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    • Related Articles Role of serum 25-hydroxyvitamin D levels and vitamin D receptor gene polymorphisms in patients with rosacea: a case-control study. Clin Exp Dermatol. 2018 Sep 23;: Authors: Akdogan N, Alli N, Incel Uysal P, Candar T Abstract
      BACKGROUND: Vitamin D has significant effects on the immune system and thereby on the pathogenesis of rosacea. However, there is a lack of information on the vitamin D status and vitamin D receptors (VDRs) of patients with rosacea.
      AIM: To evaluate the role of vitamin D in rosacea susceptibility.
      METHODS: A case-control study was conducted, enrolling patients with rosacea and healthy controls (HCs). Five VDR gene single nucleotide polymorphisms (SNPs) (Cdx2, FokI, ApaI, BsmI and TaqI) and serum 25-hydroxyvitamin D3 [25(OH)D3 ] levels were compared between patients and HCs.
      RESULTS: The study enrolled 60 patients (M/F: 14/46) and 60 age- and sex-matched HCs (M/F: 14/46). Age (mean ± SD) was 48 ± 11 years for both groups. The serum 25(OH)D3 levels (median ± interquartile range) were higher in patients with rosacea (12.9 ± 6.8 ng/mL) than in HCs (10.5 ± 3.7 ng/mL) (P < 0.001). Subjects with high serum 25(OH)D3 levels had a 1.36-fold increased risk of rosacea (95% CI 1.17-1.58). Heterozygous and mutant ApaI polymorphisms increased rosacea risk by 5.26-fold (95% CI 1.51-18.35) and 3.69-fold (95% CI 1.19-11.48), respectively, whereas mutant TaqI polymorphisms decreased the risk by 4.69 times (95% CI 1.37-16.67). Heterozygosity for Cdx2 alleles increased rosacea risk, whereas wildtype ApaI and mutant TaqI alleles decreased it.
      CONCLUSIONS: The present study suggests that an increase in vitamin D levels may contribute to the development of rosacea. ApaI and TaqI polymorphisms, and heterozygous Cdx2, wildtype ApaI and mutant TaqI alleles were significantly associated with rosacea. These results indicate a possible role of vitamin D and VDR pathways in the pathogenesis of rosacea, although causality could not be assessed.
      PMID: 30246390 [PubMed - as supplied by publisher] {url} = URL to article
    • Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience. J Am Acad Dermatol. 2018 Sep 18;: Authors: Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC Abstract
      Among individuals with skin of color, rosacea has been reported less frequently than in those with white skin, but it is not a rare disease. In fact, rosacea may be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin, as well as underestimation of the susceptibility of more highly pigmented skin to dermatologic conditions like rosacea whose triggers include sun exposure. Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. This paper reviews the epidemiology of rosacea in skin of color and highlights variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. It presents strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.
      PMID: 30240779 [PubMed - as supplied by publisher] {url} = URL to article
    • Full Text The four components of this treatment are: (1) Dextran sulfate is an anionic polymer of sulfated glucose [1] Dextran sulfate contains approximately 17% sulfur which is equivalent to approximately 2.3 sulfate groups per glucosyl residue. [2]  (2) 4-t-butylcyclohexanol  [BCH; TRP-regulin ®] [3] (3) pongamia oil [4] (4) hesperidin methyl chalcone [HMC] [5] Some of the products mentioned in the above post, "Avène redness-relief cosmetic products for sensitive skin prone to redness" are:  
      Eau Thermale Avène Antirougeurs Clean Redness-Relief Refreshing Cleansing Lotion
      Eau Thermale Avène Tolérance Extrême Emulsion
      Eau Thermale Avène Antirougeurs Calm Soothing Repair Mask
      Eau Thermale Avène Xeracalm A.D Lipid-Replenishing Cleansing Oil
      Eau Thermale Avène Skin Recovery Cream
      Eau Thermale Avène Cicalfate Restorative Skin Cream
      Eau Thermale Avène Extremely Gentle Cleanser Lotion
      Eau Thermale Avène Antirougeurs Dermo Cleansing Milk
      Eau Thermale Avène Antirougeurs Day Redness Relief Soothing SPF 25 Cream
      Eau Thermale Avène Antirougeurs Fort Relief Concentrate End Notes  [1] Dextran Sulfate, Sodium Salt (CAS 9011-18-1), Santa Cruz Biotechnology [2] Dextran Sulfate, Sigma Aldrich, Millipore Sigma [3] PubChem, Sigma Aldrich, ChemSpider, Paula's Choice, Safety Data Sheet, Effective treatment for sensitive skin: 4-t-butylcyclohexanol and licochalcone A [4] derived from the seeds of the Millettia pinnata tree [5] Paula's Choice, Truth in Aging, Douglas Laboratories, 
    • Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea. Clin Cosmet Investig Dermatol. 2018;11:421-429 Authors: Hernandez-Pigeon H, Garidou L, Galliano MF, Delga H, Aries MF, Duplan H, Bessou-Touya S, Castex-Rizzi N Abstract
      Background: Rosacea is a chronic facial skin disorder characterized by inflammation and vascular abnormalities. The pathophysiology of rosacea involves increased activation of the capsaicin receptor, TRPV1, the vascular endothelial growth factor (VEGF) pathway, and cathelicidin LL-37, MMP-9, and KLKs. We evaluated the activity of four compounds (dextran sulfate, 4-t-butylcyclohexanol [BCH; TRP-regulin®], pongamia oil, and hesperidin methyl chalcone [HMC]) on inflammatory and vascular responses implicated in rosacea.
