Part of the book: Highlights in Skin Cancer
Rosacea is a common chronic inflammatory cutaneous disorder with variable presentation and severity. Disease usually occurs between the ages of 30 and 50 years. Women are more commonly affected than men. Rosacea is divided into four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular, and one variant: lupoid or granulomatous rosacea. Erythematotelangiectatic rosacea is manifested as flushing and persistent centrofacial erythema, and papulopustular rosacea as papules and pustules in a centrofacial distribution. With disease progression, phymas consisting of sebaceous gland hypertrophy can develop. Ocular rosacea can result in blepharitis and conjunctivitis. Diagnosis is made clinically. Management of rosacea consists of protective measures such as sun protection and gentle skin care and topical and systemic treatments to suppress inflammation and erythema.
Part of the book: Acne and Acneiform Eruptions
Alopecia areata is an organ-specific autoimmune disease targeting hair follicles. It causes nonscarring hair loss. The prevalence rate of the disease is approximately 1 in 1000 people worldwide. The condition is most commonly seen as circular areas of hair loss, but it may sometimes be as extensive as to involve the whole scalp or whole body. The complex pathophysiology of alopecia areata involves an autoimmune basis. Association of alopecia areata with other autoimmune diseases, such as thyroiditis and vitiligo, and the good response of patients to immunosuppressive treatment support an autoimmune etiology. Although some poor prognostic signs are defined, the course of the disease is unpredictable and the response to treatment can be variable. To date, there are neither preventive nor curative measures to deal with the condition. First-line therapy for patchy disease is topical and intralesional steroids, whereas extensive disease is conventionally managed with immunotherapy. New treatment agents, such as excimer laser, low-dose recombinant interleukin 2, Janus kinase inhibitors, and simvastatin/ezetimibe, are promising.
Part of the book: Hair and Scalp Disorders
Urticaria is a common mast cell–mediated dermatosis presenting with pruritic erythematous superficial plaques also known as hives or wheals. Angioedema is an acute condition manifesting as localized edema affecting the skin and mucous membranes. In contrast with urticaria, itching is often absent, the skin appears normal and the edema occurs in deeper dermal and subcutaneous tissues in angioedema. Spontaneous urticaria can either be acute lasting less than 6 weeks or chronic with a duration of more than 6 weeks. In acute urticaria cases, an underlying cause, mostly medications, foods and infections, may be found in approximately 50% of patients. However, spontaneous urticaria is generally idiopathic. First-line treatment option for both acute and chronic urticaria is non-sedating H1 antihistamines. Patients with recalcitrant disease are candidates for therapy with corticosteroids, immunosuppressives or omalizumab treatment. There are two different mechanisms causing angioedema. The first is mast cell mediated and is considered to be part of the spectrum of spontaneous or inducible urticarias. Patients present with angioedema alone or angioedema combined with urticaria. The second is bradykinin-induced angioedema, as observed in the hereditary angioedema and angiotensin-converting enzyme (ACE) inhibitor–induced angioedema.
Part of the book: Urticaria and Angioedema