DOCSLIB.ORG

Rosacea - an Overview on the Diagnosis and Assessment

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rosacea - an Overview on the Diagnosis and Assessment CLINICAL REVIEW Rosacea - An overview on the diagnosis and assessment Paula Oliver ABSTRACT This article provides an overview of the assessment, diagnosis and treatment options for rosacea Citation: Oliver P (2017) Rosacea – An overview on the diagnosis and assessment. Dermatological Nursing 17(2):10-14 Introduction The word rosacea is derived from pathophysiology is still unclear to Rosacea is a common chronic the Latin adjective meaning like roses.3 date.4 A link has also been established inflammatory disorder of the skin The term acne rosacea and adult acne between high levels of the Demodex predominantly affecting the central are misleading and obsolete, acne and mite (such as D.follicularum and face. It is characterised by frequent rosacea are separate disease processes, D.brevis) and rosacea, with signs and flushing, persistent erythema, even though they may co-exist at times. symptoms of rosacea potentially telangiectasia and interspersed with It is therefore important to establish resulting from heightened pro- episodes of inflammation during which the correct disease diagnosis to ensure inflammatory skin response.5 The patients experience tissue swelling that an appropriate treatment plan may demodex mites are small worm-like with papules and pustules. Patients be implemented. inhabitants of the sebaceous follicles may also experience ocular lesions on normal adult skin. They have eight and rhinophymas (excess growth of The psychosocial impact of living short stubby legs with claw-like ends, tissue of the nose) and cutaneous with rosacea can adversely impact an which they use to move about the sensations often include stinging and individual’s well-being, and that level of facial skin surface from one follicle burning. It typically appears between psychological burden should influence to another. This apparently occurs at the ages of 30-60.1 Phymatous rosacea treatment decisions. In addition, there night as it has been shown that the can also affect other areas on the face is also a psychosocial impact associated mites react negatively to light. These such as the chin (gnathophymas), ears with rosacea treatments. Patients can organisms seem to live in a harmonious (otophyma), forehead (mentophyma) become disheartened as they are relationship with their hosts and in or the eyelids (blepharophyma). advised there is no cure for rosacea normal circumstances do not excite Characteristically, rosacea is a and there may be a need for on- an inflammatory reaction in the skin. condition of the white population and going treatment and medication costs. In patients with rosacea, these mites it is three times more common in Furthermore, trigger factor exposure are greatly increased in number and women than men.2 can lead to lifestyle limitations. are found mainly in the centrofacial Education is essential to ensure that area, the area typically affected by patients are able to manage their inflammatory pustules and papules.6 condition and minimise flare-ups of the disease where possible by avoiding triggers such as alcohol, heat, spicy foods and sunlight (list not exhaustive). Alcohol can causing flushing, but is often linked to rosacea by the misconception that excessive alcohol consumption is the cause. Paula Oliver RGN BSc(Hons) MSc INP holds Recent research suggests that an honorary clinical role at Sussex Community deregulation of innate immune OM C Dermatology Service and Brighton and Sussex pathways, as well as vascular changes . E University Hospitals NHS Trust. are present, with different degrees of Q Figure 1 E Nurse Consultant/Team Leader for Galderma importance in the various subtypes. D U RM ST (UK) Ltd The aetiology, genetics and the Image of a demodex mite close up 10 Dermatological Nursing, 2017, Vol 16, No 2 www.bdng.org.uk CLINICAL REVIEW Consensus recommendations in 2002 suggested that rosacea was classified into four subtypes based on the clinical presentation, as follows: 8 Erythematotelangiectatic rosacea (ETTR); 8 Papulopustular (PPR); 8 Phymatous rosacea (PYR); and 8 Ocular rosacea (OR). However patients often present with a varied range of symptoms that overlap these sub-types.7 As an example, patients may present with papulopustular rosacea and also persistent erythema, and even if the PPR is treated successfully the erythema either transient or fixed may Figure 2 still remain. Erythematotelangiectatic rosacea (ETTR) Rosacea features can span multiple subtypes and progress between subtypes. Therefore, their clinical presentation may be more accurately defined by the term phenotype (individual features), which describes an individual’s observable characteristics that can be influence by genetic or environmental factors. Subtype classification may not fully cover the range of clinical presentations and is likely to confuse severity assessment, whereas a phenotype-based approach could improve patient outcomes by addressing an individual patient’s clinical presentation and their concerns. Tan et al suggests that adopting a phenotype led