      Materials and methods: The anti-inflammatory activity of dextran sulfate was evaluated on PGE2 production after PMA stimulation of NCTC-2544 keratinocytes, and on normal human epidermal keratinocytes (NHEKs) after proinflammatory stimulation to mimic a rosacea environment. The anti-angiogenic activity of dextran sulfate was measured by analyzing pseudotube formation in co-cultured human microvascular endothelial cells/normal human dermal fibroblasts. HMC modulation of vascular responses and IL-8 cytokine production after SP stimulation was evaluated in human skin explants. We also assessed the effect of BCH on TRPV1 activation, and the effect of combined BCH and pongamia oil on the inflammatory response of NHEKs.
      Results: Dextran sulfate strongly and significantly inhibited PMA-induced PGE2 production, inhibited KLK5 and MMP-9 mRNA expression, and IL-8, IL-1α and VEGF production, and displayed a highly significant inhibitory effect on VEGF-induced pseudotube formation. In SP-stimulated human skin explants, HMC significantly decreased the proportion of dilated vessels, total vessel area, and IL-8 production. BCH significantly and dose-dependently inhibited TRPV1 activation, and BCH and pongamia oil inhibited CXCL1 and CXCL6 mRNA expression and IL-8 production in NHEKs. Combined BCH/pongamia oil inhibited IL-8 production synergistically.
      Conclusion: These in vitro results showed that dextran sulfate, BCH, pongamia oil and HMC, possess complementary soothing and anti-redness properties, supporting their combination in Avène redness-relief cosmetic products for sensitive skin prone to redness, and for topical adjunctive rosacea treatment.
      PMID: 30233225 [PubMed] {url} = URL to article
    • One paper links Fungal keratitis associated with ocular rosacea
    • Related Articles Procedural management of rhinophyma: A comprehensive review. J Cosmet Dermatol. 2018 Sep 17;: Authors: Krausz AE, Goldberg DJ, Ciocon DH, Tinklepaugh AJ Abstract
      BACKGROUND: Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea.
      AIMS: Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality.
      METHODS: A comprehensive literature search was conducted using the search terms "rhinophyma," "treatment," and "surgery" in PubMed. Case reports, case series, and small retrospective trials using procedural techniques for management of rhinophyma were included for review. Animal studies, non-English articles, and reports of medical treatment of rhinophyma were excluded.
      RESULTS: There are currently no prospective, randomized controlled studies evaluating procedural management of rhinophyma. The most commonly employed treatments include scalpel excision, resection with heated knives, dermabrasion, electrosurgery and lasers, specifically carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG). The main complication associated with complete excision of rhinophymatous tissue is excessive scarring. To correct for this adverse effect, partial or tangential excision with preservation of underlying adnexal structures is now the accepted technique, irrespective of the chosen modality.
      CONCLUSION: There is no accepted gold standard for management of rhinophyma, and each modality succeeds in maintaining hemostasis, reducing scarring and achieving satisfactory cosmesis to different degrees. There is a conflicting data on the theoretical risk of recurrence with partial excision due to incomplete removal of tissue. Further studies evaluating this risk and alternate methods of prevention are required.
      PMID: 30225926 [PubMed - as supplied by publisher] {url} = URL to article
    • Diagnostic Indicators of Rosacea and Demodicosis. Acta Derm Venereol. 2018 Sep 18;: Authors: Forton FMN, De Maertelaer V Abstract
      Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.
      PMID: 30226528 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles FINACEA™ (Azelaic Acid) Foam, 15. Skinmed. 2016;14(6):445-447 Authors: Gupta AK, Foley KA, Abramovits W PMID: 28031132 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Treatment of rhinophyma with the Versajet™ Hydrosurgery System and autologous cell suspension (ReCELL®): A case report. J Cosmet Laser Ther. 2018 Apr;20(2):114-116 Authors: K Y, B R K, T D, E G Abstract
      This is a case report of a 63-year-old male patient who presented with rhinophyma of 17 years duration. Several medical treatments were applied previously, with no response or poor improvement. We present our experience by combining the Versajet™ Hydrosurgery System and ReCELL® in a heavy smoker patient, which led to a good aesthetic outcome. With the combined technique, we did not encounter any difficulties either within the operation or in the follow-up period. We obtained less complications and faster wound healing, which in return led to higher patient satisfaction.
      PMID: 28872937 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Subtyping, phenotyping or endotyping rosacea: how can we improve disease understanding and patient care? Br J Dermatol. 2018 Sep;179(3):551-552 Authors: Thyssen JP PMID: 30222873 [PubMed - in process] {url} = URL to article
    • ElaineA [post no 3] reports trying this treatment and posts on September 14, 2018, "I am still clear at 7 months post oral treatment."
    • Related Articles Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63 Authors: Fromstein SR, Harthan JS, Patel J, Opitz DL Abstract
      Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.
