Chapter 053. Eczema and Dermatitis (Part 14) ppsx

Eczema and Dermatitis Part 14 Acne Rosacea Acne rosacea, commonly referred to as rosacea, is an inflammatory disorder predominantly affecting the central face.. Prominent facial erythe

Chapter 053 Eczema and

Dermatitis (Part 14)

Acne Rosacea

Acne rosacea, commonly referred to as rosacea, is an inflammatory disorder predominantly affecting the central face Those most often affected are Caucasians of northern European background, but it is seen in patients with dark skin also It is seen almost exclusively in adults, only rarely affecting patients <30 years Rosacea is more common in women, but those most severely affected are men It is characterized by the presence of erythema, telangiectases, and superficial pustules (Fig 53-8), but is not associated with the presence of comedones Rosacea only rarely involves the chest or back

Figure 53-8

Acne rosacea Prominent facial erythema, telangiectasia, scattered papules,

and small pustules are seen in this patient with acne rosacea (Courtesy of Robert

Swerlick, MD; with permission.)

There is a relationship between the tendency for facial flushing and the subsequent development of acne rosacea Often, individuals with rosacea initially demonstrate a pronounced flushing reaction This may be in response to heat, emotional stimuli, alcohol, hot drinks, or spicy foods As the disease progresses, the flush persists longer and longer and may eventually become permanent Papules, pustules, and telangiectases can become superimposed on the persistent flush Rosacea of very long standing may lead to connective tissue overgrowth, particularly of the nose (rhinophyma) Rosacea may also be complicated by various inflammatory disorders of the eye, including keratitis, blepharitis, iritis, and recurrent chalazion These ocular problems are potentially sight-threatening and warrant ophthalmologic evaluation

Acne Rosacea: Treatment

Acne rosacea can be treated topically or systemically Mild disease often responds to topical metronidazole or sodium sulfacetamide More severe disease requires oral tetracyclines: tetracycline 250–500 mg bid, doxycycline 100 mg bid,

or minocycline 50–100 mg bid Residual telangiectasia may respond to laser therapy Topical glucocorticoids, especially potent agents, should be avoided since chronic use of these preparations may elicit rosacea Topical therapy of the skin is not effective treatment for ocular disease

Skin Diseases and Smallpox Vaccination

Given the potential threat of a bioterrorism attack with smallpox, vaccinations against smallpox are available to the general public, although they are not recommended Because of a higher incidence of adverse events associated with smallpox vaccination in patients with a history of certain skin diseases, including atopic dermatitis, eczema, and psoriasis, such vaccination is contraindicated in patients with these conditions in the absence of a bioterrorism attack and a real or potential exposure to smallpox In the case of such exposure, the risk of smallpox infection outweighs the risk of adverse events from the vaccine (Chap 214)

Further Readings

James WD et al: Andrews' Diseases of the Skin Clinical Dermatology, 10th

ed Philadelphia, Saunders-Elsevier, 2006

Wolff K, Johnson RA: Fitzpatrick's Color Atlas and Synopsis of Clinical

Dermatology, 5th ed New York, McGraw-Hill, 2005

Wolff K et al (eds): Fitzpatrick's Dermatology in General Medicine, 7th ed

New York, McGraw-Hill, 2008

Wolverton SE (ed): Comprehensive Dermatologic Drug Therapy

Philadelphia, Saunders, 2001

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