Derm Cases · Dermatology / General Medicine
OSCE — assessment of papulopustular rosacea with ocular symptoms
An 8-minute OSCE station assessing phenotype-based diagnosis of rosacea, trigger counselling, ocular screening, and stepwise topical/systemic management including ivermectin and low-dose doxycycline — with clear differentiation from acne.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station assessing phenotype-based diagnosis of rosacea, trigger counselling, ocular screening, and stepwise topical/systemic management including ivermectin and low-dose doxycycline — with clear differentiation from acne.
Brief (to candidate)
A 42-year-old woman has flushing and persistent centrofacial erythema for 3 years, with recent crops of papules and pustules on the cheeks and nose, stinging with spicy food and heat, and gritty burning eyes. She has no comedones. Prior topical steroids for 'acne' worsened the redness. You have 8 minutes to diagnose by phenotype, screen ocular disease, counsel triggers, and outline stepwise therapy.
[9]Candidate instructions
- Distinguish rosacea phenotypes from acne vulgaris (comedones absent).
- Screen for ocular rosacea and when to refer ophthalmology.
- List major triggers and general measures.
- Outline stepwise topical and systemic treatment by phenotype (papulopustular vs erythema/telangiectasia vs phymatous).
- Give safety-net (steroid rosacea rebound, ocular red flags).
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Centrofacial persistent erythema ± papules/pustules; no comedones (vs acne); may note phymatous or ocular features; phenotype/ROSCO framing rather than rigid subtype-only language[1] |
| Pathophysiology brief | Innate immune dysregulation (TLR2–KLK5–cathelicidin / LL-37), neurovascular hyper-reactivity, barrier impairment, Demodex association — links to anti-inflammatory and anti-Demodex therapy[5] |
| Triggers & general care | Heat, spicy food, alcohol, UV, emotional stress, topical irritants; gentle cleanser, moisturiser, broad-spectrum sunscreen; stop topical steroids that cause rebound |
| Ocular rosacea | Asks about foreign-body sensation, dryness, blepharitis, chalazia, photophobia; lid hygiene; ophthalmology if pain, vision change, or refractory disease |
| Papulopustular Rx | First-line topical ivermectin 1% and/or metronidazole / azelaic acid; for moderate–severe: oral doxycycline (anti-inflammatory / modified-release regimens preferred over prolonged high-dose antibiotic use)[2][8] |
| Erythema / phyma | Persistent erythema: topical brimonidine/oxymetazoline or laser/IPL discussion; phymatous: early anti-inflammatory care ± surgical/laser reshaping referral |
| Safety & communication | Avoid long-term potent facial steroids; explain chronic relapsing course; review after 8–12 weeks; clear trigger plan |
Model key actions
- Diagnose papulopustular rosacea phenotype (centrofacial, no comedones) and screen ocular disease.[1]
- Stop steroid misuse; trigger and photoprotection counselling.
- Ivermectin 1% cream ± oral low-dose doxycycline for inflammatory papules/pustules; reserve prolonged antibiotics thoughtfully.[2][8]
- Refer ophthalmology for significant eye symptoms; discuss phyma/laser options if indicated.
Common errors
- Treating as acne with comedolytic-only regimens or isotretinoin without phenotype assessment.
- Missing ocular rosacea.
- Continuing topical corticosteroids on the face (steroid-induced rosacea/rebound).
- Ignoring triggers and photoprotection.
- Using high-dose antibiotics long-term without anti-inflammatory framing or step-down plan.
References5ShowHide
- [1]Tan J, Almeida LMC, Bewley A, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. The British journal of dermatology, 2017.PMID 27718519
- [2]Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology, 2020.PMID 32035944
- [5]Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nature medicine, 2007.PMID 17676051
- [8]Stein L, Kircik L, Fowler J, et al. Efficacy and safety of ivermectin 1% cream in treatment of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. Journal of drugs in dermatology : JDD, 2014.PMID 24595578
- [9]Fowler J Jr, Jackson M, Moore A, et al. Efficacy and safety of once-daily topical brimonidine tartrate gel 0.5% for the treatment of moderate to severe facial erythema of rosacea: results of two randomized, double-blind, and vehicle-controlled pivotal studies J Drugs Dermatol, 2013.PMID 23839181