Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Andrei Metelitsa, MD, FRCPC, FAAD
Co-Director, Institute for Skin Advancement
Clinical Associate Professor, Dermatology
University of Calgary, Canada
Copyright © 2017 by Sea Courses Inc.
All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any
form or by any means – graphic, electronic, or mechanical, including photocopying, recording, or information storage and retrieval systems without prior written permission of Sea Courses Inc. except
where permitted by law.
Sea Courses is not responsible for any speaker or participant’s statements, materials, acts or
omissions.
Learning Objectives
Recognize subtypes of rosacea
Understand basic pathogenesis of
rosacea
Discuss new treatment modalities
▪ Medical therapy
▪ Topical and systemic agents
▪ Laser therapy
▪ Vascular lasers
Rosacea Epidemiology
Common inflammatory condition that affects 2-10% people
Characterized by facial redness, telangiectasias, flushing and inflammatory papules and pustules
Age of onset usually 30-50 years old
2-3 times more prevalent in females
More common in fair skinned people
Rosacea Subtypes
Vascular erythematotelangiectatic rosacea (ETR)
Inflammatory papulopustular rosacea (PPR)
Phymatous rosacea
Ocular rosacea
Management strategies
Patient education and reassurance▪ Avoidance of triggers▪ Gentle skin care ▪ Broad spectrum sun protection
Topical agents▪ Mild to moderate disease▪ Considered safe for long-term use
Oral (systemic) agents▪ Anti-inflammatory dose doxycycline approved for initial and
ongoing therapy▪ Antibiotics and isotretinoin used with caution due to potential
risks Laser and phototherapy Surgical intervention
Baldwin HE. J Drugs Dermatol. 2006;5(1):16-21. Bikowski JB, Goldman MP. J Drugs Dermatol. 2004;3(3):251-261. 6
Selected topical therapies for rosacea
Therapeutic options include:*▪ Azelaic acid 15% (Finacea gel)
▪ Metronidazole 1% and 0.75% (gel, lotion and cream)
▪ Ivermectin 1% cream (Rosiver cream in Canada/ Soolantra in US)
▪ Sodium sulfacetamide/sulfur (lotion and cream; formulations with sun protection)
▪ Brimonidine gel 0.33% (Onreltea in Canada /Mirvaso in US)
Can be used for both induction and maintenance therapy Potential side effects/complications include:
▪ Cutaneous irritation
▪ Antibiotic resistance
7
Selected systemic therapies for rosacea
Baldwin HE. J Drugs Dermatol 2012;11(6):725-730. Goldgar C et al. Am Fam Physician 2009;80(5):461-468, 505.
Comments
Health Canada approved; once daily; potential to reduce
antibiotic resistance; may lessen common SEs of class
Once or twice daily
Alternative for pregnant or breast-feeding woman; many drug
interactions
Once or twice daily; skin pigmentation; CNS effects
Twice daily
Anti-inflammatory
dose doxycycline 40
mg
Doxycycline 100 mg
Erythromycin 500 mg
Minocycline 50/100
mg
Tetracycline 250/500
mg
Papulopustular Rosacea: Canadian Clinical Guidelines 2016
Maintenance: Topical ivermectin or metronidazole or azelaic acid
ETR Rosacea: Canadian Clinical Guidelines 2016
Maintenance: Topical brimonidine or metronidazole and/or Laser/IPL
Phymatous Rosacea: Canadian Clinical Guidelines 2016
Rosacea PEARLs
▪ Chronic inflammatory skin condition of the central face often characterized by flushing, erythema, papules/pustules and telangiectasias
▪ Inflammatory process – neutrophils, lymphocytes and cathelicidins play a key role in the underlying inflammatory nature of rosacea
▪ Anti-inflammatory dose doxycycline effective and safe treatment
▪ New topicals for inflammatory lesions (ivermectin) and diffuse erythema (brimonidine)