      PMID: 30214343 [PubMed] {url} = URL to article
    • Oxymetazoline Hydrochloride 1% Cream (Rhofade) for Persistent Facial Erythema Associated with Rosacea. Am Fam Physician. 2018 Jun 15;97(12):808-810 Authors: Garcia C, Birch M PMID: 30216014 [PubMed - in process] {url} = URL to article
    • Topical Steroid Damaged/Dependent Face (TSDF): A Study from a Tertiary Care Hospital in Eastern India. Indian J Dermatol. 2018 Sep-Oct;63(5):375-379 Authors: Pal D, Biswas P, Das S, De A, Sharma N, Ansari A Abstract
      Background: Awareness against abuse of topical corticosteroids (TC), especially over the face, has been going on for last 5 years in India. In spite of that we are getting lots of cases in our hospitals.
      Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face among the dermatology outpatient department (OPD) attendees and to analyze its causes.
      Methods: This study was conducted in a tertiary care medical center of eastern India. Patients with relevant facial dermatoses were asked about their current use of topical formulations and confirmed to be TSDF were included in the study.
      Results: A total of 748 patients with facial dermatoses were screened, of which 271 (36.22%) were using TC. Of them mostly young adults between 20 and 29 years (37.10%) were using TC. Average duration between starting of use of medication and the onset of symptoms was 5 months. Ninety-eight (36.16%) patients were using topical corticosteroid for the treatment of acne and 74 (27.30%) were using as depigmenting cream. About 108 (39.85%) patients bought medicine over the counter being recommended by pharmacist/shop owner. Rosacea like features with photosensitivity was the most common adverse effect found in 79 (29.15%) patients whereas comedonal acne/acne exacerbation were found in 68 (25.09%) patients. Most of them (227, 83.76%) were unaware about the side effects of steroids.
      Conclusions: TC misuse in patients with facial dermatoses is still quite common even after efforts to grow the awareness among population.
      PMID: 30210157 [PubMed] {url} = URL to article
    • Thanks Vestpocket for your post on this subject and pointing out how tiny the population of only 24 people in the study was. Wouldn't it be a novel idea for a group of rosaceans to get together and fund their own research. For example, let's get 10,000 rosacea sufferers together in a non profit organization dedicated to find the cure for rosacea and each rosacean donates $1 to this non profit organization who when funds a rosacea double blind, placebo controlled, clinical study on a rosacea trigger, such as coffee, or for that matter, whatever the 10,000 rosacea sufferers deemed to be a clinical subject worth investigating. Certainly one of the RRDi MAC members might be interested in receiving $10,000 to conduct such a clinical study that rosaceans would like to fund rather than the current status quo studies being done now by the other two non profit rosacea organizations.  As mentioned in the initial post, there is a difference between a flushing trigger and a rosacea flareup trigger. When you drink coffee (or for that matter ingest caffeine from green tea or whatever) after you flush, and eventually recover from the flush, does the flush exacerbate your rosacea seriously, or after the flush subsides, is your rosacea unchanged?
    • Related Articles Dermatoscopy of Granulomatous Disorders. Dermatol Clin. 2018 Oct;36(4):369-375 Authors: Errichetti E, Stinco G Abstract
      Although diagnosis of cutaneous granulomatous disorders (CGDs) is usually suspected based on morphologic findings, localization, and anamnestic data, clinical differentiation from each other and from similar dermatoses may be challenging. Recently, dermatoscopy has been demonstrated to be a useful tool for assisting the recognition of several CGDs. This article provides a current overview of the dermatoscopic features of the main noninfectious and infectious CGDs, including sarcoidosis, necrobiosis lipoidica, granuloma annulare, rheumatoid nodules, and leishmaniasis. Other, less common, CGDs are briefly addressed, including granulomatous rosacea, acne agminata, and leprosy.
      PMID: 30201146 [PubMed - in process] {url} = URL to article
    • Related Articles A Prunus persica genome-wide RNA-seq approach uncovers major differences in the transcriptome among chilling injury sensitive and non-sensitive varieties. Physiol Plant. 2018 Sep 11;: Authors: Nilo-Poyanco R, Vizoso P, Sanhueza D, Balic I, Meneses C, Orellana LA, Campos-Vargas R Abstract
      Chilling injury represents a major constrain for crops productivity. Prunus persica, one of the most relevant rosacea crops, have early season varieties that are resistant to chilling injury, in contrast to late season varieties, which display chilling symptoms such as mealiness (dry, sandy fruit mesocarp) after prolonged storage at chilling temperatures. To uncover the molecular processes related to the ability of early varieties to withstand mealiness, postharvest and genome-wide RNA-seq assessments were performed in two early and two late varieties. Differences in juice content and ethylene biosynthesis were detected among early and late season fruits that became mealy after exposed to prolonged chilling. Principal Component and Data Distribution Analysis revealed that cold stored late variety fruit displayed an exacerbated and unique transcriptome profile when compared to any other postharvest condition. A differential expression analysis performed using an empirical Bayes mixture modeling approach followed by co-expression and functional enrichment analysis uncover processes related to ethylene, lipids, cell wall, carotenoids and DNA metabolism, light response, and plastid homeostasis associated to the susceptibility or resistance of P. persica varieties to chilling stress. Several of the genes related to these processes are in QTLs associated to mealiness in P. persica. Together, these analyses exemplify how P. persica can be used as a model for studying chilling stress in plants. This article is protected by copyright. All rights reserved.
