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    • Related Articles Cutaneous pseudolymphoma with rhinophyma-like lesion. J Dermatol. 2019 09;46(9):e335-e337 Authors: Oginezawa M, Kawai K PMID: 30951205 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Topical treatments for rosacea. Can Fam Physician. 2019 Nov;65(11):803 Authors: Fritsch P, Kolber MR, Korownyk C PMID: 31722913 [PubMed - in process] {url} = URL to article
    • Related Articles [Rhinophyma, management methods and oncological risk]. Rev Med Liege. 2019 Nov;74(11):606-610 Authors: Bachelet JT, Delafond C, Buchholzer S, Modaressi SA, Nizet C, Termont A Abstract Rhinophyma is the most advanced stage of rosacea (stage IV). It is a benign lesion but aesthetically disabling. We present through a major case of rhinophyma and a review of the literature the diagnostic modalities, the therapeutic alternatives and the risks to be known. Particularly, we detail the risks of oncologic transformation of these poorly known lesions.The management of these rare lesions is based on a collaboration between the surgeon and the dermatologist. PMID: 31729850 [PubMed - in process] {url} = URL to article
    • Related Articles Cutaneous pseudolymphoma with rhinophyma-like lesion. J Dermatol. 2019 09;46(9):e335-e337 Authors: Oginezawa M, Kawai K PMID: 30951205 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Topical treatments for rosacea. Can Fam Physician. 2019 Nov;65(11):803 Authors: Fritsch P, Kolber MR, Korownyk C PMID: 31722913 [PubMed - in process] {url} = URL to article
    • Related Articles [Rhinophyma, management methods and oncological risk]. Rev Med Liege. 2019 Nov;74(11):606-610 Authors: Bachelet JT, Delafond C, Buchholzer S, Modaressi SA, Nizet C, Termont A Abstract Rhinophyma is the most advanced stage of rosacea (stage IV). It is a benign lesion but aesthetically disabling. We present through a major case of rhinophyma and a review of the literature the diagnostic modalities, the therapeutic alternatives and the risks to be known. Particularly, we detail the risks of oncologic transformation of these poorly known lesions.The management of these rare lesions is based on a collaboration between the surgeon and the dermatologist. PMID: 31729850 [PubMed - in process] {url} = URL to article
    • Related Articles The Skin and Gut Microbiome and Its Role in Common Dermatologic Conditions. Microorganisms. 2019 Nov 11;7(11): Authors: Ellis SR, Nguyen M, Vaughn AR, Notay M, Burney WA, Sandhu S, Sivamani RK Abstract Microorganisms inhabit various areas of the body, including the gut and skin, and are important in maintaining homeostasis. Changes to the normal microflora due to genetic or environmental factors can contribute to the development of various disease states. In this review, we will discuss the relationship between the gut and skin microbiome and various dermatological diseases including acne, psoriasis, rosacea, and atopic dermatitis. In addition, we will discuss the impact of treatment on the microbiome and the role of probiotics. PMID: 31717915 [PubMed] {url} = URL to article
    • Impact of nanostructured lipid carriers on dapsone delivery to the skin; in vitro and in vivo studies. Int J Pharm. 2019 Nov 09;:118781 Authors: Elmowafy M, Shalaby K, Ali HM, Alruwaili NK, Salama A, Ibrahim MF, Akl MA, Ahmed TA Abstract The main objective of this study was to develop, characterize and evaluate the potential use of dapsone-loaded nanostructured lipid carriers (NLCs) as a topical treatment for acne. Differently charged NLC formulations were successfully prepared using an emulsification/sonication method. The particle sizes ranged from 106.2±5.6 nm to 151.3±7.4 nm, and the NLCs possessed the predicted surface charges, depending on the emulsifier used (Tween 80, Transcutol P, or cetyltrimethylammonium bromide). The entrapment efficiencies ranged from 76.5±3.8 % to 91.1±3.9 %. Selected formulations were assessed for possible interactions, in vitro release, ex vivo skin permeation, pharmacological efficacy and safety compared with a hydroalcoholic solution. Dapsone was embedded in the lipid matrix of NLCs and behaved as controlled release system with a good occlusive effect. Dapsone-loaded cationic NLC formulation enhanced the skin permeation of dapsone, increase the amount of dapsone retained in the skin in controlled manner, and improved the anti-rosacea activity. Based on