andrei metelitsa, md, frcpc, faad co-director, institute...
TRANSCRIPT
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Andrei Metelitsa, MD, FRCPC, FAAD
Co-Director, Institute for Skin Advancement
Clinical Associate Professor, Dermatology
University of Calgary, Canada
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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
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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
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Rosacea Subtypes
Vascular erythematotelangiectatic rosacea (ETR)
Inflammatory papulopustular rosacea (PPR)
Phymatous rosacea
Ocular rosacea
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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
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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
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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
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Papulopustular Rosacea: Canadian Clinical Guidelines 2016
Maintenance: Topical ivermectin or metronidazole or azelaic acid
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ETR Rosacea: Canadian Clinical Guidelines 2016
Maintenance: Topical brimonidine or metronidazole and/or Laser/IPL
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Phymatous Rosacea: Canadian Clinical Guidelines 2016
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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)