Follicular skin diseases
Facial rash case challenge 3
Select the term(s) which best describe this facial rash.
#! Erythematous papules
# Scaly plaques
Explanation: This patient has an erythematous mid-face with scattered papules and telangiectasia. He has blepharitis i.e. inflamed eyelid margins.
Choose the best diagnosis from the following options:
* Acne vulgaris
* Seborrhoeic dermatitis
* Periorificial dermatitis
Explanation: The patient has rosacea. Unlike seborrhoeic dermatitis, there is no scaling. The distribution is different from periorificial dermatitis, which tends to affect the nasolabial fold. There are no comedones, and the patient is clearly older than those generally suffering from acne.
Which would be the most suitable twice-daily medication for the next six weeks?
#! Metronidazole gel
#! Minocycline 50mg
# Ketoconazole cream
# Hydrocortisone cream
Explanation: Rosacea may be treated topically with metronidazole gel / cream or azelaic acid cream / lotion. However, it is usual to prescribe oral tetracycline antibiotics for the first couple of months, and intermittently afterwards for flare-ups.
When the inflammatory papules clear up, he decides to seek treatment for telangiectasia. Which of the following would be most suitable?
Hint: Refer to DermNet
* Erbium-Yag laser
* Alexandrite laser
* Neodynium-Yag Q-switched laser
*! Intense pulsed light source
Explanation: There are a number of devices suitable for removing facial telangiectasia, including pulsed dye, copper vapour, copper bromide, argon, krypton and potassium-titanyl-phosphate lasers and intense pulsed light source. Vascular-specific laser systems target intravascular oxyhaemoglobin, which has primary absorption peaks at 418, 542 and 577 nm. Alexandrite is used for pigmented lesions, blue/black/green tattoos and hair removal. Neodynium-YAG is for pigmented lesions, red/orange/yellow tattoos and hair removal. Erbium:Yag is for ablative skin resurfacing and removal of epidermal lesions.