these encouraging results, cationic NLC represents a promising carrier for the safe topical delivery of dapsone. PMID: 31715347 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Treatment of Erythematotelangiectatic Rosacea With Pulsed-Dye Laser and Oxymetazoline 1.0% Cream: A Retrospective Study. Lasers Surg Med. 2019 Nov 10;: Authors: Suggs AK, Macri A, Richmond H, Munavalli G, Friedman PM Abstract BACKGROUND AND OBJECTIVES: Pulsed-dye laser (PDL) and oxymetazoline 1.0% cream are each used for the treatment of erythematotelangiectatic (ET) rosacea. PDL targets oxyhemoglobin and can reduce facial erythema and telangiectasias. Oxymetazoline 1.0% cream is an α adrenergic agonist, which has shown to reduce facial erythema. The aim of this study was to determine the degree of erythema improvement and telangiectasia clearance after combination treatment with PDL plus oxymetazoline 1.0% cream. STUDY DESIGN/MATERIALS AND METHODS: This retrospective study was conducted at two sites. Pre- and post-treatment cross-polarized images from subjects on combination treatment with PDL and oxymetazoline 1.0% cream were graded by a board-certified dermatologist at each practice. Blinded images were analyzed using the Clinical Erythema Assessment (CEA) Scale (0 = clear and 4 = severe). Unblinded images were analyzed using the five-point Telangiectasia Scale to determine the degree of improvement post-treatment compared with baseline (1 = <5% clearance and 5 = 75-100% clearance). RESULTS: Thirty-one subjects (20 females, 11 males) of age 51 ± 13 years (mean ± standard deviation) were included in the study after an average of 4 months (range: 1-13) of daily oxymetazoline 1.0% cream and two (range: 1-4) PDL treatments. At baseline, 87% of subjects had CEA Grade 2 (mild erythema) or higher. For erythema, 55% of subjects improved by at least one CEA grade and 13% achieved two grades of improvement post-treatment. For telangiectasias, 90% of subjects achieved at least a two-point clearance (5-25%), 62% at least a three-point clearance (25-50%), and 41% at least a four-point clearance (50-75%) post-treatment. Compared with subjects with baseline CEA Grade 1-2 (almost clear to mild erythema), significantly more subjects with baseline CEA Grade 3-4 (moderate to severe erythema) achieved at least one CEA grade of improvement (P = 0.021) and two grades of CEA improvement (P = 0.041). A higher percentage of baseline CEA Grade 3-4 subjects achieved at least a two-point clearance in telangiectasias (P = 0.055). CONCLUSIONS: Combination treatment with PDL and daily oxymetazoline 1.0% cream can safely and effectively reduce erythema and telangiectasias. Limitations include the retrospective design of the study, small sample size, and lack of a control group. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc. PMID: 31709571 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Sebaceous Glands participate in the inflammation of Rosacea. J Eur Acad Dermatol Venereol. 2019 Nov 11;: Authors: Lee SH, Lee SB, Heo JH, Yoon HS, Byun JW, Choi GS, Shin J Abstract Rosacea is a chronic inflammatory dermatosis that can present with a variety of cutaneous manifestations.1 Recently, mast cells are known to be importantly related to the pathogenesis of rosacea.2 The disease characteristically presents a centrofacial distribution1,3 , an area rich in sebaceous glands. PMID: 31709649 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Alterations of Immune and Keratinization Gene Expression in Papulopustular Rosacea by Whole Transcriptome Analysis. J Invest Dermatol. 2019 Nov 06;: Authors: Shih YH, Xu J, Kumar A, Li R, Chang ALS PMID: 31705873 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles [Mushroom keratoplasty in rosacea keratitis complicated by corneal perforation (a clinical case)]. Vestn Oftalmol. 