Lecture 8 Part 2

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a common initial symptom of rosacea?

Permanent redness

Development of rhinophyma

Thickening of skin

Intermittent flushing (correct)

Which treatment is primarily used for papules and pustules in rosacea?

Topical antibiotics (correct)

Pulsed dye laser

Oral steroids

Surgical removal

What happens to the skin in the later stages of rosacea?

It remains unchanged

It thickens and may develop rhinophyma (correct)

It becomes less sensitive

It starts peeling

What role do the prescribed antibiotics play in treating rosacea?

They reduce inflammation without killing microbes Signup and view all the answers

What is the most effective treatment for individuals mainly troubled by flushing due to rosacea?

Avoiding known triggers Signup and view all the answers

Which demographic is more commonly affected by rosacea?

Lightly pigmented individuals, especially of Irish or Scottish descent Signup and view all the answers

How does the pulsed dye laser treatment work for rosacea?

It targets hemoglobin to destroy superficial blood vessels Signup and view all the answers

Which symptom is common to the second phase of rosacea?

Red papules and pustules Signup and view all the answers

What is the first step in treating Raynaud’s phenomenon?

Determining if it is primary or secondary Signup and view all the answers

Which phases are classically described in Raynaud’s phenomenon?

White, blue, red Signup and view all the answers

What is the most common underlying disease associated with secondary Raynaud’s?

Connective tissue diseases Signup and view all the answers

Which of the following treatments is often recommended for Raynaud's phenomenon?

Calcium channel blockers Signup and view all the answers

What typical symptoms may accompany Raynaud’s phenomenon?

Burning or aching sensation Signup and view all the answers

In addition to checking for symptoms, what lab test is helpful in the evaluation of a patient with Raynaud’s?

Antinuclear antibody (ANA) Signup and view all the answers

What is a common demographic feature of Pemphigus Vulgaris?

Associated with Jewish or Mediterranean descent Signup and view all the answers

Which of the following describes the potential severity of Raynaud’s phenomenon?

It may lead to gangrene or ulceration Signup and view all the answers

Which desmoglein proteins are primarily affected in Pemphigus Vulgaris?

Desmoglein 1 and 3 Signup and view all the answers

What is the primary reason for the fragility of blisters in Pemphigus disorders?

They are intraepidermal blisters. Signup and view all the answers

Which medication is considered most effective for treating Pemphigus?

Prednisone Signup and view all the answers

Pemphigus Foliaceous primarily affects which of the following?

Cutaneous surfaces only Signup and view all the answers

Which immune response mechanism is involved in Pemphigus disorders?

Production of IgG Signup and view all the answers

What is a potential benefit of using azathioprine over prednisone in the treatment of Pemphigus?

It has a better long-term safety profile. Signup and view all the answers

In which demographic is Pemphigus Foliaceous more likely to be found?

Elderly patients Signup and view all the answers

What causes the erosion observed in severe cases of Pemphigus?

Rupture of fragile blisters Signup and view all the answers

What is the primary goal of intravenous immunoglobulin and plasmapheresis in resistant lupus cases?

To remove pathogenic antibodies Signup and view all the answers

Which type of cutaneous lupus is almost exclusively seen in patients with systemic lupus erythematosus?

Acute cutaneous lupus erythematosus Signup and view all the answers

How does subacute cutaneous lupus erythematosus (SCLE) typically present?

Erythematous, scaly, photo-distributed rash sparing the face Signup and view all the answers

What percentage of patients with chronic cutaneous lupus erythematosus (CCLE) typically have systemic lupus?

5 – 20% Signup and view all the answers

What is thought to cause the photo-related nature of cutaneous lupus lesions?

Release of intracellular antigens due to sunlight damage Signup and view all the answers

Which immune responses are involved in lupus as an autoimmune disease?

Both humoral and cell-mediated responses Signup and view all the answers

Which treatment is commonly associated with improvement of cutaneous lupus in patients with systemic lupus?

Systemic steroids, anti-malarial drugs, and immunosuppressants Signup and view all the answers

What is a defining characteristic of chronic cutaneous lupus erythematosus (CCLE) lesions?

1-3 cm lesions with epidermal atrophy and dyspigmentation Signup and view all the answers

What is the most common initial approach to treating erythema nodosum (EN)?

Non-steroidal anti-inflammatory medications Signup and view all the answers

What is the primary treatment for mild cutaneous lupus?

High potency topical steroids Signup and view all the answers

What underlying condition is NOT typically associated with erythema nodosum?

Chronic asthma Signup and view all the answers

Which of the following is theorized to be a potential cause of erythema nodosum?

Hypersensitivity response to circulating antigens Signup and view all the answers

Which factor is most effective for preventing flares in patients with systemic lupus?

Effective sun protection Signup and view all the answers

What is the typical duration of nodules associated with erythema nodosum?

Several weeks Signup and view all the answers

Polymorphous Light Eruption (PMLE) is most common in which demographic?

Women Signup and view all the answers

Where does PMLE typically present on the body?

Upper chest and arms Signup and view all the answers

Which treatment is considered if initial management of erythema nodosum is ineffective?

Systemic corticosteroids Signup and view all the answers

What is a common characteristic of the onset of PMLE?

Resolution as summer approaches Signup and view all the answers

What is one theory regarding the pathogenesis of PMLE?

An abnormal response to ultraviolet light Signup and view all the answers

Which treatment has been found to be effective for PMLE?

Low intensity UV exposure Signup and view all the answers

What demographic is more likely to experience Porphyria Cutanea Tarda (PCT)?