approach will Figure 3 address rosacea and its treatments in Papulopustular (PPR)I a way that is more consistent with the individual’s experience.8 The disease is unpredictable and can vary from week to week for patients. This can affect the patient’s quality of life. In addition to the physical impact, it is well documented that patients report significant psychological distress owing to the sometimes dramatic changeable nature of the signs and symptoms. The National Rosacea Society (NRS) conducted a survey of 1,675 patients, of which 90% of respondents said the effects of the disease on their personal appearance had lowered their self-esteem and self-confidence; 88% reported embarrassment; and OM C others noted feelings of frustration . E (76%), anxiety and helplessness (54%), Q Figure 4 E depressions (43%), anger (34%), and D U RM ST isolation (32%) Phymatous rosacea (PYR) www.bdng.org.uk Dermatological Nursing, 2017, Vol 16, No 2 11 CLINICAL REVIEW Primary features The presence of one or more of the following signs with central face distribution is suggestive of rosacea, although patients may have more than one of these features: 8 Flushing 8 Persistent erythema of the facial skin 8 Dome-shaped papules with or without pustules and nodule may also be present 8 Telangiectasia. Secondary features OM C Theses often appear with one or more . E of the primary features but also may Q Figure 5 E appear independently: D U RM ST 8 Burning or stinging Ocular rosacea (OR) 8 Raised plaques 8 Dry appearance rough and scaling commonly seen in teenage years, while triggered by environmental factors, 8 Oedema rosacea occurs most often between including sun exposure, temperature 8 Ocular signs that may include 30-60 years of age. Also, in acne, unlike changes, stress and spicy foods burning , itching, hyperemia, rosacea, open comedones (blackheads) to name a few. However, affected inflammation, styes, chalazia are generally present, and papules rosacea skin exhibits increased 8 Peripheral location and pustules on extra facial locations sensitivity to these triggers and 8 Phymatous changes. such as trunk and upper arms are patients need to try and identify common. While SLE and rosacea share their own individual triggers that some manifestations, including facial exacerbates their condition. Besides Rosacea can resemble erythema, sensitivity to ultra violet trigger avoidance, the most common other dermatological light and tends to affect more females treatment approaches to rosacea are disorders, including than males, clinicians have often used pharmacological in nature. acne and systemic lupus serology screening or histopathology erythematosus to confirm the diagnosis of SLE. Emollients and sunscreen are recommended for all rosacea Triggers patients to stabilise the skin’s barrier Differential diagnosis Sign and symptoms of rosacea can be dysfunction and to help prevent ETTR is characterised by centrofacial erythema, a tendency to flush frequently and typically prominent Sun 81% facial telangiectasias. PPR is usually Emotional stress 79% diagnosed on the clinical appearance Hot weather 75% of erythema, papules and pustules in Wind 57% a centrofacial distribution. In PYR, a Heavy exercise 56% range of phymatous changes may be Alcohol 52% seen in patients with rosacea, however Hot baths 51% rhinophyma is the most common and Cold weather 46% mainly occurs in males. Finally OR Spicy foods 45% is common and is often overlooked Humidity 44% by the patients and the healthcare professional, symptoms are usually Certain skin care products 41% mild and serious consequences of OR Indoor heat 41% are rare. Heated beverages 36% Certain cosmetics 27% Rosacea can resemble other dermatological disorders, Figure 6 including acne and systemic lupus Known triggers: National Rosacea Society Results based on a survey of 1,066 rosacea patients trigger for rosacea erythematosus (SLE). Acne is more http://www.rosacea.org/patients/materials/triggersgraph.php Website last accessed: March 2017 12 Dermatological Nursing, 2017, Vol 16, No 2 www.bdng.org.uk CLINICAL REVIEW photo-aggravation. Patients may need Patients need to be instructed how to anti-inflammatory and anti-parasitic, to explore a range of products to apply the gel evenly to achieve a good thereby reducing inflammation find one that will suit their skin as outcome. and inhibiting the demodex mite. moisturisers, make-up and sunscreen Metronidazole 0.75% gel or cream can potentially irritant sensitive Laser therapy using a pulsed dye historically has been used for PPR skin. Identifying trigger factors is an laser is also an option for patient and also azealic acid 15% cream these individual process and what may cause that can self-fund. Pulsed dye laser need applying twice daily both have an a skin reaction in one patient may treatment targets redness of rosacea anti-microbial mode of action. not in another. A rosacea diary could by delivering a long pulse of energy include a daily checklist of the most to the affected areas. It will often In more severe cases, or if topical common factors that trigger rosacea entail several treatment sessions over treatments fail, an antibiotic may be flare- ups in patients.
