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396 Chapter 9: Dermatology and soft tissues

effect. It can be used in women eligible for oral con- Hypertrophy of the sebaceous glands and connective tis-
traceptives. sue around the nose, most commonly in middle-aged
Oral retinoids are derivatives of vitamin A. They men, causes rhinophyma.
have an anti-inflammatory action and reduce sebum
production for up to a year, this in turn causes a de- Management
creaseinP.acnes duetoreducedsebum.Thesearevery Topical treatments using antibiotic gels, such as
effective with 80% of patients achieving long-term re- metronidazole, are used for at least 4–6 weeks.
mission after a single course of treatment. However, Systemic treatments are used in refractory cases and
retinoids are highly teratogenic causing spontaneous in patients with ocular symptoms. Prolonged courses
abortions and severe life-threatening congenital mal- of metronidazole, tetracycline, oxytetracycline or ery-
formations. Women require a pregnancy test prior thromycin are generally used, which is changed to
to starting therapy and should ideally use both an aretinoid if symptoms remain. See section Acne
oral contraceptive and a barrier contraceptive during Vulgaris for details regarding the use and safety of
and for 1 month after treatment. Retinoids may rarely retinoids.
cause hepatitis, jaundice and pancreatitis. Patients re- Rhinophyma may require electrosurgical resection.
quire regular liver function tests and lipid profile mea-
surement during treatment. Prognosis
Rosacea is a chronic condition, and topical metronida-
zole may be required to maintain remission.
Rosacea
Definition
Achronic inflammatory facial dermatosis affecting the Hair and nail disorders
central face characterised by vascular dilation, erythema
and pustules. Alopecia

Age Definition
Generally affects patients aged 30–60 years. Alopecia is defined as hair loss; it is classified into diffuse
and localised, scarring and non-scarring.
Sex
Aetiology/pathophysiology
F > M
The growth of hair from follicles passes through a cycle
(see Fig. 9.1). Causes of alopecia are given in Table 9.5.
Aetiology/pathophysiology
There is dilation of dermal blood vessels, hyperplasia of
Clinical features and management
sebaceous glands but normal excretion of sebum. The
Androgenic alopecia has a genetic tendency and is
cause is unknown but it is more common in individu-
androgen-dependent. Males are affected more than
als with fair skin, light hair and light eye colour. Some
females, starting from late teens increasing in inci-
evidence suggests a role for hair follicle mites.
dence throughout life. In males the hairline recedes
initially in the temporal regions before hair loss at the
Clinical features
Symptoms begin with recurrent flushing of the face,
which worsens on exposure to hot drinks, alcohol, stress Table 9.5 Causes of alopecia
andsunlight.Thismayprecede,byyears,erythemaofthe Diffuse non-scarring Androgenic alopecia, metabolic,
nose and cheeks. Telangiectasia are seen on the cheeks drug induced, telogen effluvium.
and sebaceous gland hyperplasia results in the formation Localised Alopecia areata, ringworm,
of papules and pustules. There may be a sensation of a non-scarring traumatic, traction.
Scarring Discoid lupus, burns, radiation,
foreign body in the eye, telangiectasia and inflammation
lichen planus.
of lid margins (blepharitis), conjunctivitis and keratitis.