Rosacea Treatment Options

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Questions and Answers

What is the primary location of melasma lesions?

Arms and legs

Forehead, zygomatic cheeks, and upper cutaneous lip (correct)

Mandibular region, nose, and forehead

Central facial area only

What is the goal of the first step in the treatment strategy for melasma?

To manage psychological stress

To prevent the formation of new pigment

To remove the underlying cause (correct)

To bleach the pigmentation

What is a possible alternative to hydroquinone for skin bleaching in melasma treatment?

Tretinoin 0.025%

Adapalene 0.1% (correct)

Azelaic acid 15%

All of the above

What is a possible complication of melasma treatment with hydroquinone?

Irritation Signup and view all the answers

What is a contributing factor to the development of melasma?

All of the above Signup and view all the answers

What is a characteristic of melasma lesions?

Homogeneous hyperpigmentation Signup and view all the answers

What is the prevalence of perioral dermatitis in females in OPD dermatology?

6% Signup and view all the answers

Which of the following is a clinical feature of perioral dermatitis?

Follicular points Signup and view all the answers

What is the age range for perioral dermatitis in children?

7 months-13 years Signup and view all the answers

Which of the following is a possible irritant in perioral dermatitis?

Facial cleansers Signup and view all the answers

What is the primary step in the treatment of perioral dermatitis?

Stop any offending agents Signup and view all the answers

Which of the following is a differential diagnosis of perioral dermatitis?

Acne vulgaris Signup and view all the answers

What is the percentage of azelaic acid in topical treatment for papulopustular rosacea?

15% Signup and view all the answers

What is the pathogenesis of perioral dermatitis?

Intolerance reaction to repetitive irritation Signup and view all the answers

What is the possible treatment for amelanotic lesions with complete loss of melanocytes?

Epidermal or melanocyte grafting Signup and view all the answers

What is the definition of alopecia?

Loss of hair attributable to inflammatory cells or physiological/mechanical factors Signup and view all the answers

What is the goal of evaluating hair loss?

To identify the correct underlying process causing alopecia Signup and view all the answers

What is androgenic alopecia also known as?

Male pattern and female pattern hair loss Signup and view all the answers

What is a characteristic feature of androgenic alopecia?

Miniaturization of hairs in a symmetric pattern Signup and view all the answers

What is a possible treatment for androgenic alopecia?

Antiandrogen medications Signup and view all the answers

What is a comorbidity associated with androgenic alopecia?

Hyperandrogenism Signup and view all the answers

What is the site most often affected by alopecia?

Scalp Signup and view all the answers

What is the primary definition of melasma?

Chronically symmetric acquired localized melanogenesis Signup and view all the answers

Which of the following is a contributing factor to melasma?

Dark skin phototype Signup and view all the answers

What is the effect of UV radiation on melanocytes?

Induces melanocyte proliferation and migration Signup and view all the answers

What is the role of estrogen and progesterone in melasma?

Stimulates melanocyte stimulation Signup and view all the answers

What is the primary treatment for melasma?

Oral doxycycline Signup and view all the answers

What is the effect of alpha-MSH and adrenocorticotropic hormone on melanocytes?

Upregulates melanocyte proliferation and melanogenesis Signup and view all the answers

What is the role of stem cell factor and tyrosine kinase receptor c-kit in melasma?

Overexpresses melanocyte proliferation Signup and view all the answers

What is the prevalence of melasma in women compared to men?

7-9 times more common Signup and view all the answers

What is the characteristic feature of hair loss in alopecia areata?

Coin-shaped patches of non-inflammatory hair loss Signup and view all the answers

What is the typical time frame for spontaneous recovery from telogen effluvium?

6 months Signup and view all the answers

What is a possible associated medical condition with alopecia areata?

Autoimmune thyroid disease Signup and view all the answers

What is the treatment for isolated lesions of alopecia areata?

Intralesional triamcinolone Signup and view all the answers

What is the characteristic feature of trichotillomania?

Asymmetric, jagged, or scattered areas of hair loss Signup and view all the answers

What triggers telogen effluvium?

All of the above Signup and view all the answers

What is a characteristic histopathological feature of alopecia areata?

Collections of lymphocytes at terminal hair follicles Signup and view all the answers

What is the treatment approach for trichotillomania?

Discontinue hair pulling and counseling Signup and view all the answers

Study Notes

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.

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Description

This quiz covers the different treatment options for rosacea, including topical and systemic medications, as well as laser therapy. It's ideal for medical students or professionals looking to test their knowledge on rosacea therapy.