Load more

Recommended publications
  • 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]
  • 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]
  • 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]
  • Pathological Investigation of Rosacea with Particular Regard Of
    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]
  • Abscess, 600, 601F, 602 Apocrine Sweat Gland, 14–16
    3038r_ind_1023-1041 4/11/01 2:14 PM Page 1023 INDEX A Allergic phytodermatitis (APD), 26–28, Abscess, 600, 601f, 602 28f–29f apocrine sweat gland, 14–16, 15f, 17f Allopurinol, drug reaction to, 554 tuberculosis, metastatic, 661–662, 664, 666 ALM (acral lentiginous melanoma), 295–296, Acantholytic dermatosis, transient, 112, 113f 297f Acanthosis nigricans (AN), 82–83, 83f Alopecia classification, 82 nonscarring, 928–940 malignant, 82–83, 493, 493f–494f alopecia areata, 928–930, 929f, 931f ACD. See Allergic contact dermatitis alopecia totalis, 928 ACDRs (adverse cutaneous drug reactions). alopecia universalis, 928, 931f See Drug reactions anagen effluvium, 940, 940f ACE (angiotensin-converting enzyme) inhib- androgenetic alopecia, 932–936, 933f, itors, reactions to, 556 935f–936f Acetowhitening, 1015 neoplastica, 482 Acne keloidalis, 941, 945f telogen effluvium, 937–939, 938t–939t, Acne rosacea. See Rosacea 939f Acne vulgaris, 2–6, 3f, 5f, 7f scarring, 941, 942f–945f, 942t acne conglobata, 4 α1 antitrypsin-deficiency panniculitis, 146 acne fulminans, 4 Amiodarone-induced pigmentation, 566, 567f recalcitrant acne, 4 Amoxicillin drug reaction, 554 Acneform drug eruptions, 548 Ampicillin drug reaction, 553f, 554 Acral lentiginous melanoma (ALM), 295–296, Amyloidosis, systemic, 334–336, 335f, 337f 297f acquired, 334–336, 335f, 337f Acrochordon, 209f secondary, 334, 336 Acrodermatitis continua of Hallopeau, 69 AN. See Acanthosis nigricans Acrodermatitis enteropathica, 430–431, 432f Anagen effluvium, 940, 940f Acrosclerosis, 375f Anaphylaxis and anaphylactoid reactions, 547, ACTH-induced pigmentation, 568 556, 558 Actinic keratosis, 217, 219, 220f Angioedema and urticaria, 338–344, 339f, Actinic prurigo, 230, 234 341f–343f, 344t, 345f Acute febrile neutrophilic dermatosis. See drug reaction, 547, 556–558, 559f Sweet’s syndrome urticaria perstans, 393–394, 394f Acute retroviral syndrome (ARS), 912–915, urticarial vasculitis, 393–394, 394f 915f, 915t Angiokeratoma, 183f AD.
