Rosacea: The Daily PANCE Blueprint
A 72-year-old man presents to your office complaining of an area of redness associated with the perinasal region. He states that the rash is often worse in the summer, and he has noticed that sunlight exposure makes it worse. Appropriate treatment of this condition consists of
A. Hydrocortisone cream
B. Tretinoin gel
C. Metronidazole cream
D. Mupirocin ointment
E. Acyclovir ointment
Answer and topic summary
The answer is C: Metronidazole cream
Rosacea is a common problem.The condition is associated with areas of erythema and telangiectasia on the face. It is exacerbated by sunlight, hot or spicy foods, and alcohol. Pronounced rosacea may appear as acneiform papules, pustules, or ruddiness. Northern Europeans and those of Celtic descent are most commonly affected. Treatment involves oral tetracycline or doxycycline. Topical metronidazole is also effective for milder cases.
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Pearls
Rosacea – women aged 30-50, facial erythema, telangiectasias, papules, may cause rhinophyma
- Differentiate from acne by lack of comedones (blackheads)
- Triggers include heat, alcohol, and spicy foods
- Differentiate from facial seborrhea by the presence of telangiectases, and papules/pustules vs. seborrhea which has macules and an orange-red greasy scale
- Most common on the forehead, cheeks, and nose
- Associated with telangiectasia, flushing, papules, and pustules
Diagnosis
Diagnosis is based on the characteristic appearance and history and there are no specific diagnostic tests. The age of onset and absence of comedones help distinguish rosacea from acne.
- Differential diagnosis includes acne vulgaris, SLE, sarcoidosis, photodermatitis, drug eruptions (particularly caused by iodides and bromides), granulomas of the skin, and perioral dermatitis.
Treatment
Topical metronidazole, azelaic acid, and topical ivermectin are considered first-line therapies in mild to moderate disease
- Oral antibiotic therapy with tetracycline, doxycycline, and minocycline in those who fail topical therapy
- Oral isotretinoin in patients who fail to respond to topical and oral therapy
- Clonidine may be used for flushing
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology (5%) ⇒ ⇒