      PMID: 30203620 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Efficient isolation and observation of the most complex human commensal, Demodex spp. Exp Appl Acarol. 2018 Sep 06;: Authors: Clanner-Engelshofen BM, Ruzicka T, Reinholz M Abstract
      Demodex spp. mites are an often neglected member of the human skin microbiome. Mostly they are commensals, although their pathophysiological role in rosacea, spinulosis folliculorum, and other skin diseases is recognized. Little is known about their life cycle, biology, and physiology. Demodex mites cannot be cultivated in vitro, thereby complicating research immensely. The manual extraction from human sebum is laborious and death can only be detected by surrogate markers like ceased movement or loss of fluorescence. Here we present a new approach for the extraction of larger mite numbers and the hitherto most precise way to detect death. The extraction of mites from sebum and debris by hand can be accelerated by a factor 10 using sucrose gradient centrifugation, which is well tolerated by the mites. Staining with propidium iodide allows for easy identification of dead mites, excluding frail mites that stopped moving, and has no negative effect on overall mite survival. We anticipate our methods to be a starting point for more sophisticated research and ultimately in vitro cultivation of Demodex spp. mites.
      PMID: 30191497 [PubMed - as supplied by publisher] {url} = URL to article
    • Advances in Acne and Rosacea Therapy. Semin Cutan Med Surg. 2018 Jun;37(3S):S63-S66 Authors: Stein Gold LF, Alexis AF, Harper JC, Tan JKL Abstract
      New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.
      PMID: 30192344 [PubMed - in process] {url} = URL to article
    • This is also a myth based on a poorly designed study, and it is a common for someone to skim the study and come to a false conclusion.     There WAS an increase in the MTCI (malar temperature circulation index) of the cold-caffeine/caffeine pill administered group(s). That's a number indicating the difference in baseline temperature of your skin vs. the temperature after the studied element was introduced. For reference, redness was seen at MTCI of 1.4 or higher. MTCI ranged from 0.8 bare minimum to 2.2 for the average high values. Since 0.8 was the bare minimum seen, all agents had an effect, even the caffeine. These are low doses of caffeine -- a single cup of coffee is 90-120 mg, and the researchers stopped at 200 mg when administering caffeine pills. The caffeine did have an effect on increased blood flow to the cheeks at this dose.  In fact, the MCTI was 0.8 to 1.1 in the caffeine treated participants, where 1.4 is the flushing threshold (per the researchers.)  Naturally, if 200 mg brought the skin that close to flushing they ought to have tried 300 to 400 mg, which would have likely brought the MCTI to 1.6 to 2.2 -- very visible flushing. However, they did not try any higher doses, so we can not draw a conclusion.   What the study actually found is that in a tiny sample of 24 people, a 200 mg caffeine pill did increase malar skin temperature towards the flush point, but didn't cause visible flushing at a 200 mg dose.  It also found that in some of the cohort, hot water alone caused a reaction just as bad as caffeine alone!   More specifically, the 200 mg caffeine pill group saw MTCI of 0.8 to 1.1. Cold coffee was nearly identical. The hot water people saw 1.1 to 3.6 MTCI. So, in some of the participants, the caffeine pill WAS exactly as bad as hot water.  The worst reaction was, of course, the group administered caffeine + hot water.   The dose of caffeine used is very important, because the average daily caffeine intake among caffeine drinkers is much higher.  Per Villanova University, "More than half of all American adults consume more 300 milligrams (mg) of caffeine every day, making it by far America's most popular drug."     Let's look at the actual numbers from the study: (agent: MTCI) Hot coffee: 1.4 - 2.2 (a few were higher) Hot water: 1.1 - 2.2 (a few were higher) Cold coffee: 1.1- 2.2 200 mg caffeine.: 0.8-1.1 So, essentially, we know caffeine has an effect, and at 200 mg, it's slightly lower than what would cause visible redness. It stands to reason that doubling the caffeine would cause a more pronounced effect, but the authors did not bother to try this obvious test of their hypothesis.   24 people is a tiny sample. Caffeine allergy is uncommon, and a 24 person cohort would easily miss these people. For example, my mother, from a single cup of black coffee, becomes dizzy and violently ill. That'd be a classic example of caffeine intolerance. No such people were part of the study.   If you had a 24 person study, you'd miss all sorts of genetic anomalies. You wouldn't even find a person with common peanut allergy in a group that small due to the indicience of same, so this study is only worth the fact that heat is a contributor to flushing. It does not tell us that caffeine is not.   Anecdotally, my interest in this crappy study from 1981 is because my sole rosacea trigger is caffeine.  I'm not a coffee drinker.  I developed rosacea from a few years of strong green tea (10 minute brews, multiple tablespoons of raw leaf per day.)   Hot drinks, and hot herbal teas without caffeine have absolutely no effect on my flushing.   However, even a half cup of COLD white tea, or a single sip of yerba mate, or COLD green tea sends me into an immediate reaction within 30 minutes, followed by a 12 hour period of facial itching and very hot cheeks.  Every single time.   Caffeine reaction is very real.  I know of two popular rosacea bloggers who accidentally removed caffeine from their diet (say, because of stomach upset) and had all flushing symptoms resolve after years of playing around with other factors and medications that had no effect. 