    [Show full text]
  • Inhoudsopgave ­Officiële Orgaan Van De Nederlandse Vereniging Voor Dermatologie En Venereologie
    NEDERLANDS TIJDSCHRIFT VOOR DERMATOLOGIE EN VENEREOLOGIE | VOLUME 21 | NUMMER 02 | FEBRUARI 2011 61 Het Nederlands Tijdschrift voor Dermatologie en Venereologie is het InhoudsoPgave officiële orgaan van de Nederlandse Vereniging voor Dermatologie en Venereologie. Het NTvDV is vanaf 1 januari 2008 geïndiceerd in NVDV NASCHOLING - DERMATOLOGENDAGEN 2011 EMBase, de internationale wetenschappelijke database Programma 24 en 25 maart 2011 62 van Elsevier Science. Psoriasis genetics and clinical implications 68 Hoofdredactie Dr. P.G.M. van der Valk, hoofdredacteur Is psoriasis een afwijking van het verworven immuunsysteem? 70 79 artiKeLeN Psoriasis: een ziekte veroorzaakt door onze innate immuniteit? Dr. R.C. Beljaards, dr. J.J.E. van Everdingen, dr. C.J.W. van Ginkel, Psoriasis: een huidbarrièreziekte? 82 dr. M.J. Korstanje, prof. dr. A.P. Oranje, dr. R.I.F. van der Waal Kritische blik op psoriasis en cardiovasculaire ziekten 87 Leerzame zieKtegescHiedeNisseN Dr. R. van Doorn, dr. S. van Ruth, dr. M. Seyger, Stress, cortisol en psoriasis: als stress onder de huid gaat… 89 dr. J. Toonstra, dr. M. Vermeer Juveniele psoriasis 92 rubrieK dermatocHirurgie Een kritische beschouwing over de beschikbare behandelingen A.M. van Rengen, dr. J.V. Smit , dr. R.I.F. van der Waal van psoriasis 96 rubrieK referaat Dr. W.P. Arnold, dr. A.Y. Goedkoop, dr. E.M. van der Snoek, Kliniek, epidemiologie en pathogenese van acneïforme dr. T.J. Stoof, dr. H.B. Thio, dermatosen 101 rubrieK vereNigiNg Klinische presentaties en histopathologische kenmerken Dr. M.B. Crijns, dr. J.J.E. van Everdingen van acne vulgaris 102 rubrieK oNderzoeK vaN eigeN bodem Dr. H.J.
    [Show full text]
  • Dermatology 101: from Acne to Zebras and the Pearls in Between
    Dermatology 101: From Acne to Zebras and the Pearls in Between Dr Kyle Cullingham, BA, BSc, MSc, MD, FRCPC Dermatologist Skinsense Dermatology, Saskatoon,SK Assistant Professor University of Saskatchewan Disclosures Speaker: Dr Kyle Cullingham Relationships with commercial interests: Speakers Bureau/Honoraria: Abbvie, Allergan, Celgene, LEO Consulting Fees: Abbvie, Celgene, Galderma, Janssen, LEO, Novartis Conflict of Interest Declaration: Nothing to Disclose Presenter: Dr. Kyle Cullingham Title of Presentation:Dermatology for GPs I have no financial or personal relationship related to this presentation to disclose. Objectives Discuss some common dermatological concerns – focus on recognition, management, what’s new and pearls. Acne Clinical pearls Rosacea Psoriasis Eczema Interspersed with interesting real Dermatology cases with common pitfalls, red flags, or learning points. Time for questions/comments Acne disorder of the pilosebaceous unit affects certain areas of the body: face > trunk >> buttocks manifests during adolescence, but can occur at any stage of life comedones, papulopustules, nodules, cysts scarring can follow Epidemiology acne affects approximately 85% of adolescents onset during puberty (10-19 y/o); may appear after age 25 more severe in men higher incidence in caucasians and indigenous population inheritance: multifactorial; most patients with cystic acne have parental history of severe acne Pathogenesis Corneocyte Sebum Propionibacterium acnes Inflammatory cell Drugs Diet Recent JAAD review
    [Show full text]
