A 54-year-old woman comes to the office for evaluation of a rash on her face. She initially developed facial flushing and redness 8 months ago and has had intermittent, progressive symptoms since then. She has also had a burning sensation in the cheeks. The rash worsens with sun exposure and spicy foods. The patient has traveled extensively the past few months and has been outdoors more than usual. She has no history of tobacco or alcohol use.
Vital signs are within normal limits. Skin examination is shown in the exhibit. The remainder of the physical examination is normal.
Which of the following is the best next step in management of this patient's rash?

Question

A 54-year-old woman comes to the office for evaluation of a rash on her face.  She initially developed facial flushing and redness 8 months ago and has had intermittent, progressive symptoms since then.  She has also had a burning sensation in the cheeks.  The rash worsens with sun exposure and spicy foods.  The patient has traveled extensively the past few months and has been outdoors more than usual.  She has no history of tobacco or alcohol use.
Vital signs are within normal limits.  Skin examination is shown in the exhibit.  The remainder of the physical examination is normal.
Which of the following is the best next step in management of this patient's rash?

Quizplus · Accepted Answer

11ec193a_978a_65f3_853d_9ba075d703d3_MD0002_00 This patient's rash is consistent with erythematotelangiectatic rosacea, which typically occurs in light-skinned individuals (women > men) age >30. Subtypes of rosacea include erythematotelangiectatic, papulopustular, phymatous, and ocular. The etiology is not fully understood but may relate to a chronic inflammatory reaction to cutaneous microorganisms, ultraviolet light damage, or vasomotor dysfunction. Common triggers include sun exposure, extreme temperatures (cold or heat), spicy foods, alcohol, and exercise. papulopustular phymatous Erythematotelangiectatic rosacea is characterized by chronic erythema in the nose and medial cheeks (including the nasolabial folds), facial flushing, telangiectasias, roughness or scaling, sensitive skin with burning, and occasionally facial edema. Patients with mild to moderate symptoms (such as this patient) often improve with gentle cleansers, sunscreen, and avoidance of triggers that cause flushing (eg, hot or spicy foods, alcohol, temperature extremes, emotional distress). Patients not responding to conservative therapy may benefit from laser/pulsed light therapy or topical brimonidine (Choice D). (Choice A) Antinuclear antibodies are used to screen for cutaneous lupus erythematosus, which can cause a facial rash similar to rosacea. However, the malar rash in cutaneous lupus spares the nasolabial folds. Although it can occur at any age, most patients develop symptoms at age 15-44. cutaneous lupus erythematosus (Choice B) The diagnosis of rosacea is usually based on clinical findings. Skin biopsy is occasionally helpful if an alternate diagnosis is being considered but is rarely necessary. (Choice E) Topical corticosteroids can treat seborrheic dermatitis, which can affect the lateral sides of the nose, nasolabial folds, eyebrows, and scalp. The rash is often erythematous but usually has oily scaling and pruritus. In contrast to rosacea, seborrheic dermatitis is not associated with facial flushing. seborrheic dermatitis Educational objective: Erythematotelangiectatic rosacea is characterized by erythema in the nose and medial cheeks, flushing, telangiectasias, and burning sensations. Initial management includes mild cleansers, sunscreen, and avoidance of triggers that cause flushing (eg, hot or spicy foods, alcohol, temperature extremes, emotional distress). __________ References: Rosacea management. (http://www.ncbi.nlm.nih.gov/pubmed/27843919) Once-daily topical brimonidine tartrate gel 0•5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicenter, randomized and vehicle-controlled studies. (http://www.ncbi.nlm.nih.gov/pubmed/22050040)

A 54-Year-Old Woman Comes to the Office for Evaluation of a Rash