    • Related Articles Thiol/disulfide homeostasis as a marker of oxidative stress in rosacea: a controlled spectrophotometric study. Cutan Ocul Toxicol. 2018 Sep 03;:1-15 Authors: Sener S, Akbas A, Kılınc F, Baran P, Erel O, Aktas A Abstract
      BACKGROUND: Rosacea is the chronic inflammatory disease of the facial skin. Although its etiology is not clear yet, inflammatory processes triggered by oxidative stress and oxidation of lipids have been suggested to have a role. While studies on the relationship between inflammation and oxidative stress are ongoing, thiol metabolism and its role in oxidative stress have also begun to be investigated. Thiols are among the key molecules of protein metabolism in the organism and they are firstly consumed antioxidants in case of oxidative stress. Thiols regulate intracellular redox metabolism and protect keratinocytes against the results of oxidative alterations in the stratum corneum. There is a balance known as dynamic thiol/disulfide homeostasis between thiols and their oxidized forms; disulfides.
      AIM: This study aimed to determine the effects of oxidative stress on protein metabolism in rosacea patients by investigating thiol/disulfide homeostasis using a newly developed and fully automated method. Determination of plasma thiol levels provides important clues regarding the extent of free radical-mediated oxidation of proteins causing damage in rosacea.
      METHODS: The study included 50 rosacea patients who were diagnosed clinically or histopathologically with rosacea and 42 age- and gender-matched healthy controls. Serum plasma levels of native thiol, total thiol, and disulfide were determined. The following ratios were calculated: Disulfide/native thiol ratio, disulfide/total thiol ratio, and native thiol/total thiol ratio.
      RESULTS: The mean age was 41.8±10.5 in the rosacea patients (35 females) and 42.5±10.3 years in the control group (33 females). The mean disulfide level was found to be significantly higher in the rosacea patients than in the control group (23.4±5.5 µM/L and 17.3±6.2µM/L, respectively; p < 0.001). The mean disulfide/native thiol ratio (0.055±0.016 vs. 0.041±0.017) and the mean disulfide/total thiol ratio (0.049±0.012 vs.0.037±0.013) were significantly higher and the mean native thiol/total thiol ratio (0.884±0.118 vs. 0.923±0.027) was significantly lower in the patients as compared with the controls (p < 0.05 for all).
      CONCLUSION: In rosacea patients, the thiol/disulfide balance was observed to shift towards disulfides, which could be considered an indicator of oxidative stress in rosacea.
      PMID: 30173569 [PubMed - as supplied by publisher] {url} = URL to article
    • The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis. Australas J Dermatol. 2018 Sep 03;: Authors: Maarouf M, Platto JF, Shi VY Abstract
      Nutrition plays a critical role in the manifestation and management of inflammatory pilosebaceous disorders. There is rich potential for insight into the impact of dietary effects on the pathophysiology of inflammatory pilosebaceous disorders including acne vulgaris, hidradenitis suppurativa, rosacea, and the closely related seborrhoeic dermatitis. Acne vulgaris and hidradenitis suppurativa are thought to have similar diet-modulating pathogenic pathways. Western diet influences Acne vulgaris and hidradenitis suppurativa by increasing insulin and modulating FOX01/mTOR, resulting in over-expression of cytokeratins, hyperproliferation of keratinocytes, and hypercornification of the follicular wall. Key receptors in rosacea are alternatively activated by UV radiation, hot beverages, spicy foods, vanilla, cinnamon, caffeine, alcohol, cold temperatures, and niacin- and formalin-containing foods, to increase oedema and flushing, resulting in erythema, telangiectasia, and warmth, characteristic features of the condition. Seborrhoeic dermatitis, while not a follicular disorder, is closely related, and can be modulated by dietary influences, such as biotin and probiotics. This overview summarizes the role that nutrition plays on these disorders, and identifies dietary modifications as potential adjunctive therapies.
      PMID: 30175843 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Expression of inflammatory and fibrogenetic markers in acne hypertrophic scar formation: focusing on role of TGF-β and IGF-1R. Arch Dermatol Res. 2018 Aug 29;: Authors: Yang JH, Yoon JY, Moon J, Min S, Kwon HH, Suh DH Abstract
      Acne vulgaris is a universal skin disease and it may leave a scar when the original skin lesion disappears. These scars can cause cosmetic problems and psychological burden, leading to poor quality of life of patients. Acne scars are classified into atrophic scars and hypertrophic scars. As most of the acne scars are atrophic, many studies have been conducted focusing on the treatment of atrophic lesions. This study was conducted to investigate the underlying pathogenesis of acne hypertrophic scars by identifying roles of fibrogenetic and inflammatory markers. Skin biopsy samples were obtained from hypertrophic scars of face and back and from adjacent normal tissues as control group. Some samples from back were immature hypertrophic scars and the other samples were in mature stages. Immunohistochemistry staining and quantitative PCR were performed for fibrogenetic and inflammatory markers. Both in mature and immature hypertrophic scars, vimentin and α-SMA were increased. Production of TGF-β3 protein as well as transcription of TGF-β3 was also significantly elevated. In contrast, expression of TGF-β1 showed no increase. Instead, expression levels of SMAD2 and SMAD4 were increased. Elevations of CD45RO, TNF-α and IL-4 and reduction of IL-10 were observed. In immature hypertrophic scars, IGF-1R and insulin-degrading enzyme expression were increased. Increased apoptosis was observed in immature stages of hypertrophic scars but not in mature stages. Elevations of TGF-β3, SMAD2 and SMAD4 in hypertrophic scars and increase of IGF-1R in immature stages may give some clues for acne hypertrophic scar formation.
