Postepy Dermatol Alergol. 2024 Oct;41(5):495-499. doi: 10.5114/ada.2024.142597. Epub 2024 Aug 9. ABSTRACT INTRODUCTION: Rosacea is a chronic inflammatory disease presenting with facial flushing, non-transient erythema, papules/pustules, telangiectasia, and phymatous changes. Secondary manifestations, such as itching, burning, or stinging, are often observed in patients with rosacea. The pathogenesis of rosacea is not fully understood, but immune dysfunction, Demodex infection, neurovascular dysregulation, and exposure to ultraviolet radiation represent contributing factors. AIM: To evaluate and compare effectiveness of fractional micro-needling radiofrequency with systemic isotretinoin and micro-needling alone in the treatment of rosacea. MATERIAL AND METHODS: A cross-sectional comparative study between fractional microneedling radiofrequency with systemic isotretinoin and micro-needling alone in the treatment of rosacea was carried out in a private outpatient clinic and Al-Yarmouk teaching hospital from January 2022 to June 2023. Group A comprised 25 patients treated with systemic isotretinoin (10 mg/day) for 6 weeks and fractional microneedling radiofrequency for 16 weeks. Patients received a session every 2 weeks during the first 2 months of treatment then one session per month. Group B comprised 25 patients treated with fractional microneedling radiofrequency for 16 weeks. The patients received a session every 2 weeks during the first 2 months of treatment then one session per month. Measurement of baseline serum lipid profile, complete blood count, and liver enzyme levels was done to all patients receiving isotretinoin. All patients in both groups were instructed to use sunscreen and emollients. Follow-up of all patients was carried out for 3 months after treatment. Patients were assessment according to the Grade system of rosacea, patient satisfaction, and relapse rate. Relapse rate: no relapse (0), relapse (1). Patient satisfaction: poor (0), fair (1), and good (2). RESULTS: There was no significant difference in the mean severity score for rosacea between group A and group B, before, after 8 weeks, and after 16 weeks. Patients in group A showed higher good satisfaction (72%) than group B (32%). During the follow-up period the relapse rate was higher in group B (32%) than in group A (16%), the percentage reduction (response rate) of the mean of severity score was 41.37% after 8 weeks and 91.37% after 16 weeks in group A, and 34.48% after 8 weeks and 82.75% after 16 weeks in group B. CONCLUSIONS: Fractional microneedling radiofrequency is a safe and effective method in the treatment of rosacea, and so it can be used when there are contraindications to other lines of therapy, when patients are resistant to long-term oral therapy, and when patients (including pregnant women) choose not to take oral or topical drugs. PMID:39606600 | PMC:PMC11589633 | DOI:10.5114/ada.2024.142597 {url} = URL to article

J Eur Acad Dermatol Venereol. 2024 Nov 28. doi: 10.1111/jdv.20463. Online ahead of print. ABSTRACT The skin barrier can be divided into at least four functional units: chemical, microbial, physical and immunological barriers. The chemical and microbial barriers have previously been shown to exhibit different characteristics in topographically distinct skin regions. There is increasing evidence that the physical and immunological barriers also show marked variability in different areas of the skin. Here, we review recent data on the topographical variations of skin barrier components, the contribution of these variations to the homeostatic function of the skin and their impact on the pathogenesis of specific immune-mediated skin diseases (such as atopic dermatitis and papulopustular rosacea). Recognition of these topographical barrier differences will improve our understanding of skin homeostasis and disease pathogenesis and provide a basis for body site-specific targeted therapies. PMID:39607016 | DOI:10.1111/jdv.20463 {url} = URL to article

Dermatol Surg. 2024 Dec 1;50(12S):S225-S229. doi: 10.1097/DSS.0000000000004474. Epub 2024 Oct 23. ABSTRACT BACKGROUND: Injectable and device-based treatments are used for medical dermatologic conditions, but understanding dermatologists' practices remains limited. OBJECTIVE: This study examines injectable and device-based treatments for medical dermatologic conditions to identify patterns and potential improvements. MATERIALS AND METHODS: A survey was distributed to Association of Academic Cosmetic Dermatology members, covering practice settings, conditions treated, pricing, and resident involvement. RESULTS: Thirty-four of 40 (85%) respondents practiced in academic teaching hospitals, primarily in urban settings. Conditions treated included acne vulgaris, alopecia, skin cancers, disorders of pigmentation, follicular disorders, gender-affirming care, birthmarks, oncodermatology, rosacea, scars, tattoos, and vascular lesions. Treatments were offered at various prices, with clinical trials and insurance used in some cases. Resident involvement ranged from 72% to 94% of cases. Respondents also reported laser usage, with 100% using lasers for treating scars, 98% for treating vascular lesions, 98% for treating rosacea, and 88% for treating disorders of pigmentation. For acne vulgaris and associated scarring, the top treatments were chemical peels (86%), lasers (83%), and mechanical modalities (48%). With gender-affirming care, respondents used lasers (100%), filler (55%), and neurotoxins (48%). CONCLUSION: Academic dermatologists treat medical dermatologic conditions and involve residents. PMID:39589851 | DOI:10.1097/DSS.0000000000004474 {url} = URL to article

