with scarring. commonnot treatment of roscea, is an effective agent Ocular rosacea may precede cutaneous findings against H pylori. by many years; however, in most cases the ocular Understanding the clinical variants and disease findings occur concurrently or develop later on in course of rosacea is important to differentiate this the disease course. The most consistent findingsDo in entity from other conditions that can mimic rosacea. ocular rosacea are blepharitis and conjunctivitis. Laboratory studies and histopathologic examina- Symptoms of burning or stinging, itching, light sen- tion via skin biopsy may be needed to differentiate sitivity, and a foreign body sensation are common in between rosacea and rosacealike conditions. these patients.3 Pathogenesis—Several investigators have proposed Common Rosacealike Conditions that Demodex folliculorum may play a pathogenic role Systemic Lupus Erythematosus—Systemic lupus in rosacea. Demodex is a CUTIScommon inhabitant of erythematosus (SLE) is a chronic inflammatory dis- normal human skin, and its role in human disease ease that has protean clinical manifestations and fol- is a matter of controversy.3 Demodex has a predilec- lows a relapsing and remitting course. Characteristic tion for the regions of the skin that are most often malar erythema appears in approximately 50% of affected by rosacea, such as the nose and cheeks. patients and may accompany or precede other symp- The clinical manifestations of rosacea tend to appear toms of lupus. The affected skin generally feels warm later in life, which parallels the increase in the den- and appears slightly edematous. The erythema may sity of Demodex mites that occurs with age.4 It has last for hours to days and often recurs, particularly been hypothesized that beneficial effects of metroni- with sun exposure. The malar erythema of SLE can dazole in the treatment of rosacea may be related to be confused with the redness of erythematotelangi- an antiparasitic effect on Demodex; however, these ectatic rosacea. Nevertheless, the color of the skin in mites can survive high concentrations of the drug.3 SLE has a violaceous quality and may show a more Moreover, modern techniques that employ cyanoac- abrupt cutoff, especially at its most lateral margins. rylate surface biopsies, which are extremely sensitive, Marzano et al15 reported 4 cases in which lupus estimate that the prevalence of Demodex in healthy erythematosus was misdiagnosed as rosacea. All skin approaches 100%.4 Consequently, the simple 4 patients presented with erythema that was local- identification of Demodex is by no means proof of ized to the central face along with a few raised, pathogenesis. Whether Demodex is truly pathogenic smooth, round, erythematous to violaceous papules 40 CUTIS® WWW.CUTIS.COM Copyright Cutis 2014. No part of this publication may be reproduced, stored, or transmitted
Load more

Recommended publications
  • Proper Preop Makes for Easier Toenail Surgery
    April 15, 2007 • www.familypracticenews.com Skin Disorders 25 Proper Preop Makes for Easier Toenail Surgery BY JEFF EVANS sia using a digital block or a distal approach to take ef- Senior Writer fect. Premedication with NSAIDs, codeine, or dextro- propoxyphene also may be appropriate, he said. WASHINGTON — Proper early management of in- To cut away the offending section of nail, an English grown toenails may help to decrease the risk of recur- anvil nail splitter is inserted under the nail plate and the rence whether or not surgery is necessary, Dr. C. Ralph cut is made all the way to the proximal nail fold. The hy- Daniel III said at the annual meeting of the American pertrophic, granulated tissue should be cut away as well. Academy of Dermatology. Many ingrown toenails are recurrent, so Dr. Daniel per- “An ingrown nail is primarily acting as a foreign-body forms a chemical matricectomy in nearly all patients after reaction. That rigid spicule penetrates soft surrounding tis- making sure that the surgical field is dry and bloodless. sue” and produces swelling, granulation tissue, and some- The proximal nail fold can be flared back to expose more times a secondary infection, said Dr. Daniel of the de- of the proximal matrix if necessary. Dr. Daniel inserts a Cal- partments of dermatology at the University of Mississippi, giswab coated with 88% phenol or 10% sodium hydroxide Jackson, and the University of Alabama, Birmingham. and applies the chemical for 30 seconds to the portion of For the early management of stage I ingrown toenails the nail matrix that needs to be destroyed.
