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    • Related ArticlesStatPearls Book. 2020 01 Authors: Abstract Rosacea is a common chronic inflammatory disease that presents with recurrent flushing, erythema, telangiectasia, papules, or pustules on nose, chin, cheeks, and forehead. There are four clinical subtypes of rosacea based on the predominant signs and symptoms: erythematotelangiectatic, papulopustular, phymatous, and ocular. The subtypes are not mutually exclusive. Patients can present with features of multiple subtypes, and the predominant features and areas of involvement can change over time. Fifty to seventy-five percent of patients with rosacea have eye involvement with symptoms including dryness, redness, tearing, tingling/burning sensation, foreign-body sensation, light sensitivity, and blurred vision. In addition to the skin and eye symptoms, rosacea can cause anxiety, embarrassment, and depression and can have a significant impact on the quality of life. Although usually limited to the skin, an association of rosacea with systemic comorbidities such as neurologic diseases, inflammatory bowel disease, and cardiovascular diseases has been reported.[1][2][3][4] PMID: 32491506 {url} = URL to article
    • Related ArticlesAssessment of the abdominal fat index by ultrasonography in patients with rosacea. Australas J Dermatol. 2020 Jun 03;: Authors: Özkur E, Bülbün G, Karataş D, Kıvanç Altunay İ PMID: 32491195 [PubMed - as supplied by publisher] {url} = URL to article
    • "A variety of repurposed drugs and investigational drugs such as remdesivir, chloroquine, hydroxychloroquine, ritonavir, lopinavir, interferon‐beta, and other potential drugs have been studied for COVID19 treatment. We reviewed the potential dermatological side‐effects of these drugs." Dermatol Ther. 2020 May 22 : e13476.doi: 10.1111/dth.13476 [Epub ahead of print] Cutaneous sıde‐effects of the potential COVID‐19 drugs Ümit Türsen, Belma Türsen, Torello Lotti 
    • There are different approaches offered by the various 'authorities' on rosacea diagnosis into phenotypes. [1] However, they all agree that the phenotype classification is superior to the subtype classification that has been used since 2002 initially proposed by the NRS 'expert' panel. [2] The general consensus is "at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea." [3] {1} Diagnostic Cutaneous Signs (only one required) The ROSCO panel list includes persistent centrofacial erythema associated with periodic intensification by potential trigger factors as a minimum diagnostic feature of rosacea and phymatous changes are individually diagnostic of rosacea.  Fixed centrofacial erythema, papules and pustules, flushing or blushing, phymatous changes are included in the NRS panel diagnostic list.  Dr. Tan with the ROSCO panel, as well as the NRS Panel, and Dr. Del Rosso with the AARS panel both concur that facial erythema is essential to a diagnosis of rosacea. [4] OR {2} RRDi Phenotypes (two required) (1) Flushing (2) Persistent Erythema (3) Telangiectasia (4) Papulopustular (Papules/pustules Lesion Counts) (5) Phymatous (6) Ocular Manifestations Variances in Phenotype Listings The ROSCO panel has no numbering phenotype system but lists the above phenotypes.  The NRS 'expert' committee's approach has no numbering system and divides four phenotypes with three secondary phenotypes. [5] Galderma tweets four major phenotypes and four minor phenotypes.  The AAD follows the NRS expert panel recommendations.  The AARS has its own way of acknowledging the phenotype classification into six phenotypes:  "central facial erythema without papulopustular (PP) lesions;"  "central facial erythema with PP lesions;"  "the presence of phymatous changes," "ocular signs, and symptoms;"  "extensive presence of facial telangiectasias;"  "and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea)"  Medscape recognizes four major phenotypes and three secondary phenotypes following the NRS recommendations End Notes [1] ROSCOE Panel • NRS Expert Panel • Galderma • AAD • AARS • Medscape [2] Phenotype Treatment is Superior [3]  Clinical, Cosmetic and Investigational Dermatology February 2020 [4] Phenotype Classification Uses Signs and Symptoms Better [5] The four phenotypes the NRS lists are Papules and Pustules, Flushing, Telangiectasia, and  Ocular manifestations. The secondary phenotypes are  Burning or stinging, Edema, and Dry Appearance.  Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. 
