00:02
With the rosacea, you have
a myriad of presentations.
00:06
You may have what’s known
as your rhinophyma.
00:10
And if you take a look
at the nose here,
and if you take a look at
it on closer examination,
you’ll notice that there
is absolutely no comedone.
00:18
And on top of that, there’s erythema
in the background of telangiectasia.
00:23
How is rosacea being triggered?
You’re looking for spices,
maybe alcohol or maybe stress.
00:29
So, every so often with
my medical students,
obviously, a lot of stress in
our particular profession.
00:36
No doubt.
00:38
And so therefore, many of these
students end up having rosacea,
and you can tell by
looking at the nose,
it becomes reddened, but
they’re not alcoholics.
00:47
So therefore, there has been a stereotype
where we find a bulbous nose or rhinophyma,
in which the patient
is embarrassed that
people may think that he
or she is an alcoholic.
00:59
Not always the case,
keep that in mind.
01:03
Demographics: When
do you find rosacea?
Adulthood.
01:07
More often of those of
Northern European descent,
and women are affected
much more so than men.
01:14
And if it is men, then as I
showed you a picture earlier,
it’s the rhinophyma that
you’re paying attention to.
01:21
You know what rhino- means,
rhinoplasty so on and so forth.
01:25
It’s the nose undergoing erythematous
telangiectasia type of changes.
01:31
Acne rosacea is the full name.
01:34
I have abbreviated it for you for
convenience sake as rosacea.
01:39
Keep in mind that this is going to
be a differential for acne vulgaris.
01:43
As we travel through our
course in dermatology,
you’re going to have this long
list of differentials in which
you will be able to clearly rule
things in or rule things out.
01:55
And man, let me tell you,
that is such a good feeling.
01:59
Etiology: poorly understood.
02:02
But we know that there is going to be
involvement of your blood vessels,
vasoactivity.
02:07
Flushing
or blushers
is what they’re called
“because of the erythema.”
And there is a particular mite
that you probably want to memorize.
02:18
In current day practice,
you still have possibly
the involvement of a
particular mite called demodex
having been implicated
in some research
and theory that you want
to keep in mind, please.
02:31
Acne rosacea.
02:33
Morphology:
Well, here, you find your
papules and pustules,
usually on the central
aspect of the face.
02:39
Also, keep it as a differential,
something like your SLE that we’ll talk
about soon enough with malar rash,
and this is not that.
02:47
It’s not a malar rash.
02:48
You must have telangiectasia, please.
02:51
You must have.
02:52
And they will give this to
you in a clinical vignette.
02:55
Telangiectasia,
which obviously means your little blood
vessels that are undergoing inflammation.
03:00
And with that type of
dilation that’s taking place,
there is every possibility that you’re
going to find these areas of erythema.
03:07
The triggers: sunlight/wind,
spicy food, hot temperatures,
and caffeine, and
perhaps, alcohol.
03:15
Look for the triggers, please,
in the history of your patient,
either on your wards
or on the boards.
03:23
Management:
Here, possibly metronidazole.
03:27
Mechanism of action
poorly understood.
03:30
Other topical agents, we have
something called azelaic acid.
03:35
Tetracycline derivatives, only those
with anti-inflammatory properties.
03:39
And cosmetic procedures,
maybe something like your
rhinophymectomy and laser treatment.
03:45
Why?
Because you’re trying to take
care of the telangiectasia.
03:47
Cosmetically speaking, I showed
you that nose to begin with.
03:51
And so therefore, cosmetically, you try
to treat this so that, or manage it
so that you’re able to restore
some of the self-esteem
in your patient psychologically.
04:00
Please make sure that
you’re familiar with the
steps of management of
rosacea and the triggers.
04:07
Differential diagnosis, quickly here.
04:10
By acne, we mean acne vulgaris.
04:12
Once again, you know about
your patient, andrenarche,
puberty age, comedones
are huge feature.
04:18
Next once again, here we have
another differential diagnosis,
perioral or periocular
dermatitis.
04:25
Occurs in specific
areas as noted here.
04:28
Monomorphic in its appearance.
04:29
And so you don’t
have these areas of,
I showed you a picture of rhinophyma
where you might have areas of erythema.
04:37
A little bit darker, maybe
a little bit lighter,
or even acne vulgaris.
04:40
But here, it’s monomorphic and
inflammatory papules without comedones.
04:47
Other differentials: well, I showed
you that picture of the nose.
04:50
And as I told you earlier, malar rash, it
could be confused with systemic lupus.
04:56
But with lupus,
it’s an abrupt onset with greater confluence
in these triggers that we talked about.
05:01
Rosacea are not so present
at all, actually.
05:05
And spares -- huge here --
nasolabial fold.
05:13
So with SLE.
05:14
and that malar rash, it
spares the nasolabial fold,
photodistribution.
05:20
That’s huge.
05:22
I’ll talk about this over and over
again so that it becomes part of your,
what’s known as, I like to call
it your reflexive consciousness.
05:29
Another differential:
well, in a baby, we call this
cradle cap, and you’ll see why.
05:36
This is seborrheic, and
I’m going to repeat this,
reinforce it, reinforce
it, reinforce it,
and I’m going to shove this
down your throat, I’m sorry.
05:43
I usually don’t like doing
that but I need to here.
05:45
There’s a condition that we’ll talk about
later called seborrheic keratosis.
05:50
That is not our topic here.
05:51
As a differential for rosacea,
we have seborrheic dermatitis.
05:56
Is that clear?
So, when the time is right, we’ll
walk through seborrheic dermatitis,
seborrheic keratosis, and you’ve heard of
another condition called actinic keratosis.
06:08
All of this is coming, I’m just
introducing one thing at a time.
06:12
We have seborrheic dermatitis
as being a differential.
06:15
So, how can you rule
it in or rule it out?
Often, intensely pruritic.
06:18
What does that mean?
Itch, itch, itch.
06:20
Greasy, yellow scale.
06:24
Prominent involvement of
the nasolabial folds,
the glabella and the hairline are areas
that you want to pay attention to,
seborrheic dermatitis.
06:32
And we will expand upon this further and
I’ll show you pictures, not to worry.