    [Show full text]
  • Aars Hot Topics Member Newsletter
    AARS HOT TOPICS MEMBER NEWSLETTER American Acne and Rosacea Society 201 Claremont Avenue • Montclair, NJ 07042 (888) 744-DERM (3376) • [email protected] www.acneandrosacea.org Like Our YouTube Page We encourage you to TABLE OF CONTENTS invite your colleagues and patients to get active in AARS in the Community the American Acne & Don’t forget to attend the 14th Annual AARS Networking Reception tonight! ........... 2 Rosacea Society! Visit Our first round of AARS Patient Videos are being finalized now ............................... 2 www.acneandrosacea.org Save the Date for the 8th Annual AARS Scientific Symposium at SID ..................... 2 to become member and Please use the discount code AARS15 for 15% off of registration to SCALE ........... 2 donate now on www.acneandrosacea.org/ Industry News donate to continue to see Ortho Dermatologics launches first cash-pay prescription program in dermatology . 2 a change in acne and Cutera to unveil excel V+ next generation laser platform at AAD Annual Meeting ... 3 rosacea. TARGET PharmaSolutions launches real-world study .............................................. 3 New Medical Research Epidemiology and dermatological comorbidity of seborrhoeic dermatitis ................... 4 A novel moisturizer with high SPF improves cutaneous barrier function .................... 5 Randomized phase 3 evaluation of trifarotene 50 μG/G cream treatment ................. 5 Open-label, investigator-initiated, single site exploratory trial..................................... 6 Erythematotelangiectatic
    [Show full text]
  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G
    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).
    [Show full text]
  • Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition
    Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition: Redness, warmth, tenderness and exudate coming from the areas adjacent to the nail plate. Initial Diagnosis and Management: History and physical examination. In chronic infection appropriate radiographic (foot or toe series to rule out distal phalanx osteomyelitis) and laboratory evaluation (CBC and ESR). Ongoing Management and Objectives: Primary care should consist of Epsom salt soaks, or soapy water, and antibiotics for ten days. If Epsom salt soaks and antibiotics are ineffective, the primary care provider has the following options: Reevaluate and refer to podiatry. Perform temporary avulsion/I&D. Perform permanent avulsion followed by chemical cautery (89% Phenol or 10% NaOH application – 3 applications maintained for 30 second intervals, alcohol dilution between each application). Aftercare for all of the above is continued soaks, daily tip cleaning and bandage application. Indications for Specialty Care Referral: After the reevaluation at the end of the antibiotic period the primary care provider can refer the patient to Podiatry for avulsion/ surgical care if they do not feel comfortable performing the procedure themselves. The patient should be given a prescription for antibiotics renewal and orders to continue soaks until avulsion can be performed. Test(s) to Prepare for Consult: Test(s) Consultant May Need To Do: Criteria for Return to Primary Care: After completion of the surgical procedure, patients will be returned to the primary care provider for follow-up. Revision History: Created Revised Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be considered inclusive of all accepted methods of care or exclusive of other methods of care reasonably directed to obtaining the same results.
    [Show full text]
  • C&P Service Clinician's Guide
    C&P Service Clinician’s Guide CLINICIAN’S GUIDE MARCH 2002 1 C&P Service Clinician’s Guide Table of Contents Table of Contents 2 PREFACE 4 Chapter 1 – INTRODUCTION TO COMPENSATION AND PENSION 5 Worksheet – Aid and Attendance or Housebound Examination 16 Worksheet – General Medical Examination 18 Chapter 2 – DISEASES OF THE SKIN INCLUDING SCARS 22 Worksheet – Skin Diseases (Other Than Scars) 28 Worksheet – Scars 29 Chapter 3 – BIRTH DEFECTS IN CHILDREN OF VIETNAM VETERANS 30 SECTION I: Children with spina bifida who are the children of Vietnam veterans 30 SECTION II: Children with birth defects who are the children of women Vietnam veterans 32 Chapter 4 – EYE 34 Worksheet – Eye Examination 39 Chapter 5 – EAR, MOUTH, NOSE AND THROAT 42 Worksheet – Audio 57 Worksheet – Dental and Oral 59 Worksheet – Ear Disease 60 Worksheet – Mouth, Lips and Tongue 62 Worksheet – Nose, Sinus, Larynx, and Pharynx 63 Worksheet – Sense of Smell and Taste 64 Chapter 6 – RESPIRATORY 65 Worksheet – Respiratory (Obstructive, Restrictive, and Interstitial) 71 Worksheet – Respiratory Diseases, Miscellaneous 73 Worksheet – Pulmonary Tuberculosis and Mycobacterial Diseases 75 Chapter 7 – CARDIOVASCULAR SYSTEM 77 Worksheet – Arrhythmias 88 Worksheet – Arteries, Veins, and Miscellaneous 90 Worksheet – Heart 93 Worksheet – Hypertension 95 1 C&P Service Clinician’s Guide Chapter 8 – DISEASES OF THE DIGESTIVE SYSTEM 96 SECTION I: ESOPHAGUS 96 SECTION II: STOMACH 101 SECTION III: INTESTINE 103 SECTION IV: RECTUM AND ANUS 107 SECTION V: ALIMENTARY APPENDAGES 110 Worksheet