    • Related ArticlesStudy of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital. Indian Dermatol Online J. 2020 Mar-Apr;11(2):208-211 Authors: Jain S, Mohapatra L, Mohanty P, Jena S, Behera B Abstract Background: Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately. Aim: The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population. Materials and Methods: This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded. Results: A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form "No-Scar" preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone. Conclusion: Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse. PMID: 32477980 [PubMed] {url} = URL to article
    • Stem cell colonies that are not yet differentiated. Image courtesy of Wikimedia Commons One of the many theories on the cause of rosacea is that it is caused by sun damaged skin. A paper published by Wolters Kluwer Health according to Science Daily states, "Some plastic surgeons have been using stem cells to treat aging, sun-damaged skin. But while they've been getting good results, it's been unclear exactly how these treatments work to rejuvenate 'photoaged' facial skin. A new study finds that within a few weeks, stem cell treatment eliminates the sun-damaged elastin network and replacing them with normal, undamaged tissues and structures." [1] Controversial "Stem-cell therapy has become controversial following developments such as the ability of scientists to isolate and culture embryonic stem cells, to create stem cells using somatic cell nuclear transfer and their use of techniques to create induced pluripotent stem cells. This controversy is often related to abortion politics and to human cloning. Additionally, efforts to market treatments based on transplant of stored umbilical cord blood have been controversial." [2] Regenerative Medicine Stem-cell therapy is what is called regenerative medicine. To understand the basics of this therapy watch this short TED video: How much does it cost? That is usually what most want to know the answer about before considering this treatment. The doctor from this clinic actually gives you a range of the cost since it depends on what your chief complaint issue is and various factors.  Could 10K members of the RRDi get together and each donate a dollar to sponsor a stem cell therapy for rosacea clinical study? That would be less than  the cost of a cup of coffee at Starbucks. Why not donate now? End Notes [1] Stem cell treatments 'go deep' to regenerate sun-damaged skin, Science Daily [2] Stem-cell Therapy, Wikipedia
    • Zilxi is a minocycline topical foam that has been going through clinical trials for some time now. It has been announced recently as FDA approved for rosacea (see fifth post in this thread). Minocycline, a tetracycline drug, has been shown to be just as effective as doxycycline for rosacea. If you are using Zilxi please find the green reply button and post your experience using this new treatment for rosacea. 
    • Menlo Therapeutics Inc. announced that the U.S. Food and Drug Administration (FDA) has approved ZILXI™ (minocycline) topical foam, 1.5%, for the treatment of inflammatory lesions of rosacea in adults. ZILXI, developed as FMX103 by Menlo’s wholly-owned subsidiary Foamix Pharmaceuticals Ltd. (“Foamix”), is the first minocycline product of any kind to be approved by the FDA for use in rosacea. Official Announcement Zilzi is a tetracycline what has done well in clinical trials. You will need to ask your physician for a prescription.  Product Insert  
    • Update "A massive study that raised health concerns over hydroxychloroquine, the anti-malaria drug touted by President Trump as a coronavirus treatment, is coming under scrutiny from scientists who are demanding to see the data behind it." Massive hydroxychloroquine study raising health concerns about the drug under scrutiny from scientists, Tal Axelrod, The Hill, MSN "After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure." N Engl J Med DOI: 10.1056/NEJMoa2016638 A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 David R. Boulware, M.D., M.P.H., Matthew F. Pullen, M.D., Ananta S. Bangdiwala, M.S., Katelyn A. Pastick, B.Sc., Sarah M. Lofgren, M.D., Elizabeth C. Okafor, B.Sc., Caleb P. Skipper, M.D., Alanna A. Nascene, B.A., Melanie R. Nicol, Pharm.D., Ph.D., Mahsa Abassi, D.O., M.P.H., Nicole W. Engen, M.S., Matthew P. Cheng, M.D., et al.
    • Related ArticlesOut of the Blue: A Case of Blue Subungual Discoloration Associated with Prolonged Tetracycline Use. Cureus. 2020 Apr 24;12(4):e7810 Authors: Ahmad Y, Boutros H, Hanna K Abstract Tetracycline derivatives are antibiotics such as minocycline and doxycycline that have been commonly utilized for inflammatory dermatological conditions such as acne and rosacea. Hyperpigmentation of the skin, nails, thyroid, oral mucosa, teeth, and bones is a known but rare side effect of prolonged tetracycline use. The hyperpigmentation typically takes months to years to develop. There may also be residual changes to the skin after discontinuation of the medication. For this reason, the time tetracyclines are used should be minimized and patients should be monitored for the skin findings. Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms. PMID: 32467786 [PubMed] {url} = URL to article
    • Related ArticlesSurgical mask dermatitis caused by formaldehyde (releasers) during the COVID-19 pandemic. Contact Dermatitis. 2020 May 28;: Authors: Aerts O, Dendooven E, Foubert K, Stappers S, Ulicki M, Lambert J PMID: 32468589 [PubMed - as supplied by publisher] {url} = URL to article
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