Acne and Rosacea Charity Training Manual

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Type III Phytomatous rosacea. This generally occurs in long standing rosacea and is more common in men but can occur in women. The increased blood flow through the skin leads to hypertrophic growth of sebaceous glands and fibrous tissue leading to lumpy swelling of the skin. The commonest is rhinophyma, affecting the nose, which becomes lumpy and bulbous, often mistaken for the alcoholic nose. It may also occur on the cheeks, chin and forehead. The swelling is firm and persistent. Type 3 Rosacea Rhynophyma in a 60 year old man Type IV Ocular rosacea. This can occur with even very mild rosacea and affects up to 50% of rosacea sufferers. Initially the eyes become dry and gritty, followed by chemosis and red eyes. In severe cases this may lead to keratitis and is a recognized cause of blindness. Type 4 Rosacea Moderate ocular involvement with chemosis
Pathogenesis of Rosacea The pathogenesis of rosacea is unclear but a number of hypotheses have been proposed. 1. Rosacea is associated with Helicobacter pylori infections and may be associated with gastrointestinal symptoms. It has been shown that type II rosacea will improve when patients are treated for H pylori eradication, but this is most likely to be due to the anti-inflammatory effects of the antibiotics used in this condition and the rosacea relapses once the antibiotics are stopped 2. Rosacea is caused by the demodex mite, Demodex folliculorum. Demodex are a commensal in the skin. In some situations, the density of demodex increases, mainly due to the use of cream cleansers of the skin and avoidance of soap and water which would normally reduce the level of demodex. Studies have shown that systemic ivermectin, which clears the skin of demodex mites led to no improvement in rosacea. 3. Rosacea is caused by an abnormality of one of the skin’s antimicrobial peptides. The skin produces a series of naturally occurring antibiotics, the antimicrobial peptides. These are the cathelicidins and the human defensins. Only one cathelicidin is found in human skin LL37. Studies have shown in patients with rosacea that cathelicidin processing is disturbed resulting in peptide fragments causing inflammation, erythema and telangiectasias. More work need to be performed on this. 4. Rosacea is caused by an abnormal vascular response in the skin and can be associates with migraine. This is the most plausible proposal. Blood vessels in the skin form two plexuses parallel to the surface of the skin – the superficial and deep plexuses. Their primary function is to feed and oxygenate the skin but the maximal blood flow through the skin is very much higher that the metabolic needs of the skin. The second important function of the skin vasculature is to cool the body. This is orchestrated via the sympathetic nervous system via receptors in the brain, heart, large vessels and stomach, which stimulate receptors on the blood vessels – receptors cause vasoconstriction and receptors cause vasodilation. In rosacea, this system is abnormal leading to flushing. With time, the skin blood vessels become leaky with serous fluid escaping into the dermis, causing swelling and acting as a focus for inflammation and spot formation. The fourth proposal is the most likely and gives some direction as to the management of rosacea. The primary abnormality is the vascular instability, with flushing being the first and cardinal sign of rosacea. This needs to be addressed if rosacea is to be treated properly. Patient with rosacea have very sensitive skin and patients will often not tolerate a vast array of topical agents including moisturizers and cosmetics. It is important for patients to try different products to find what their skin will tolerate. Glossary • Peptide – a molecule composed of 2 or more amino acids – may result from the breakdown of protein
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A R A U K Acne and Rosacea Associat
Page 4 and 5:
Acne - Pathogenesis The pathogenesi
Page 6 and 7:
Follicular Hypercornification The o
Page 8 and 9:
Inflammation The inflammatory respo
Page 10 and 11: High humidity The comedone is forme
Page 12 and 13: Psychological impact of acne Acne i
Page 14 and 15: Module - 2 Acne - Clinical
Page 16 and 17: In some patients, comedones can be
Page 18 and 19: With deeper lesion developing the d
Page 20 and 21: Module - 3 Conventional Treatments
Page 22 and 23: Topical retinoids Retinoids work by
Page 24 and 25: Alternative agents for non-inflamma
Page 26 and 27: Inflammatory acne In mild to modera
Page 28 and 29: Erythromycin Erythromycin is availa
Page 30 and 31: Systemic Antibiotics Tetracyclines
Page 32 and 33: Hormonal therapy in women In women
Page 34 and 35: Oral Isotretinoin Oral isotretinoin
Page 36 and 37: Module - 4 Additional Treatments of
Page 38 and 39: Salicylic Acid Peel (Enerpeel SA) E
Page 40 and 41: Jessners Peel (Enerpeel JR) Jessner
Page 42 and 43: Light and Laser Treatment Sunlight
Page 44 and 45: Lasers 1450 nm Laser with Cooling S
Page 46 and 47: Scientific studies have shown that
Page 48 and 49: Advice for the Acne Sufferer A larg
Page 50 and 51: Module - 7 Acne Scarring
Page 52 and 53: Types of scarring Scarring in acne
Page 54 and 55: Needling Devices (dermal rollers an
Page 56 and 57: Fraxel Laser The Fraxel laser is ef
Page 58 and 59: Rosacea Rosacea is a relatively com
Page 62 and 63: Module - 9 Treatment of Rosacea
Page 64 and 65: adrenergic blockers (antagonists) T
Page 66 and 67: Synchrorose This product contains f
Page 68 and 69: Systemic antibiotics Tetracyclines
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Acne and Rosacea Charity Training Manual

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