    [Show full text]
  • Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol
    Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail
    [Show full text]
  • Skin Conditions and Related Need for Medical Care Among Persons 1=74 Years United States, 1971-1974
    Data from the Series 11 NATIONAL HEALTH SURVEY Number 212 Skin Conditions and Related Need for Medical Care Among Persons 1=74 Years United States, 1971-1974 DHEW Publication No. (PHS) 79-1660 U.S, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Office of the Assistant Secretary for Health National Center for Health Statistics Hyattsville, Md. November 1978 NATIONAL CENTIER FOR HEALTH STATISTICS DOROTHY P. RICE, Director ROBERT A. ISRAEL, Deputy Director JACOB J. FELDAMN, Ph.D., Associate Director for Amdy.sis GAIL F. FISHER, Ph.D., Associate Director for the Cooperative Health Statistics System ELIJAH L. WHITE, Associate Director for Data Systems JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics ROBERT C. HUBER, Associate Director for Managewzent MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics PETER L. HURLEY, Associate Director for Operations JAMES M. ROBEY, Ph.D., Associate Director for Program Development PAUL E. LEAVERTON, Ph.D., Associate Director for Research ALICE HAYWOOD,, Information Officer DIVISION OF HEALTH EXAMINATION STATISTICS MICHAEL A. W. HATTWICK, M.D., Director JEAN ROEERTS, Chiej, Medical Statistics Branch ROBERT S. MURPHY, Chiej Survey Planning and Development Branch DIVISION OF OPERATIONS HENRY MILLER, ChieJ Health -Examination Field Operations Branch COOPERATION OF THE U.S. BUREAU OF THE CENSUS Under the legislation establishing the National Health Survey, the Public Health Service is authorized to use, insofar as possible, the sesw?icesor facilities of other Federal, State, or private agencies. In accordance with specifications established by the National Center for Health Statis- tics, the U.S. Bureau of the Census participated in the design and selection of the sample and carried out the household interview stage of :the data collection and certain parts of the statis- tical processing.
    [Show full text]
  • Pathological Investigation of Rosacea with Particular Regard Of
    CORE Metadata, citation and similar papers at core.ac.uk Provided by White Rose E-theses Online A Clinico-Pathological Investigation of Rosacea with Particular Regard to Systemic Diseases Dr. Mustafa Hassan Marai Submitted in accordance with the requirements for the degree of Doctor of Medicine The University of Leeds School of Medicine May 2015 “I can confirm that the work submitted is my own and that appropriate credit has been given where reference has been made to the work of others” “This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement” May 2015 The University of Leeds Dr. Mustafa Hassan Marai “The right of Dr Mustafa Hassan Marai to be identified as Author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988” Acknowledgement Firstly, I would like to thank all the patients who participate in my rosacea study, giving their time and providing me with all of the important information about their disease. This is helped me to collect all of my study data which resulted in my important outcome of my study. Secondly, I would like to thank my supervisor Dr Mark Goodfield, consultant Dermatologist, for his continuous support and help through out my research study. His flexibility, understanding and his quick response to my enquiries always helped me to relive my stress and give me more strength to solve the difficulties during my research. Also, I would like to thank Dr Elizabeth Hensor, Data Analyst at Leeds Institute of Molecular Medicine, Section of Musculoskeletal Medicine, University of Leeds for her understanding the purpose of my study and her help in analysing my study data.
    [Show full text]
  • Daily Scientific Programme Saturday 15 June, 2019