Men in their 40s Signup and view all the answers

Study Notes

Rosacea

Very common in individuals with light skin, especially those of Irish or Scottish descent
Often begins with intermittent flushing triggered by hot drinks, alcohol, caffeine, spicy food, wind, or sunlight, leading to facial warmth and redness.
Redness can become permanent, and facial telangiectasias may develop.
Next phase includes red papules and pustules, mainly on cheeks, nose, and forehead.
Third phase involves thickening of the nose (rhinophyma) often after years of other symptoms
Poorly understood, likely a component of facial cutaneous vasculature hyperresponsiveness.
One theory suggests excess vasodilation causing skin edema and inflammation
Primarily treated with topical antibiotics (e.g., metronidazole, clindamycin) to treat papules and pustules, though not general redness or rhinophyma, due to their supposed anti-inflammatory effects rather than microbial killing.
Oral antibiotics (e.g., doxycycline) for severe cases, also work as anti-inflammatory agents
Flushing triggers should be avoided
For erythema and telangiectasias, pulsed dye laser treatment is often most effective due to its focus on hemoglobin and blood vessel destruction.
Rhinophyma surgically treated for excess tissue.

Livedo Reticularis (LR)

A bluish/violet, net-like pattern on the skin, usually on the legs.
Usually no palpable component or symptoms.
Mostly caused by skin exposure to cold temperature; resolves with warming
Can be persistent and unrelated to cold exposure, presenting with skin "aching" if unrelated to cold, which warrants a review of systems.
Represents increased deoxygenated blood in cutaneous venules, visible through skin.
Any process increasing blood or reducing oxygen in venules can cause it:
- Cold-related: arterial vasoconstriction and slower blood flow causing more deoxygenation.
- Persistent: Increased viscosity (e.g., lupus anticoagulant, cryoglobulinemia) or vasodilation causes (e.g., neurologic or endocrine disorders).
Usually does not require treatment unless persistent; assess for underlying causes if not resolving.
Associated with lupus anticoagulant in women.

Raynaud's Phenomenon

Relatively common in young women.
Vasospastic disorder affecting the hands.
Triggers (e.g., cold exposures):
- Skin color change (white, then blue, then red)
- Numbness or tingling
- Swelling and burning/aching.
Severe cases may cause gangrene or ulcers.
Possible causes:
- Sympathetic nervous system control of digital vessels issues
- Blood hyperviscosity
- Abnormalities or blockages in digital vessels, or local overproduction of vasoconstrictors/underproduction of vasodilators
Primary Raynaud's (80-90%) has no underlying medical issues, while secondary Raynaud's is associated with an underlying disease.
Diagnosis requires a review of systems and general examination. Checking for ANA and ESR in patients with Raynaud's could be useful; abnormalities of capillaries on the proximal nail folds might indicate systemic sclerosis as possible underlying disease
Treatments:
- Maintain warm extremities
- Calcium channel blockers (e.g., nifedipine or diltiazem)

Pemphigus Vulgaris (PV) and Pemphigus Foliaceous (PF)

Rare, autoimmune blistering diseases usually impacting 30s, 40s, or 50s
More common in Jewish or Mediterranean people
Often involves oral and cutaneous erosions/blisters (potentially severe, life-threatening)
Differentiated based on affected desmoglein:
- PV involves desmoglein 1 and 3, leading to oral and cutaneous involvement
- PF involves only desmoglein 1 and hence primarily cutaneous involvement
Treatment includes immunosuppressants (e.g. prednisone) and sometimes intravenous immunoglobulin or plasmapheresis in resistant cases.

Cutaneous Lupus

Systemic autoimmune disorder, more common in women.
Presents in three forms:
- Acute Cutaneous Lupus Erythematosus (ACLE): Malar rash (cheeks and nasal bridge), erythema and edema.
- Subacute Cutaneous Lupus Erythematosus (SCLE): Wide spread, erythematous, scaly, photo-distributed rash which avoids the face
- Chronic Cutaneous Lupus Erythematosus (CCLE) or discoid lupus: 1-3 cm lesions (atropy, dilated pores), scaling, and pigmentary changes (hypo- or hyper-pigmentation). Primarily affects the conchal bowl of the ear
Photo-related, and related to sun exposure damages to cells.
Treatment emphasizes sun protection and sometimes systemic steroids, antimalarials (e.g. hydroxychloroquine and quinacrine) if severe, or other immunosuppressants

Polymorphous Light Eruption (PMLE)

Often affects upper chest, arms, upper back (temporarily).
Symptoms often appear in spring.
Papules/plaques, erythematous and edematous, without scales.
Mild, self-resolving, & rarely seeking medical attention
Treatment generally combines sun protection and antimalarial medications, potentially low-intensity UV exposures to reduce symptoms

Porphyria Cutanea Tarda (PCT)

Uncommon. More often found in men in their 40s, typically.
Skin lesions (e.g. fragility, blisters, scarring, milia) affecting sun-exposed skin
Deficiency in uroporphyrinogen decarboxylase (UROD) enzyme causes build-up of uroporphyrins that cause damage. This damage also is related to sun exposure.
Often associated with liver disease (hemochromatosis, alcoholism, hepatitis C).
Treated with phlebotomy (blood removal) and, if necessary, other immunosuppresants

Erythema Nodosum (EN)

Inflammation in subcutaneous fat, producing painful red nodules on shins.
Common in 20s, 30s, or 40s.
Often associated with systemic disorders like sarcoidosis, infections, and medications.
Treatment typically includes non-steroidal anti-inflammatory drugs (NSAIDs), elevation, rest. Systemic steroids may be used if symptoms persist.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the characteristics, phases, and treatment options for rosacea, a common skin condition particularly affecting those with light skin. Learn about the triggers, symptoms, and different approaches to manage this condition effectively. Assess your knowledge on this often misunderstood dermatological issue.