  • Kazlouskaya V
    MINISTRY OF HEALTH OF REPUBLIC OF BELARUS GOMEL STATE MEDICAL UNIVERSITY V. V. Kazlouskaya SELECTED LECTURES ON DERMATOLOGY Manual for foreign medical students Gomel GSMU 2008 УДК 616.5 (075.8)=20 ББК 55.8 К 59 Рецензеты: заведующий кафедрой дерматовенерологии УО «Витебский государственный медицинский университет», доктор медицинских наук, профессор В. П. Адаскевич; заведующий кафедрой поликлинической терапии и общеврачебной практики с курсом дерматовенерологии УО «Гомельский государственный медицинский университет», кандидат медицинских наук, доцент Э. Н. Платошкин. Козловская, В. В. К 59 Курс лекций по дерматологии: учеб.-метод. пособие для студентов- медиков = Selected Lectures on Dermatology: manual for foreign medical students / В. В. Козловская. — Гомель: Учреждение образования «Го- мельский государственный медицинский университет», 2008. — 160 с. ISBN 978-985-506-210-4 Учебно-методическое пособие «Selected Lectures on Dermatology» представляет собой курс лекций по дерматологии, предназначенный для иностранных студентов 3 курса, обучающихся на английском языке. Лекции составлены в соответствии с типовой учебной программой и содержат основные разделы цикла дерматология. Утверждено и рекомендовано к изданию Центральным учебным научно- методическим советом учреждения образования «Гомельский государственный медицинский университет» 20 ноября 2008 г., протокол № 11. УДК 616.5 (075.8) ББК 55.8 ISBN 978-985-506-210-4 © Учреждение образования «Гомельский государственный медицинский университет», 2008 2 Abbreviations Used in the Book AA
    [Show full text]
  • UC Davis Dermatology Online Journal
    UC Davis Dermatology Online Journal Title Otophyma: a rare benign clinical entity mimicking leprosy Permalink https://escholarship.org/uc/item/41p4q5xq Journal Dermatology Online Journal, 21(3) Authors Shuster, Marina McWilliams, Ashley Giambrone, Danielle et al. Publication Date 2015 DOI 10.5070/D3213024280 Supplemental Material https://escholarship.org/uc/item/41p4q5xq#supplemental License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 21 Number March 2015 Photo vignette Otophyma: a rare benign clinical entity mimicking leprosy Marina Shuster BA1, Ashley McWilliams BS2, Danielle Giambrone BS3, Omar Noor MD3, Jisun Cha MD3 Dermatology Online Journal 21 (3): 22 1Harvard Medical School 2Virginia Commonwealth University School of Medicine 3Rutgers- Robert Wood Johnson Medical School Correspondence: Danielle Giambrone Department of Dermatology Rutgers- Robert Wood Johnson Medical School 1 World’s Fair Drive Somerset, NJ 08873 Email: [email protected] Phone: 609-220-7710 Abstract Otophyma is a rare condition characterized by edematous deformation of the ear that is considered to be the end-stage of an inflammatory process such as rosacea and eczema. This report illustrates a case in an elderly male, originally thought to have leprosy. Biopsy revealed a nodular infiltration of inflammatory cells around adnexal structures and an intraepidermal cyst. No acid-fast organisms were identified. We present a patient who is of a different ethnic group than usually seen with this disease and provide a review of the clinical presentation, histopathological features, and management of this rare condition. Keywords: Otophyma, Leprosy, Rhinophyma, Rosacea Case synopsis A 62-year-old Filipino male presented for evaluation of his grossly enlarged ears.
