Acne rosacea

Isotretinoin COOH Topical 0.05% cream Oral 0.251.0 mg/kg/ d Cystic acne, recalcitrant nodular acne Rosacea gram-negative folliculitis pyoderma faciale hidradenitis suppurativa cancer prevention... 

Given these findings, indications for salicylic acid peels include acne vulgaris (inflammatory and non-inflammatory lesions), acne rosacea, melasma, post-inflammatory hyperpigmentation, freckles, lentigines, mild to moderate photodamage, and texturally rough skin. 

Fig. 6.6a,b. Acne rosacea before and after three salicylic acid peels, moderate improvement... 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

Metronidazole also is indicated for amebiasis and trichomoniasis, intravaginally for bacterial vaginosis, and topically for acne rosacea. 

Inflammatory conditions Treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, lid, sclera, cornea, and anterior segment of the globe, such as Allergic conjunctivitis acne rosacea superficial punctate keratitis herpes zoster keratitis iritis cyclitis and selected infective conjunctivitis (when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation [prednisolone]) vernal conjunctivitis episcleritis epinephrine sensitivity and anterior uveitis. 

Interferes w/ DNA synth Dose Adults. Anaerobic Infxns 500 mg IV q6-8h Amebic dysentery 750 mg/d PO for 5-10 d Trichomoniasis 250 mg PO tid for 7 d or 2 g PO X 1 C. difficile 500 mg PO or IV qSh for 7-10 d (PO preferred IV only if pt NPO) Vaginosis 1 applicator-full intravag bid or 500 mg PO bid for 7 d Acne rosacea/skin Apply bid Peds. 30 mg/ kg PO/IV/d q6H, 4 g/d max-s-. Amebic dysentery 35-50 mg/kg/24 h PO in 3 -s- doses for 5-10 d Rx 7-10 d for C. difficile-, in hepatic impair Caution [B, M] Avoid EtOH Contra 1st tri of PRO Disp Tabs, caps, IV, topical lotion, intravag gel, cream SE Disulfiram-like Rxn dizziness, HA, GI upset, anorexia, urine discoloration Interactions t Effects W/ cimetidine T effects OF carbamazepine, fluorouracil, Li, warfarin -1- effects W/ barbiturates, cholestyramine, colestipol, phenytoin EMS t Effects of anticoagulants concurrent EtOH use can cause disulfiram-like Rxn (tach, N/V, sweating, flushing, headache, blurred vision, confusion) may cause a metallic taste and discolored urine OD May cause N/V/D, numbness in hands and feet, Szs, and loss of coordination symptomatic and supportive... 

Metronidazole is effective in the treatment of acne rosacea although for this indication its mechanism of action is not clearly understood. Long-term topical use for this indication is not recommended. This advice is founded on experiments in animals showing a carcinogenic effect by oral administration of metronidazole. There is inadequate evidence of the safety of metronidazole in human pregnancy. Metronidazole is classified in Lactation Risk Category L3 (moderately safe). 

Another topical antibiotic, metronidazole, is effective in the treatment of acne rosacea. Metronidazole is a synthetic nitroimidazole derivative that reduces inflammation by an unknown mechanism. Other selected topical antibiotics are listed in Table 41.2. 

Antibiotics are used in dermatology for both infectious and noninfectious skin eruptions. Noninfectious skin eruptions, such as acne vulgaris and acne rosacea, are often treated with systemic antibiotics. The mechanism of action is not clear, although tetracycline inhibits lipases derived from resident flora in the sebaceous follicle Staphylococcus epidermidis, Propionibacterium ac-nes). These lipases cleave irritating fatty acids from triglycerides in sebum, presumably contributing to cutaneous inflammation. 

Unlabeled Uses Treatment of bacterial vaginosis, grade 111-lV decubitus ulcers with anaerobic infection, Flelicobacler pytori-associated gastritis and duodenal ulcer, inflammatory bowel disease topical treatment of acne rosacea... 

Clindamycin is active against Propionibacterium acnes. Erythromycin alone and in combination with benzoyl peroxide is used in the treatment of acne vulgaris. Topical metronidazole is effective in the treatment of acne rosacea. 

Topical sulfacetamide is available alone as a 10% lotion (Klaron) and as a 10% wash (Ovace), and in several preparations in combination with sulfur for the treatment of acnevulgaris and acne rosacea. The mechanism of action is thought to be inhibition of P acnes by competitive inhibition of p-aminobenzoic acid utilization. Approximately 4% of topically applied sulfacetamide is absorbed percutaneously, and its use is therefore contraindicated in patients having a known hypersensitivity to sulfonamides. 

