Rosacea Treatment Options

Rosacea Therapy

• Topical brimonidine tartrate (0.33% gel) is used to treat rosacea.
• Topical oxymetazoline HCl (1% cream) is also used to treat rosacea.
• Laser therapy is an option for rosacea treatment.
• Papulopustular rosacea is treated with topical metronidazole (0.75% gel or cream), ivermectin (1% cream), azelaic acid (15% gel), erythromycin (2% solution), clindamycin (1% lotion), and benzoyl peroxide 5% plus clindamycin 1%.
• Systemic doxycycline 40 mg and tetracycline 250 mg are also used to treat papulopustular rosacea.

Perioral Dermatitis

• Perioral dermatitis is an inflammation of the perioral, periorbital, and perinasal skin.
• It is characterized by erythematous papules, vesicles, pustules on an erythematous base, sometimes with scale.
• The condition is triggered by the use of potent corticosteroids.
• It affects 6% of females and 0.3% of males in the outpatient dermatology department.
• Age range is 16-45 years, with children affected from 7 months to 13 years.

Pathogenesis of Perioral Dermatitis

• The condition is caused by an intolerance reaction of the facial skin to repetitive irritation due to suppression of the epidermal barrier.
• Topical corticosteroids or steroid inhalers can exacerbate the condition.
• Majority of patients possess atopic diathesis.
• Facial cleansers, facial skin care cream, and other irritants can trigger the condition.

Clinical Findings of Perioral Dermatitis

• The mouth region is affected, with sparing of a small perilabial zone, nasolabial fold, and cheeks.
• Lower eyelid involvement is also common.
• Erythema with sharp borders, small papulovesicles, follicular points, and conic papules are present.
• Symptoms include moderate burning, pain, and sometimes pruritus.

Differential Diagnosis of Perioral Dermatitis

• Acne vulgaris, allergic contact dermatitis, seborrheic dermatitis, and rosacea must be considered in the differential diagnosis.

Treatment of Perioral Dermatitis

• Stop any offending agents.
• Oral doxycycline 100 mg 2dd for 4 weeks, with tapering off for 4-6 weeks, is an effective treatment.
• Alternative treatments include tetracycline and minocycline.
• Topical metronidazole cream 1% or gel 0.75%, erythromicin cream 2%, and anti-inflammatory pimecrolimus and tacrolimus can also be used.

Melasma

• Melasma is a chronic, symmetric, acquired, localized melanosis disorder affecting the face, especially in women of reproductive age (30-35 years).
• It is more common in dark skin (Fitzpatrick type III-V) and in sun-exposed regions.
• The pathogenesis is poorly understood, but contributing factors include darker skin phototype, UV irradiation, hormonal factors, genetic predisposition, cosmetics use, thyroid dysfunction, and antiepileptic medication.

Pathogenesis of Melasma

• UV radiation induces melanocyte proliferation and migration, increasing melanin production.
• The role of visible light and UVA 1 in Fitzpatrick type IV-VI is significant.
• Dermal factors, including overexpression of stem cell factor and tyrosine kinase receptor c-kit, increased expression of vascular endothelial growth factor (VEGF), and elevated levels of estrogen, progesterone, and MSH, contribute to melanocyte stimulation.
• Estrogen and progesterone receptors have been demonstrated in human melanocytes in vitro.

Clinical Picture of Melasma

• Homogeneously hyperpigmented macules and geographic or irregular patches typically located on the forehead, zygomatic cheeks, upper cutaneous lip, and nose.
• Central facial involvement is most common, but mandibular involvement may also occur.

Treatment of Melasma

• Remove the underlying cause.
• Bleach the pigmentation using hydroquinone, adapalene 0.1%, or tretinoin 0.025%, or azelaic acid 20%.
• Prevent the formation of new pigment by blocking sun exposure.

Alopecia and Hair Loss

• Alopecia, or hair loss, has a broad spectrum of causes, including inflammatory cells, physiological or mechanical factors, and genetic predisposition.
• The scalp is the site most often affected, but any region of the skin that bears hair follicles may be involved.
• Types of alopecia include androgenetic, alopecia areata, telogen effluvium, and trichotillomania.

Androgenetic Alopecia

• Also known as male pattern and female pattern hair loss.
• Genetically determined sensitivity of scalp hair follicles to adult levels of androgens.
• Miniaturization of hairs in a symmetric "pattern" on the crown, vertex, and frontal regions.
• Antiandrogen medications can be used for successful treatment.