2019;135(5. Vyp. 2):215-219 Authors: Trufanov SV, Krakhmaleva DA, Zaitsev AV, Salovarova EP, Tekeeva LY, Budnikova EA Abstract Rosacea is a polyethiologic chronic inflammatory disease with varying clinical manifestations. It is primarily a dermatologic disease, which often manifests in the eyes affecting eyelids, cornea and conjunctiva. The leading role in the pathological process belongs to disruption of regulatory mechanisms in the vascular, immune and nervous systems. It is accompanied by increased levels of metalloproteinases and vascular endothelial growth factor (VEGF). Treatment depends on the severity of the disease and may vary from hygiene of the eyelid margins and use of artificial tears for dry eye disease management, to antibiotics and anti-inflammatory agents in moderate cases, and surgical treatment in severe or neglected state. A clinical case of severe rosacea shows that keratoplasty with mushroom-shaped profile of the surgical incision helps achieve good functional results and reduce the post-operative rehabilitation time, while significantly reducing the risk of postsurgical complications. Anti-VEGF therapy significantly reduces the risk of histoincompatibility reaction typical for rosacea keratitis. PMID: 31691663 [PubMed - in process] {url} = URL to article
    • Related Articles [Chronic mucocutaneous candidiasis with STAT1 gain-of-function mutation associated with herpes virus and mycobacterial infections]. Ann Dermatol Venereol. 2019 Oct 30;: Authors: Baghad B, Benhsaien I, El Fatoiki FZ, Migaud M, Puel A, Chiheb S, Bousfiha AA, Ailal F Abstract INTRODUCTION: Chronic mucocutaneous candidiasis (CMC) is characterized by susceptibility to chronic or recurrent infections with yeasts of the genus Candida affecting the skin, nails and mucous membranes. We describe a Moroccan patient presenting CMC with heterozygous STAT1 gain-of-function (GOF) mutation. PATIENTS AND METHODS: A 5-year-old boy with no consanguinity presented recurrent episodes of oral thrush, chronic nail candidiasis and herpetic gingivostomatitis from the age of 8 months. He also had mycobacterial adenitis secondary to BCG vaccination and atypical rosacea. Genetic analysis revealed GOF mutation of the STAT1 gene. DISCUSSION: CMC was diagnosed in our patient despite poor clinical features. Sequencing of the genome revealed STAT1GOF mutation. This mutation affects production of IL-17, an important cytokine in mucocutaneous defense against Candida. The association with mycobacterial adenitis is rare and continues to be poorly understood. The presence of atypical rosacea in this setting is suggestive of this entity. Antifungal therapy and prevention of complications are necessary to reduce the morbidity and mortality associated with this condition. CONCLUSION: CMC due to STAT1GOF mutation is characterized by a broad clinical spectrum and should be considered in all cases of chronic or recurrent fungal infection, whether or not associated with other infections. PMID: 31677808 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Association of dental foci of infection and rosacea: a case report. Gen Dent. 2019 Nov-Dec;67(6):52-54 Authors: Sopi M, Meqa K Abstract Rosacea, a chronic inflammatory disease of the skin, is characterized by rash, pustules, papules, and dilated blood vessels. The etiology is unknown, and the disease is more common among women than among men. Among the proposed causes of this disorder are dental foci of infection, with periapical lesions the most common pathologic lesion in the alveolar bone. The aim of this report is to examine the possible relationship between periapical lesions as dental foci and rosacea. A 50-year-old woman reported redness in her face, for which she had been treated by a gastroenterologist for Helicobacter pylori and a dermatologist for rosacea. After clinical, radiographic, and laboratory examinations, suspicions of dental foci were raised. The residual roots of teeth 4, 5, 12, 15, and 18 were extracted, and teeth 16, 29, and 31 underwent endodontic treatment. One year after dental treatment, all signs of redness in the patient's face had healed, she stopped all treatments, and her laboratory values were normal. PMID: 31658025 [PubMed - in process] {url} = URL to article
    • Related Articles Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea. Dermatol Surg. 2019 Nov;45(11):1401-1405 Authors: Schilling LM, Halvorson CR, Weiss RA, Weiss MA, Beasley KL Abstract BACKGROUND: Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE: The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS: Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS: No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION: The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices. PMID: 31658188 [PubMed - in process] {url} = URL to article
