Rosacea Rosacea: - PDF Document

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  1. 9/11/11 Rosacea Rosacea: how I hates ya! Richard Castillo, OD, DO The Oklahoma College of Optometry Northeastern State University Tahlequah, OK —  Clinical Features —  Flushing —  Telangiectasia —  Erythema —  Papules & Pustules —  Rhinophyma —  Coarseness of skin Introduction —  Ocular – blepharitis, conjunctivitis, and keratitis —  20% of Rosacea patients may exhibit only ocular manifestations History —  14th century - Dr. Guy de Chauliac —  Goutterose – French for rosacea —  Early literature —  Chaucer’s Canterbury Tales —  Shakespeare’s Henry V —  Ghirlandaio’s – “An Old Man and His Grandson” – 15 century – Louvre —  Leeches 1

  2. 9/11/11 “An Old Man and His Grandson” Pathophysiology? Epidemiology? —  Flushing triggers —  ETOH, hot beverages, tobacco, spicy foods, vasodilating meds, stress Mainly affects Caucasians —  May affect up to 10% of US population —  50% of these have ocular involvement —  —  UV light? Female to Male ratio ~ 2:1 —  —  Migraines? 50% have + FmHx —  —  Demodex Mites? Severity is greater in men —  —  Helicobacter pylori? Ocular manifestations are about equal between men and women —  —  Any condition that triggers vasodilation? Rosacea can be very disfiguring and lead to blindness —  —  Conclusion: —  We just don’ ’t know! Types of Rosacea 1.  Erythematotelangiectactic 1.  Facial Redness 2.  Papulopustular 2.  Papules & Pustules 3.  Phymatous 3.  Facial Skin Growth/ Thickening, Rhinophyma 4.  Ocular 4.  Eye Symptoms 5.  Neuropathic 5.  Facial Burning/ Stinging Sensations 2

  3. 9/11/11 Erythematotelangiectactic Subtype —  Central facial redness —  May mimic lupus —  Skin starts out smooth then becomes scale- like. —  Evolves into a chronic low-grade dermatitis Papulopustular Subtype —  Concomitant signs & symptoms of flushing —  Erythematous papules —  Pinpoint pustules —  Resembles acne vulgaris but in an older patient Phymatous Subtype • Skin becomes thickening with an irregular surface • Fibrous nodules • Rhinophyma 3

  4. 9/11/11 Ocular Rosacea Symptoms Signs —  Stinging —  Blepharitis —  Rosettes —  Meibomitis —  Burning —  Dryness —  Conjunctivitis —  Conj. Hyperemia —  Conj. Telangiectasias —  Light Sensitivity —  Foreign Body Sensation —  Keratitis —  Blurred Vision Ocular Rosacea Ocular signs and symptoms may be the only manifestation in up to 20% of rosacea patients Ocular Rosacea 4

  5. 9/11/11 “Neuropathic” Subtype —  Not an “official” subtype (yet) but presents with: —  Burning and pain following exposure to triggers —  Damaged nociceptors (pain) —  Can become somewhat permanent —  Resembles Diabetic neuropathy Differential Diagnosis (Facial) —  Seborrheic Dermatitis —  Clinical Diagnosis —  Systemic Lupus Erythematosus —  Biopsy can rule out other diseases —  Carcinoid Syndrome —  Histological findings vary depending on stage and severity —  Perioral Dermatitis —  Cutaneous Sarcoidosis —  Other Photodermatoses 5

  6. 9/11/11 Differential Diagnosis (Ocular) —  Allergic Conjunctivitis —  Adult Blepharitis —  Bacterial Conjunctivitis —  Central Sterile Corneal Ulcer —  Viral Conjunctivitis —  Atopic Dermatitis —  Recurrent Corneal Erosion —  Cicatricial Pemphigoid —  Chalazion —  Bacterial Keratitis —  Episcleritis —  Keratoconjunctivitis Sicca —  Dry Eye Syndrome —  Chlamydia —  Atopic Keratoconjunctivitis Facial Therapy —  Avoid triggers —  Avoid products that irritate skin —  Non-ablative laser – 3 x over 4 months —  Intense pulsed-light therapy —  Electrosurgery/Radiosurgery —  Dermabrasion/Laser Skin Resurfacing Skin Products Too many to count… 6

  7. 9/11/11 Vascular Lasers —  Pulsed dye laser —  Diode laser —  Potassium-titanyl- phosphate laser —  Long-pulsed Alexandrite laser —  Diode-pumped frequency-doubled laser —  Long-pulsed Nd:YAG laser —  755-1064nm —  Oxyhemoglobin —  532-595nm Erythema Reduction Telangiectasia Removal 7

  8. 9/11/11 CP5 Face Lift Laser Pharmaceuticals —  OTC Acne Preps- benzoyl peroxide, azelaic acid, sodium sulfacetamide —  Antibiotics – azithromycin (Azasite), metronidazole, erythromycin, fusidic acid, clindamycin, tetracycline, minocycline, doxycycline (Oracea), clarithromycin (H. pylori) —  Retinoids - tretinoin and isotretinoin (Accutane) —  Immunosuppressants - tacrolimus Ocular Therapy —  Lid Hygiene —  Hot compresses??? —  Artificial tears —  Antibiotics —  Retinoids —  Amniotic Membrane Graft —  Keratoplasty 8

  9. 9/11/11 Conclusion Rosacea can not be cured, but it can be controlled —  Common skin disorder —  Pathophysiology is unknown —  Clinical Diagnosis —  Palliative treatment 9