      PMID: 30167815 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature. Open Access Maced J Med Sci. 2018 Aug 20;6(8):1438-1441 Authors: Demir O, Tas IS, Gunay B, Ugurlucan FG Abstract
      BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue.
      CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia.
      CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis.
      PMID: 30159072 [PubMed] {url} = URL to article
    • Related Articles The investigation of the relationships of demodex density with inflammatory response and oxidative stress in rosacea. Arch Dermatol Res. 2018 Aug 27;: Authors: Falay Gur T, Erdemir AV, Gurel MS, Kocyigit A, Guler EM, Erdil D Abstract
      The relationships of demodex density with systemic oxidative stress, inflammatory response, and clinical severity in rosacea are not clear. This study aimed to (a) analyze the levels of systemic oxidative stress, antioxidant capacity, inflammatory parameters, and matrix metalloproteinases (MMPs) in systemic circulation in patients with rosacea, (b) identify the relationship between mite density and both oxidative stress and inflammation, and (c) investigate the role of photoaging and sebum secretion in etiopathogenesis. Forty patients with rosacea and 40 age-, sex-, and skin phenotype-matched healthy volunteers were included in the study. Clinical disease severity of the patients was determined. Sebum levels were measured in both the groups, and photoaging was evaluated. Reflectance confocal microscopy was used to calculate demodex density. Serum total antioxidant capacity (TAC), total oxidant capacity (TOC), myeloperoxidase (MPO), MMP-1, MMP-9, arylesterase (ARES), interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and tumor necrosis factor-α (TNF-α) levels were also analyzed. The patients with rosacea had significantly higher serum TOC and lower TAC levels (p < 0.001). The serum ARES and PON-1 levels were significantly lower (p = 0.045 and p < 0.001, respectively); however, the serum levels of MMP-1, MMP-9, IL-1β and MPO were higher in the patient group. Demodex parameters were higher in the patient group compared to the control group. There was no significant correlation between the number of mites and disease severity. In addition, the number of mites was not correlated with the serum levels of TAC, TOC, OSI, MPO, MMP-1, MMP-9, ARES, PON-1, TNF-α, and IL-1β. However, sebum levels were directly proportional to the number of mites. Photoaging severity was similar between the patients and control subjects. The changing sebaceous microenvironment in rosacea leads to an increase in the number of demodex mites. However, increased demodex density does not alter disease severity, level of oxidative stress, or inflammation. Although none of the patients with rosacea had any underlying systemic disease, patients' systemic oxidative stress and inflammation parameters were found high in systemic circulation. It is assumed that the patients with rosacea are more prone to systemic diseases.
      PMID: 30151656 [PubMed - as supplied by publisher] {url} = URL to article
    • Head-and-neck dermatitis: Diagnostic difficulties and management pearls. Pediatr Dermatol. 2018 Aug 28;: Authors: Maarouf M, Saberian C, Lio PA, Shi VY Abstract
      Head-and-neck dermatitis is a variant of atopic dermatitis (AD) often seen in children and is challenging to diagnose, as it frequently overlaps with other eczematous dermatoses. Successful head-and-neck dermatitis (HND) treatment requires identification of common triggers and clinical mimickers, such as airborne dermatitis, periorificial dermatitis, and steroid-induced rosacea. Head-and-neck involvement negatively impacts quality of life and is often harder to treat than other body parts, as long-term topical corticosteroid use carries higher risks for skin atrophy on the face. Heating and flushing associated with HND further exacerbate the itch-and-scratch-cycle and disrupt sleep. We aim to address diagnostic gaps, identify clinical mimickers, and share clinical pearls in managing HND, including cooling pillows, thermal water sprays, rice starch paper facial masks, and tips to minimize food and saliva-induced facial irritation.
      PMID: 30152560 [PubMed - as supplied by publisher] {url} = URL to article
    • Let's review what the good points of having a non profit organization for rosacea founded by rosacea sufferers for patient advocacy vs the other two non profits for rosacea founded by non rosacea sufferers (NRS, and the AARS). (1) The purpose of this non profit obviously isn't for personal profit since everyone who has had anything to do with the RRDi hasn't done it for money. All Volunteers. Compare that with the other two non profit organizations for rosacea (NRS, and the AARS) and follow the money.  (2) There is a wealth of rosacea treatment data in the member forum in logical categories. The search feature can help you find what you are looking for.  (3) Education grants.  (3) The RRDi MAC is one of the Crown Jewels, since these medical and research professionals have some interest in rosacea and have graciously volunteered to have their name listed on our website and have agreed to answer questions and help guide the RRDi.  (4) The affiliate shopping cart is an incredible source of over the counter treatments and publications related to treatment not only for rosacea, but also other skin conditions.  You can review what research the NRS and the AARS have engaged in, and decide if you think these two non profit organizations funding for research is the way it should be done. Or if you think there should be improvement into what rosacea research needs to be done, think about this option:  Reaching the goal of 10,000 rosacea sufferers becoming members of the RRDi. Each member contributes one dollar a year. The RRDi could sponsor their own unique rosacea research that rosacea sufferers want done and fund it themselves. Can you do that with the other two non profit organizations for rosacea?   So think about all this and volunteer! Join the RRDi. Contact admin and let us know you want to volunteer. 