    • Related Articles Use of laser therapy in the treatment of severe rhinophyma: a report of two cases. J Cosmet Laser Ther. 2019 Oct 24;:1-5 Authors: Borzęcki A, Turska M, Strus-Rosińska B, Sajdak-Wojtaluk A Abstract Rhinophyma is a rare manifestation of rosacea. It is clinically characterized by sebaceous hypertrophy, fibrosis, and telangiectasia. Usually, it is considered as a cosmetic defect; however, in some cases, it might cause problems with nasal breathing and food consumption which forces the need for treatment. The following article presents the effectiveness of laser treatment with the neodymium-yttrium-aluminum garnet (Nd:YAG), carbon dioxide laser (CO2), and fractional CO2 laser. PMID: 31648601 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Apoptosis Induction of Armeniacae Semen Extractin Human Acute Leukemia (NALM-6 and KG-1) Cells. Int J Hematol Oncol Stem Cell Res. 2019 Jul 01;13(3):116-121 Authors: Mosadegh Manshadi S, Safavi M, Rostami S, Nadali F, Shams Ardekani MR Abstract Background: Prunusarmeniaca is a member of the Rosacea family. The most important ingredient of this family is amygdalin that is believed to have anti-tumor and analgesic properties. The aim of this study was to evaluate the anti-proliferative effects of Armeniacae semen extract on the acute leukemia, NALM-6, and KG-1 cell lines, and investigate the effect of the extract on apoptosis of these cell lines and caspase-3 gene expression. Materials and Methods: We prepared aqueous, ethyl acetate, and hydro alcoholic extracts of the Armeniacae semen. The NALM-6 and KG-1 cell lines and mononuclear cells (PBMCs) of healthy controls were treated with different doses of the extracts for 48 hours, and then cell viability was investigated with the MTT test. High-Performance Liquid Chromatography was done for amygdalin identification. The percentage of apoptotic cells was determined using the Annexin V-FITC/PI flow cytometric kit, and caspase-3 gene expression was evaluated. Results: MTT test revealed that the strongest Inhibition Concentration (IC50) in KG-1 and NALM-6 cell lines was related to the ethyl acetate extract. This extract did not have toxic effects on PBMCs. Flow cytometric analysis showed that the ethyl acetate extract at its IC50 concentration led to almost 50% apoptosis in both cell lines after 48 hours. In the molecular examination, after treatment, a significant increase was seen in caspase-3 gene expression in NALM6 and KG1 cells compared to the control (P<0.001 and P <0.05, respectively). Conclusion: Our data confirmed that the ethyl acetate extract of Prunusarmeniaca could reduce the proliferation of KG-1 and NALM-6 cell lines probably by activating the apoptotic pathway. PMID: 31649801 [PubMed] {url} = URL to article
    • Related Articles Rosacea causing unilateral Morbihan syndrome. BMJ Case Rep. 2019 Oct 25;12(10): Authors: Weeraman S, Birnie A Abstract Morbihan syndrome is a rare entity causing woody induration of the face. There are numerous case reports of bilateral Morbihan syndrome. We present a case of a 46-year-old man with right infra-orbital cheek swelling and symptoms of rosacea who had histology consistent with granulomatous rosacea following debulking surgery. His clinical presentation and investigation findings support a diagnosis of rosacea causing unilateral Morbihan syndrome. PMID: 31653629 [PubMed - in process] {url} = URL to article
    • Pediatric Ocular Acne Rosacea: Clinical Features and Long Term Follow-Up of Sixteen Cases. Ocul Immunol Inflamm. 2019 Oct 24;:1-9 Authors: Donmez O, Akova YA Abstract Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients. Methods: The medical records of pediatric ocular acne rosacea patients were reviewed. Results: There were 16 patients with a mean age of 7.7 ± 5 (1-16) years. The mean follow-up period was 52.8 ± 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 ± 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases. Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes. PMID: 31647686 [PubMed - as supplied by publisher] {url} = URL to article
    • Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Image courtesy of Wikimedia Commons Chronic Mucocutaneous Candidiasis (CMC) "is an immune disorder of T cells, it is characterized by chronic infections with Candida that are limited to mucosal surfaces, skin, and nails." [1] One report states, "Heterozygous STAT1 gain-of-function (GOF) mutations result in a combined form of immunodeficiency which is the most common genetic cause of chronic mucocutaneous candidiasis (CMC)." [2] This same report connects "chronic demodicosis in the form of a facial papulopustular eruption, blepharitis, and chalazion" with CMC. This could also be described as demodectic rosacea.  Candida has been connected to rosacea in at least one paper. [3] End Notes [1] Wikipedia [2] Pediatr Dermatol. 2019 Oct 21; STAT1 gain-of-function and chronic demodicosis. Molho-Pessach V, Meltser A, Kamshov A, Ramot Y, Zlotogorski A [3] Candida Albicans