Azelaic acid is a straight-chain saturated dicarboxylic acid that is effective in the treatment of acnevulgaris (in the form of Azelex) and acne rosacea (Finacea). Its mechanism of action has not been fully determined, but preliminary studies demonstrate antimicrobial activity against P acnes as well as in vitro inhibitory effects on the conversion of testosterone to dihydrotestosterone. Initial therapy is begun with once-daily applications of the 20% cream or 15% gel to the affected areas for 1 week and twice-daily applications thereafter. Most patients experience mild irritation with redness and dryness of the skin during the first week of treatment. Clinical improvement is noted in 6-8 weeks of continuous therapy. 

Topical metronidazole is effective in the treatment of acne rosacea. The mechanism of action is unknown, but it may relate to the inhibitory effects of metronidazole on Demodex brevis or as an anti-inflammatory agent by direct effect on neutrophil cellular function. Oral metronidazole had been shown to be a carcinogen in susceptible rodent species, and topical use during pregnancy and by nursing mothers and children is therefore not recommended. (See Chapter 53 Antiprotozoal Drugs for a more detailed discussion.)... 

Oral tetracycline or doxycycline can be an effective therapy for noninfections conditions involving the eye such as acne rosacea and meibomianitis. When patients with acne rosacea or meibomianitis receive oral tetracycline, two changes occur amelioration of the symptoms and rednction of free fetty acids in the surfece sebum. Free fetty acids are released from sebum by bacterial lipases and are irritating as well as inflammatory. Tetracycline causes a significant decrease in lipase... 

Immune reaction after keratoplasty Herpes zoster keratitis Disciform keratitis Marginal corneal infiltrates Superficial punctate keratitis Chemical burns Acne rosacea keratitis Interstitial keratitis Uvea... 

Etiology. Acne rosacea, better described as rosacea, may be associated with acne but is not caused by it. Rosacea is a chronic, fecial, inflammatory skin disorder frequently related to infectious blepharitis. Rosacea affects the face, nose, chin, and forehead. It has been reported to occur in up to 10% of the population and roughly 14 million Americans. It affects mostly fair-skinned individuals with an onset of between 20 and 50 years. It is characterized by periods of exacerbation that may be mild to very severe. One of the many forms of rosacea is ocular rosacea. 

Dermatologic disease and its related ocular complications are commonly encoimtered entities in general ophthalmic practice. The conjimctiva frequently is affected with ocular involvement. Although numerous dermatologic conditions can affect the eye, this section focuses on the three conditions that are most often encountered acne rosacea, psoriasis, and atopic dermatitis. 

Rarely, a history of sensitization to an external agent can be identified. In these cases removal of the offending agent is the recommended treatment. Possible contributory or causal diseases, such as dry eye syndrome, acne rosacea, ocular allergic disease, or blepharitis, have been noted in up to 50% of episcleritis patients.These concurrent conditions should be treated if present. Full response to treatment in any patient who smokes can be delayed by a month or more. For this reason and because episcleritis... 

Comedonal acne and acne rosacea respond well to tretinoin. In fact, the anti-aging effect of tretinoin was first observed in patients being treated with tretinoin for comedonal acne their skin texture and skin tone were gradually seen to improve. 

Oral isotretinoin (9-a s-retinoic acid) is often used in treating severe or stubborn acne rosacea. A 1994 study compared the treatment of rosacea with 10 mg/day low-dose oral isotretinoin, 0.025% low-dose topical tretinoin and a combination of the two. The results showed that before the 16th week of treatment, isotretinoin was more effective, but that afterwards there was no difference between tretinoin and isotretinoin. The combination of systemic and topical treatment does not give any further improvement in low doses. 

Telangiectasias, seborrheic dermatitis, eczema, acne rosacea, lupus and other autoimmune disorders are among the forms of dermatitis that may be aggravated by a phenol peel. 

Oregon grape root (Mahonia aquafolium). This is one of the preeminent skin/acne remedies of the eclectic physicians. It is used for a wide array of skin problems, especially chronic ones involving liver congestion and a slight yellow hue to the skin. It can also be used topically as a wash for acne and acne rosacea. 

There are no laboratory tests to diagnose acne vulgaris. Diagnosis is based on clinical signs. Other dermatologic conditions, such as folliculitis, acne rosacea, and other various acneiform disorders, sometimes may be confused with acne vulgaris. ... 

For acne rosacea, add Flos Carthami Tinctorii (Hong Hua), raw Radix Rehmanniae (Sheng Di), and Radix Rubrus Paeoniae Lactiflorae (Chi Shao). 

In healthy individuals taking oral antibiotics for acne, laboratory monitoring is not necessary. Orally administered antibiotics also may be indicated in other noninfectious conditions, including acne rosacea, perioral dermatitis, hidradenitis suppurativa, autoimmune blistering diseases, sarcoidosis, and pyoderma gangrenosum. 

Isotretinoin is prescribed for severe, recalcitrant nodular acne, moderate acne unresponsive to oral antibiotics, and acne that produces scarring. It also is used commonly for other related disorders, such as Gram-negative folliculitis, acne rosacea, and hidradenitis suppurativa. 

Decubitus ulcers acne rosacea perioral dermatitis... 

---