Chapter 053. Eczema and Dermatitis (Part 14) ppsx

Chapter 053. Eczema and Dermatitis (Part 14) Acne Rosacea Acne rosacea, commonly referred to as rosacea, is an inflammatory disorder predominantly affecting the central face. Those most often affected are Caucasians of northern European background, but it is seen in patients with dark skin also. It is seen almost exclusively in adults, only rarely affecting patients <30 years. Rosacea is more common in women, but those most severely affected are men. It is characterized by the presence of erythema, telangiectases, and superficial pustules (Fig. 53-8), but is not associated with the presence of comedones. Rosacea only rarely involves the chest or back. Figure 53-8 Acne rosacea. Prominent facial erythema, telangiectasia, scattered papules, and small pustules are seen in this patient with acne rosacea. (Courtesy of Robert Swerlick, MD; with permission.) There is a relationship between the tendency for facial flushing and the subsequent development of acne rosacea. Often, individuals with rosacea initially demonstrate a pronounced flushing reaction. This may be in response to heat, emotional stimuli, alcohol, hot drinks, or spicy foods. As the disease progresses, the flush persists longer and longer and may eventually become permanent. Papules, pustules, and telangiectases can become superimposed on the persistent flush. Rosacea of very long standing may lead to connective tissue overgrowth, particularly of the nose (rhinophyma). Rosacea may also be complicated by various inflammatory disorders of the eye, including keratitis, blepharitis, iritis, and recurrent chalazion. These ocular problems are potentially sight-threatening and warrant ophthalmologic evaluation. Acne Rosacea: Treatment Acne rosacea can be treated topically or systemically. Mild disease often responds to topical metronidazole or sodium sulfacetamide. More severe disease requires oral tetracyclines: tetracycline 250–500 mg bid, doxycycline 100 mg bid, or minocycline 50–100 mg bid. Residual telangiectasia may respond to laser therapy. Topical glucocorticoids, especially potent agents, should be avoided since chronic use of these preparations may elicit rosacea. Topical therapy of the skin is not effective treatment for ocular disease. Skin Diseases and Smallpox Vaccination Given the potential threat of a bioterrorism attack with smallpox, vaccinations against smallpox are available to the general public, although they are not recommended. Because of a higher incidence of adverse events associated with smallpox vaccination in patients with a history of certain skin diseases, including atopic dermatitis, eczema, and psoriasis, such vaccination is contraindicated in patients with these conditions in the absence of a bioterrorism attack and a real or potential exposure to smallpox. In the case of such exposure, the risk of smallpox infection outweighs the risk of adverse events from the vaccine (Chap. 214). Further Readings James WD et al: Andrews' Diseases of the Skin Clinical Dermatology, 10th ed. Philadelphia, Saunders-Elsevier, 2006 Wolff K, Johnson RA: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 5th ed. New York, McGraw-Hill, 2005 Wolff K et al (eds): Fitzpatrick's Dermatology in General Medicine, 7th ed. New York, McGraw-Hill, 2008 Wolverton SE (ed): Comprehensive Dermatologic Drug Therapy . Philadelphia, Saunders, 2001 Bibliography Ellis MW, Lewis II JS: Treatment approaches for community- acquired methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis 18:496,2005 [PMID: 16258322] Kowalski TJ: Epidemiology, treatment, and prevention of community- acquired methicillin-resistant Staphylococcus aureus infections. Mayo Clin Proc 80:1201,2005 [PMID: 16178500] Krueger J G: The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 46:1, 2002 [PMID: 11756941] Nghiem P et al: Tacrolimus and pimecrolimus: From clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis . J Am Acad Dermatol 46:228, 2002 [PMID: 11807435] Peto R, zur Hausen H: Viral Etiology of Cervical Cancer . Banbury Report. Cold Spring Harbor, NY, Cold Spring Harbor Laboratory, 1986 . Chapter 053. Eczema and Dermatitis (Part 14) Acne Rosacea Acne rosacea, commonly referred to as rosacea, is an. persists longer and longer and may eventually become permanent. Papules, pustules, and telangiectases can become superimposed on the persistent flush. Rosacea of very long standing may lead. diseases, including atopic dermatitis, eczema, and psoriasis, such vaccination is contraindicated in patients with these conditions in the absence of a bioterrorism attack and a real or potential