    15 JUNE DAILY SCIENTIFIC PROGRAMME SATURDAY SATURDAY 15 JUNE, 2019 SATURDAY 15 JUNE, 2019 AMBER 1 07:00-08:00 07:00 Cutaneous Lymphomas: therapeutic update Nicola Pimpinelli (ITALY) GRUPPO SIDeMaST ALLERGIE CUTANEE: 07:10 Laser in capillary malformations Acrylates: Old and new allergens IS Francesca Negosanti (ITALY) CO-CHAIRS: Colombina Vincenzi (ITALY), Paolo Pigatto (ITALY) 07:20 Nevi treatments with lasers Davide Brunelli (ITALY) 07:00 Introduction Paolo Pigatto (ITALY) 07:30 Lasers in Rhinophyma Giovanni Cannarozzo (ITALY) 07:05 Contact allergy to electrocardiogram electrodes caused by acrylic acid without sensitivity to 07:40 Lasers in Neurofibromatosis methacrylates and ethyl cyanoacrylate Giuseppe Lodi (ITALY), Mario Sannino (ITALY) Paolo Romita (ITALY), Caterina Foti (ITALY) 07:50 Discussion 07:15 2-HEMA as screening tool in the detection of (Meth) Acrylates allergy: the Italian experience AMBER 5+6 07:00-08:00 Katharina Hansel (GERMANY), Luca Stingeni (ITALY) GRUPPO SIDeMaST DERMATOLOGIA 07:25 Hands contact dermatitis to (Meth) Acrylates in IS CHIRURGICA: Case reports in Dermatologic dental technicians Surgery Antonio Cristaudo (ITALY) CO-CHAIRS: Klaus Eisendle (ITALY), Mario Puviani (ITALY) 07:35 Contact stomatitis to (Meth) Acrylate in odontoiatric patients 07:00 Squamocellular carcinoma in albino africans Paolo Pigatto (ITALY), Gianpaolo Guzzi (ITALY) Massimo Gravante (ITALY) 07:45 Discussion 07:08 Reconstruction of full thickness nasal alar defect in a patient with sebaceous carcinoma Daniele Dusi (ITALY) AMBER 2 07:00-08:00
    [Show full text]
  • Pathogenesis of Rosacea Anetta E
    REVIEW Pathogenesis of Rosacea Anetta E. Reszko, MD, PhD; Richard D. Granstein, MD Rosacea is a chronic, common skin disorder whose pathogenesis is incompletely understood. An inter- play of multiple factors, including genetic predisposition and environmental, neurogenic, and microbial factors, may be involved in the disease process. Rosacea subtypes, identified in the recently published standard classification system by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea, may in fact represent different disease processes, and identifying subtypes may allow investigators to pursue more precisely focused studies. New developments in molecular biology and genetics hold promise for elucidating the interplay of the multiple factors involved in the pathogen- esis of rosacea, as well as providing the bases for potential new therapies. osacea is a common, chronic skin disorder and secondary features needed for the clinical diagnosis primarily affecting the central and con- of rosacea. Primary features include flushing (transient vex areas of COSthe face. The nose, cheeks, DERM erythema), persistent erythema, papules and pustules, chin, forehead, and glabella are the most and telangiectasias. Secondary features include burn- frequently affected sites. Less commonly ing and stinging, skin dryness, plaque formation, dry affectedR sites include the infraorbital, submental, and ret- appearance, edema, ocular symptoms, extrafacial mani- roauricular areas, the V-shaped area of the chest, and the festations, and phymatous changes. One or more of the neck, the back, and theDo scalp. Notprimary Copy features is needed for diagnosis.1 The disease has a variety of clinical manifestations, Several authors have theorized that rosacea progresses including flushing, persistent erythema, telangiecta- from one stage to another.2-4 However, recent data, sias, papules, pustules, and tissue and sebaceous gland including data on therapeutic modalities of various sub- hyperplasia.
    [Show full text]
  • Skin Disease and Disorders
    Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin.
    [Show full text]
  • Richtlijn Acneïforme Dermatosen
    Richtlijn Acneïforme dermatosen Richtlijn: Acneïforme dermatosen Colofon Richtlijn Acneïforme dermatosen © 2010, Nederlandse Vereniging voor Dermatologie en Venereologie (NVDV) Postbus 8552, 3503 RN Utrecht Telefoon: 030-2823180 E-mail: [email protected] Alle rechten voorbehouden. Niets uit deze uitgave mag worden verveelvoudigd of openbaar worden gemaakt, in enige vorm of op enige wijze, zonder voorafgaande schriftelijke toestemming van de Nederlandse Vereniging voor Dermatologie en Venereologie. Deze richtlijn is opgesteld door een daartoe geïnstalleerde werkgroep van de Nederlandse Vereniging voor Dermatologie en Venereologie. De richtlijn is vervolgens vastgesteld in de algemene ledenvergadering. De richtlijn vertegenwoordigt de geldende professionele standaard ten tijde van de opstelling van de richtlijn. De richtlijn bevat aanbevelingen van algemene aard. Het is mogelijk dat deze aanbevelingen in een individueel geval niet van toepassing zijn. De toepasbaarheid en de toepassing van de richtlijnen in de praktijk is de verantwoordelijkheid van de behandelend arts. Er kunnen zich feiten of omstandigheden voordoen waardoor het wenselijk is dat in het belang van de patiënt van de richtlijn wordt afgeweken. 1 Versie 18-06-2010 WERKGROEP Prof. dr. P.C.M. van de Kerkhof, dermatoloog, voorzitter werkgroep Mw. J.A. Boer, huidtherapeut Drs. R.J. Borgonjen, ondersteuner werkgroep Dr .J.J.E. van Everdingen, dermatoloog Mw. M.E.M. Janssen, huidtherapeut Drs. M. Kerzman, NHG/huisarts Dr. J. de Korte, dermatopsycholoog Drs. M.F.E. Leenarts, dermatoloog i.o. Drs. M.M.D. van der Linden, dermatoloog Dr. J.R. Mekkes, dermatoloog Drs. J.E. Mooij, promovendus dermatologie Drs. L. van ’t Oost, dermatoloog i.o. Dr. V. Sigurdsson, dermatoloog Mw. C. Swinkels, hidradenitis patiënten vereniging/patiëntvertegenwoordiger Drs.
    [Show full text]