Cureus. 2024 Oct 25;16(10):e72363. doi: 10.7759/cureus.72363. eCollection 2024 Oct. ABSTRACT BACKGROUND: Systemic abnormalities in the immune system may contribute to rosacea pathogenesis. Several studies have found a higher prevalence of abnormal bacterial growth, such as Helicobacter pylori (H. pylori) and small intestinal bacterial overgrowth (SIBO) in rosacea subjects. However, discrepancies remain in the literature, likely perpetuated by inconsistent testing methods and incomplete controlling for potential confounders. OBJECTIVE: We aimed to evaluate the prevalence of H. pylori and SIBO in rosacea subjects after controlling for several potential confounders. METHODS: This cross-sectional study evaluated subjects with papulopustular or erythematotelangiectatic rosacea. Subjects with previous or existing gastrointestinal (GI) disease, GI surgery, autoimmune disorders, immunosuppression, or significant comorbidities were excluded. Certain medication use (antibiotics, steroids, GI-modulating medications, anti-inflammatories) required an appropriate washout period. Rosacea history and severity were assessed. Subjects answered questions regarding their rosacea and GI health. H. pylori andSIBO were evaluated by 13C-urea breath test and glucose-breath test methods, respectively. RESULTS: Of 27 subjects, 14.8% (N=4) tested positive for H. pylori and 33.3% (N=9) tested positive for SIBO. Compared to the general population prevalence, the proportion of H. pylori in the rosacea cohort was significantly less (p=0.02). Though the estimated population prevalence of SIBO had a wider range, compared to midrange, the prevalence of SIBO in the rosacea cohort was greater (p<0.001). There were no significant associations between demographics, rosacea characteristics, or GI symptoms and H. pylori or SIBO positivity. Conclusion: When eliminating several potential confounders, SIBO is more prevalent in subjects with rosacea compared to the general population. Thus, SIBO may be associated with rosacea, though it remains incompletely understood whether SIBO itself contributes to rosacea pathophysiology or rather SIBO prevalence and rosacea are both downstream effects of abnormalities in systemic immunity. Future studies are warranted to elucidate this relationship further, though this observed association may be promising for novel therapeutic targets in rosacea treatment. PMID:39583431 | PMC:PMC11585968 | DOI:10.7759/cureus.72363 {url} = URL to article

Drug Des Devel Ther. 2024 Nov 19;18:5299-5306. doi: 10.2147/DDDT.S498938. eCollection 2024. ABSTRACT BACKGROUND: Dermatologists consistently face challenges in treating demodicosis due to its high recurrence rate and difficulty normalizing the Demodex density (Dd) even after clinical improvement. Oral ivermectin has proven to be an effective treatment for demodicosis. However, there is a lack of comprehensive information on the clinical and acaricidal effects of oral ivermectin in treating demodicosis. PURPOSE: This study aims to evaluate the effectiveness of oral ivermectin on clinical symptoms and Dds of patients with demodicosis. METHODS: This prospective, quasi-experimental study included 40 demodicosis patients (20 with Demodex densities (Dds) < 20 D/cm2, 20 with Dds ≥20 D/cm2). Both groups of patients were treated with oral ivermectin (200 µg/kg/week) until excellent clinical improvement (Grade 4 according to the Quartile Grading Scale), and Dds ≤ 5 D/cm2 or treated with oral ivermectin for a total of eight weeks period. RESULTS: In our study, 75% of patients achieved clinical remission, showing excellent clinical improvement with Dds ≤ 5 D/cm2. All patients with a Dds <20 D/cm² experienced remission, while 50% with a Dds ≥20 D/cm² achieved remission. The median time to remission after oral ivermectin treatment was 28 days for Dds <20 D/cm² and 56 days for Dds ≥20 D/cm² (p < 0.001). CONCLUSION: Oral ivermectin effectively improves clinical symptoms and normalizes Dds in patients with demodicosis. Patients with higher Dds require a longer treatment than those with lower Dds. PMID:39583635 | PMC:PMC11585293 | DOI:10.2147/DDDT.S498938 {url} = URL to article