Erbium-doped Yttrium Aluminium Garnet (Er:YAG) Laser Resurfacing Restores Normal Function and Cosmesis in Patients with Severe Rhinophyma. J Clin Aesthet Dermatol. 2019 Jul;12(7):28-33 Authors: Mathis J, Ibrahim SF Abstract Background: Rhinophyma is a dermatologic condition that can lead to severe disfiguration and psychological distress. Many therapies, both medical and surgical, have been reported, but few with acceptable and reproducible cosmesis. Objective: We assessed the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser resurfacing as a treatment modality for rhinophyma of all degrees. Design, Setting, and Participants: Eleven Caucasian male patients were classified into categories of mild, moderate, or severe rhinophyma and were treated at the University of Rochester Medical Center with a dual mode Er:YAG fully ablative laser. Measurements: Severity was graded as mild, moderate, or severe, based on the degree of distortion of normal anatomy. Results: The Er:YAG laser allowed for increased ablative precision, a decreased risk of complications, shorter downtime, and improved outcomes compared to currently available treatments. Conclusion: Our results suggest Er:YAG laser resurfacing is an effective treatment modality, with low risk and excellent, reproducible cosmetic outcomes, for patients with rhinophyma of any severity. PMID: 31531160 [PubMed] {url} = URL to article

Recognizing Rosacea: Tips on Differential Diagnosis J Drugs Dermatol. 2019 Sep 01;18(9):888-894 Authors: Johnson SM, Berg A, Barr C Abstract Rosacea is a common chronic inflammatory dermatosis with a variety of clinical manifestations. Rosacea primarily affects the central face, and includes papules, pustules, erythema, telangiectasias, perilesional redness, phymatous changes, and even ocular involvement. Symptoms may vary among different patients and even vary over time in an individual patient. Central facial redness affects many adults and can be an indicator of the chronic inflammatory disease rosacea. Rosacea is a clinical diagnosis based on the patient’s history, physical examination, and exclusion of other disorders. It is under-diagnosed, particularly in individuals with skin of color. The goal of this article is to provide clinicians with the tools and understanding needed to correctly identify rosacea and differentiate it from other conditions that have overlapping signs and symptoms. J Drugs Dermatol. 2019;18(9):888-894 PMID: 31524344 [PubMed - as supplied by publisher] {url} = URL to article

Anti-Inflammatory Dose Doxycycline Plus Adapalene 0.3% and Benzoyl Peroxide 2.5% Gel for Severe Acne J Drugs Dermatol. 2019 Sep 01;18(9):924-927 Authors: Kircik LH Abstract Acne is primarily an inflammatory disease. Anti-inflammatory dose doxycycline (40mg: 30mg immediate release and 10mg delayed release beads) is approved for the treatment of rosacea but with demonstrated efficacy for acne. Fixed combination adapalene 0.3% and benzoyl peroxide 2.5% gel is a once-daily formulation approved for the topical management of acne vulgaris. It has both anti-inflammatory and anti-comedogenic properties. Options for management of severe acne are somewhat limited; many patients are not candidates for or refuse treatment with isotretinoin. Systemic antibiotics may be indicated; acne treatment guidelines emphasize antibiotic stewardship in light of increasing concerns about antibiotic resistance and call for the judicious use of conventional systemic antibiotics. This single-center, open label pilot study involving 20 subjects with severe acne assessed the effects of combination treatment using anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel on IGA scores as well as inflammatory lesion, non-inflammatory lesion, and nodule counts. By week 12, 95% of subjects had at least a 2-grade improvement in IGA scores. Reductions in inflammatory and non-inflammatory lesion counts were statistically significant beginning at week 4 and continuing through week 12. By week 4, the percentage of patients with 0 nodules was 70%, compared to baseline of 20%. Further improvements were seen through week 12. Treatment was well-tolerated with no serious treatment-related adverse events. Combination treatment with anti-inflammatory dose doxycycline plus combination adapalene 0.3% and benzoyl peroxide 2.5% gel is safe and effective for management of severe acne. J Drugs Dermatol. 2019;18(9):924-927. PMID: 31524349 [PubMed - as supplied by publisher] {url} = URL to article

Intralesional Steroids for the Management of Periorificial Granulomatous Dermatitis J Drugs Dermatol. 2019 Sep 01;18(9):955 Authors: von Csiky-Sessoms S Abstract A 42-year-old male with skin type I and a history of rosacea and eczema presented with crusting, erythema, and pustules distributed on the left oral commissure. Angular cheilitis was diagnosed and regular petrolatum use recommended until resolution of the lesion. Eight days later, with no improvement in symptoms, fungal and bacterial cultures were performed which resulted in the growth of cutibacterium acnes, a variant of p. acnes. PMID: 31524997 [PubMed - as supplied by publisher] {url} = URL to article

The gut microbiome alterations in allergic and inflammatory skin diseases - an update. J Eur Acad Dermatol Venereol. 2019 Sep 14;: Authors: Polkowska-Pruszyńska B, Gerkowicz A, Krasowska D Abstract The human microbiome is a wide range of microorganisms residing in and on our body. The homeostasis between host immune system and the microbial environment allows mutual benefits and protection. Physiological bacterial colonization is essential for the establishment of organism immunity. The human microbiota ecosystem can be divided into several compartments, out of which intestinal flora strongly affects our health and plays a crucial role in the pathophysiology of many diseases. The gastrointestinal tract, being a major guardian of the immune system, maintains the homeostasis with the commensal microorganisms by tolerating the typical flora antigens. The dysbiosis may trigger an inflammatory response followed by tissue damage or autoimmune processes. The gut microbiome alterations are linked to the pathogenesis of the allergic, cardiovascular, gastrointestinal, metabolic, neurodevelopmental, psychiatric and neurodegenerative diseases and cancer. Moreover, there is increasing evidence connecting the skin condition with the gastrointestinal microbiome, which has been described as the skin-gut axis. The aim of this study was to review the literature regarding the role of the gut microbiome alterations in the pathogenesis of selected allergic and inflammatory skin diseases. PMID: 31520544 [PubMed - as supplied by publisher] {url} = URL to article