    [Show full text]
  • The Treatment of Rosacea Anetta E
    Review The Treatment of Rosacea Anetta E. Reszko MD, PhD; Diane Berson MD Rosacea is a chronic condition affecting the facial and frequently ocular tissues. It is historically underdi- agnosed and affects people of all ethnicities, with higher overall prevalence in people of Celtic descent. The exact pathophysiology of rosacea is poorly understood. A variety of medical therapies, depending on the subtype, are available to treat the various signs and symptoms of rosacea. osacea is a common, chronic skin disorder differentiated from chronic sun damage and photoder- that frequently affects light-skinned white matitis. Papulopustular rosacea must be distinguished population. Overall prevalence of rosacea from acne vulgaris, seborrheic dermatitis, lupus miliaris ranges from less than 1% up to 10%. The disseminates faciei, collagen vascular diseases, perioral nose, cheeks, chin, forehead, and glabella dermatitis, and Demodex folliculitis. Differential diag- areR the most frequently affected sites. The disease has a nosis of ocular rosacea includes allergic conjunctivitis variety of clinical manifestations ranging from flushing, and blepharitis. persistent COSerythema, telangiectasias, papules, pustules, DERM Therapy of rosacea is centered on symptomatic and sebaceous gland hyperplasia. Significant psycho- improvement, including reduction of facial erythema logical stress and perceived diminished quality of life and number of inflammatory lesions; decrease in the often accompany this condition.1 The pathogenesis is number, duration and intensity
    [Show full text]
  • Internal Medicine In-Review Study Guide
    INTERNAL MEDICINE IN-REVIEW STUDY GUIDE Companion to the Online Study System InReviewIM.com Senior Editor Norman H. Ertel, MD Associate Editors James M. Horowitz, MD Miguel A. Paniagua, MD, FACP Available through support from the makers of Powered by © 2013 Educational Testing & Assessment Systems. All Rights Reserved. This document contains proprietary information, images, and marks of Educational Testing & Assessment Systems. No reproduction or use of any portion of the contents of these materials may be made without the express written consent of Educational Testing & Assessment Systems. If you feel you have obtained this illegally, please contact Educational Testing & Assessment Systems immediately. The questions and answers, statements or opinions contained in this Study Guide or Web Site have not been approved by McNeil Consumer Healthcare Division of McNEIL-PPC, Inc., the makers of TYLENOL®. McNeil will not be held responsible for any questions and answers, statements or opinions, contained in the Study Guide, Web Site, or any supplementary materials. Any questions about the content of Internal Medicine In-Review should be directed to Educational Testing and Assessment Systems, Inc. which controls the content and owns all copyrights in the materials. The developments in medicine are always changing, from clinical experiences, new research, and changes in treatment and drug therapy. The Internal Medicine In-Review team use reasonable efforts to include information that is complete and within accepted standards at the time of publication. However, the faculty, authors, publisher, nor any other party who has been involved in the preparation of Internal Medicine In-Review make representations, warranties, or assurances as to the accuracy, currency, or completeness of the information provided.
    [Show full text]
  • Triggers and Treatment of Rosacea
    MedicineToday 2015; 16(1): 34-40 PEER REVIEWED FEATURE 2 CPD POINTS Triggers and treatment of rosacea SHIEN-NING CHEE MB BS, MMed PATRICIA LOWE MB BS, MMed, FACD Key points Rosacea is a common chronic inflammatory skin condition that can • Rosacea is a common lead to significant facial changes, ocular involvement and decreased condition characterised by quality of life. Its cause is multifactorial and not completely understood. flushing, erythema, inflammatory lesions and Treatment aims to control, but not cure, the disease. telangiectasia. • The cause is multifactorial osacea is a common chronic inflam­ PATHOPHYSIOLOGY and not completely matory skin disease primarily affecting The pathophysiology of rosacea is multifactorial understood: genetics, the facial convexities. It is characterised and not completely understood. At present, neurovascular dysregulation Rby vascular lability, leading to flushing, rosacea is thought of as a complex inflammatory and infections may be telangiectasia and fixed erythema, and cuta­ disorder arising in genetically predisposed involved. neous inflammation, manifesting as papules, individuals. • Diagnosis of rosacea is pustules and lymphoedema. Although not based on clinical findings, life ­threatening, rosacea may have a significant Genetics although investigations may impact on a patient’s self­esteem and quality of Rosacea often affects multiple family members. be required to exclude life. Early diagnosis and treatment will reduce Recent analyses have found distinct genetic differential diagnoses. morbidity. profiles for each rosacea subtype, with expres­ • Treatment is tailored to the sion of more than 500 different genes compared individual and aims to EPIDEMIOLOGY with healthy skin.3 The skin of patients with control symptoms and signs, Estimated prevalence rates of rosacea range from rosacea has been found to be dry and acidic, but not cure the disease.
    [Show full text]