    • Related Articles Rhinophyma treatment using Versajet hydrosurgery. ANZ J Surg. 2017 Dec;87(12):E331-E332 Authors: Wong WL, Wong She R, Mathy JA PMID: 26073902 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Treatment of Rosacea using acupuncture for improving the local skin microcirculation: A case report. Medicine (Baltimore). 2018 Aug;97(34):e11931 Authors: Gao Y, Lin W, Zhou S, Shi G, He J, Chen Y Abstract
      RATIONALE: Rosacea is an irritating disease that affects patients' health and life quality. The current treatments for rosacea have limited efficacy and are generally not satisfying most patients. This report presents a patient diagnosed with rosacea who was treated with acupuncture to a satisfactory effect. Laser Doppler was used to measure the local blood perfusion of the nose before, during, and after acupuncture treatment. The Dermatology Life Quality Index (DLQI) was used to measure the impact of rosacea on the quality of the patient's life.
      PATIENT CONCERNS: A 52-year-old woman had been diagnosed with rosacea 18 months before this study. She had tried medical treatments in other hospitals with metronidazole cream, antifungal drugs, and steroidal ointments, but the effect was poor and limited.
      DIAGNOSES: In this study, the diagnosis of rosacea (stage I, subtype Erythematotelangiectatic) was made by a dermatologist according to physical examination).
      INTERVENTIONS: The patient's treatment included a half-hour of acupuncture 3 times per week.
      OUTCOMES: The patient experienced significant improvements in the region around the nose after 3 sessions of acupuncture treatment within the first week and reported that there was no relapse for 6 months after acupuncture treatment. The perfusion of blood flow was redistributed during and after acupuncture treatment according to laser Doppler measurements. The patient's DLQI score substantially improved. The patient was generally satisfied with the acupuncture treatment.
      LESSONS: The results suggested that acupuncture might be an alternative therapy for facial localized rosacea. As well, acupuncture may be effective in treating rosacea through redistributing micro-circulation of blood at the localized area of effect. The overall costs of the rosacea treatment may be reduced, provided that this therapy is demonstrated to be effective in future controlled studies.
      PMID: 30142810 [PubMed - in process] {url} = URL to article
    • Related Articles Effectiveness of photopneumatic technology: a descriptive review of the literature. Lasers Med Sci. 2018 Aug 24;: Authors: Rajabi-Estarabadi A, Choragudi S, Camacho I, Moore KJ, Keri JE, Nouri K Abstract
      Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.
      PMID: 30143923 [PubMed - as supplied by publisher] {url} = URL to article
    • "SCFA (short-chain fatty acids) molecules are a subset of fatty acids that are churned out by some types of gut microbes during the fermentation of fiber. They're associated with maintaining gut health and protecting against disease....And experiments recently showed that certain types of bacteria extracted from baby feces could promote the production of short-chain fatty acids (SCFA) in mice, and in a medium simulating the human gut...."Short-chain fatty acids are a key component of good gut health," lead study author Hariom Yadav, an assistant professor of molecular medicine at Wake Forest School of Medicine, said in a statement....Fecal microbiota transplants (FMT), or "poop transplants," can treat a type of gut disorder with an infusion of diverse bacteria from a healthy digestive system, distilled from a donor's poop. This helps to correct imbalances of microbial diversity when the gut microbiome is dominated by the bacteria Clostridium difficile (C. diff), which can lead to serious gut disorders." "Previous studies have investigated the use of probiotics — those healthy gut bacteria — by testing their impact in guts already affected by disease, the researchers wrote in the study. For the new investigation, they wanted to see how a probiotic would impact SCFA production in a healthy gut. They chose to work with baby poop because infants' gut microbiomes are typically free from age-related diseases "such as diabetes and cancer," and because of the sheer abundance of infant feces at their disposal. ("Their poop is readily available," Yadav said.)" Will Baby Poop Bacteria Become the New Probiotic?
      By Mindy Weisberger, Senior Writer, Live Science "While the new study examined what happened to mice after they received the mixture — there hasn’t been a study on humans yet — Yadav says that 'we are also planning to put these probiotics in yogurt, kombucha, and several other mediums for human use.' ” Why Scientists Think Baby Poop Is a Medical Gold Mine
      Probiotics are the future, baby.
      By Sarah Sloat, Inverse
       
    • The worldwide epidemiology of rosacea. Br J Dermatol. 2018 Aug;179(2):239-240 Authors: Parisi R, Yiu ZZN PMID: 30141542 [PubMed - in process] {url} = URL to article
    • Elevated Tear Human Neutrophil Peptides 1-3, Human Beta Defensin-2 Levels and Conjunctival Cathelicidin LL-37 Gene Expression in Ocular Rosacea. Ocul Immunol Inflamm. 2018 Aug 24;:1-10 Authors: Gökçınar NB, Karabulut AA, Onaran Z, Yumuşak E, Budak Yıldıran FA Abstract
      PURPOSE: To investigate the role of innate immunity in ocular rosacea.
      METHODS: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1-3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction.
      RESULTS: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups.
      CONCLUSION: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels.
