Acne Rosacea

Exam Cram

• Presentation: over 30 years with facial erythematous rash with papules, pustules and telangiectasia

• Diagnosis: examination- persistent facial erythema

• Management: topical metronidazole 

• Steroids make this condition worse

Outline

Background 

• Prevalence: Worldwide 5%

Assessment

History

• Erythema and skin thickening around cheeks and nose

• Consumes alcohol & smokes

Examination:

• Persistent facial erythema

• Rhinophyma

Investigations

• Nil required

Diagnosis

Diagnostic criteria: clinical

Management

Acute

1. Reduce triggers- spicy food, hot baths, alcohol & sun exposure

2. Topical

   1. 1.  Metronidazole 0.75%

      2. Ivermectin

      3. Brimonidine (less effective for nasal pustules, good for flushing)

      4. Azelaic acid (hypersensitivity reactions)

3. Oral

   1. 1. Doxycycline

      2. Brimonidine

      3. Isotretinoin

4. Laser Ablation- advance rhinophyma

Considerations

• Steroids worsen condition and are not indicated (one of the few conditions!)

• I find answers in MCQs frustratingly inconsistent so therefore this is my best guess solution!

• If Rhinophyma or pustules consider PO doxycycline first

References

1. Kuo, O. (2022) Rosacea | DermNet NZ, dermnetnz.org. Available at: https://dermnetnz.org/topics/rosacea.