      PMID: 30142005 [PubMed - as supplied by publisher] {url} = URL to article
    • Screening for depression in rosacea patients. Cutis. 2018 Jul;102(1):36-38 Authors: Alinia H, Cardwell LA, Tuchayi SM, Nadkarni A, Bahrami N, Richardson IM, Huang KE, Feldman SR Abstract
      Rosacea patients often are burdened with embarrassment, social anxiety, and psychiatric comorbidities. The Patient Health Questionnaire 9 (PHQ-9) is a validated and reliable self-administered tool for diagnosis of depression and designation of depression severity. This study aimed to examine the relationship between rosacea severity scores and level of depression using a validated rosacea self-assessment tool and the PHQ-9, respectively. Our results indicated that there is a direct relationship between rosacea severity and level of depression, and the PHQ-9 could prove useful in screening for depression in rosacea patients given the high incidence of psychiatric comorbidities in this patient population.
      PMID: 30138493 [PubMed - in process] {url} = URL to article
    • Related Articles Parkinson's disease pathogenesis, evolution and alternative pathways: A review. Rev Neurol (Paris). 2018 Aug 18;: Authors: Alexoudi A, Alexoudi I, Gatzonis S Abstract
      Sporadic Parkinson's disease (PD) is one of the most common neurodegenerative diseases of the elderly. In the scientific literature, surveys aiming to investigate the potential diagnostic biomarkers for PD have focused on skin and intestinal tissue biopsies, whereas more recent studies have reported an association between PD and skin disorders, such as seborrheic dermatitis and rosacea. In addition, a connection between PD and Crohn's disease has been established. These data suggest the hypothesis of a possible link between the gastrointestinal tract and skin and the development of PD. In fact, the nervous system, gastrointestinal tract and skin are analogous in their embryological development and, therefore, have molecular networks and pathogenic pathways in common. Based on these data, it may be assumed that the gastrointestinal tract and skin might be implicated in the pathogenesis of PD. The evolutionary hypothesis might also be a useful tool for further investigations into the overlap across neurological, gastrointestinal and skin disorders.
      PMID: 30131173 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Structure and gating mechanism of the transient receptor potential channel TRPV3. Nat Struct Mol Biol. 2018 Aug 20;: Authors: Singh AK, McGoldrick LL, Sobolevsky AI Abstract
      Transient receptor potential vanilloid subfamily member 3 (TRPV3) channel plays a crucial role in skin physiology and pathophysiology. Mutations in TRPV3 are associated with various skin diseases, including Olmsted syndrome, atopic dermatitis, and rosacea. Here we present the cryo-electron microscopy structures of full-length mouse TRPV3 in the closed apo and agonist-bound open states. The agonist binds three allosteric sites distal to the pore. Channel opening is accompanied by conformational changes in both the outer pore and the intracellular gate. The gate is formed by the pore-lining S6 helices that undergo local α-to-π helical transitions, elongate, rotate, and splay apart in the open state. In the closed state, the shorter S6 segments are entirely α-helical, expose their nonpolar surfaces to the pore, and hydrophobically seal the ion permeation pathway. These findings further illuminate TRP channel activation and can aid in the design of drugs for the treatment of inflammatory skin conditions, itch, and pain.
      PMID: 30127359 [PubMed - as supplied by publisher] {url} = URL to article
    • Evaluation of the Performance of a Nature-Based Sensitive Skin Regimen in Subjects With Clinically Diagnosed Sensitive Skin. J Drugs Dermatol. 2018 Aug 01;17(8):908-913 Authors: Draelos ZD, Levy SB, Lutrario C, Gunt H Abstract
      BACKGROUND: Unique whole formula nature-based sensitive skin products are formulated to minimize irritation while providing conditioning and soothing benefits to clinically diagnosed sensitive skin.
      OBJECTIVE: To evaluate and compare the efficacy and tolerability of a regimen of cleanser containing natural oils, beeswax, and witch hazel, and day & night creams containing natural oils, glycerin, and botanical anti-inflammatories (NR); and a synthetic dermatologist-recommended regimen of cetyl alcohol, sodium lauryl sulphate-containing cleanser and glycerin, polyisobutene-containing lotion (CR) in clinically diagnosed sensitive skin resulting from eczema/atopic dermatitis, rosacea, or cosmetic intolerance.
      METHODS: 120 subjects were randomized to receive either NR or CR, twice daily for 4 weeks in this double-blind study. Blinded investigator-rated and subject-rated overall skin appearance was assessed using a 5-point scale (0=none, 4=severe) at baseline, 2 weeks, and 4 weeks. Noninvasive skin assessments for skin hydration and skin barrier function were made by corneometry and TEWL, respectively.
      RESULTS: NR resulted in a 34% improvement from baseline in investigator-rated overall skin appearance (P less than 0.001); and CR resulted in a 4% improvement. Similar NR and CR results were found in the other efficacy parameters: tactile and visual smoothness, clarity, and radiance. Both regimens improved barrier function from baseline to week 4 (17%, 15%; NR, CR, P equals NS). NR maintained hydration from baseline to week 4 while CR increased hydration by 21% (P less than 0.001). No clinically significant tolerability issues were reported in either regimen at week 4.
      CONCLUSIONS: The study demonstrated that NR was effective, well tolerated, and superior to CR in the management of sensitive skin. J Drugs Dermatol. 2018;17(8):908-913.
      PMID: 30124733 [PubMed - in process] {url} = URL to article
    • tranexamic acid solution in treatment of erythematotelangiectatic rosacea.
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