    • Related Articles Analysis of acne-related judicial precedents from 1997 to 2018 in South Korea. J Dermatol. 2019 Oct 23;: Authors: Cho SI, Shin SH, Yang JH, Lee W, Kim SY, Suh DH Abstract Medicolegal disputes are increasing in practical medicine. Medications or procedures related to acne could lead to medical malpractice. This study analyzed medical litigation associated with acne in South Korea. Acne-related judgments were searched using the Supreme Court of Korea's Written Judgment Management System based on the keyword "acne". Eleven cases were selected; eight cases were related to acne scar and three cases were related to acne. Treatment modalities such as peeling, laser treatment, photodynamic therapy and antibiotics resulted in lawsuits. Claimed sequelae of the treatments were hyperpigmentation, scar worsening, erythema, skin bumps and liver transplant. Eight cases were awarded to the plaintiff, and the others were dismissed. This study shows that various treatments for acne can cause medical disputes. PMID: 31642108 [PubMed - as supplied by publisher] {url} = URL to article
    • The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant. image courtesy of Wikimedia Commons "I’d never heard of antidepressants causing any issues with skin, which made me wonder if anyone else was having the same issue and just putting up with it in silence – or if the whole thing was in my head. I chatted with Dr Zubair Ahmed, the CEO of MedicSpot digital clinics, who confirmed that yes, antidepressants can absolutely cause or worsen skin conditions. ‘These skin issues range from innocent facial flushing to life threatening systemic rashes such as Stevens-Johnson syndrome,’ Dr Ahmed told metro.co.uk. ‘You may also notice purple dots on your skin (Purpura) or a condition called urticaria which is often due to an allergic reaction. ‘Eczema is also associated with antidepressant medication.’ " How your antidepressants might be messing with your skin, Ellen Scott, Metro Chai reports a serious rosacea flareup after withdrawing from mirtazapine.
    • Related Articles STAT1 gain-of-function and chronic demodicosis. Pediatr Dermatol. 2019 Oct 21;: Authors: Molho-Pessach V, Meltser A, Kamshov A, Ramot Y, Zlotogorski A Abstract Heterozygous STAT1 gain-of-function (GOF) mutations result in a combined form of immunodeficiency which is the most common genetic cause of chronic mucocutaneous candidiasis (CMC). We present a pedigree with a GOF mutation in STAT1, manifesting with chronic demodicosis in the form of a facial papulopustular eruption, blepharitis, and chalazion. So far, demodicosis has been described in only one family with STAT1-GOF mutation. We suggest that chronic demodicosis is an under-recognized feature of the immune dysregulation disorder caused by STAT1 gain-of-function mutations. PMID: 31637766 [PubMed - as supplied by publisher] {url} = URL to article
    • image courtesy of Wikimedia Commons There are a number of anti-flushing prescriptions reported by rosaceans and we have an exhaustive list here (also includes a list of non prescription treatments as well). 
    • Related Articles ADAMDEC1 promotes skin inflammation in rosacea via modulating the polarization of M1 macrophages. Biochem Biophys Res Commun. 2019 Oct 15;: Authors: Liu T, Deng Z, Xie H, Chen M, Xu S, Peng Q, Sha K, Xiao W, Zhao Z, Li J Abstract Rosacea is a chronic inflammatory cutaneous disease which mainly affects central face, leading to cosmetic disfigurement and compromised social psychology in billions of rosacea patients. Though the exact etiology of rosacea remains elusive, accumulating evidence has highlighted the dysfunction of innate immunity and inflammation in rosacea pathogenesis. Disintegrin Metalloprotease ADAM-like Decysin-1 (ADAMDEC1) is an orphan ADAM-like metalloprotease which is believed to be closely related to inflammation. Here for the first time, we reported that Adamdec1 expression was significantly increased in the skin lesions of rosacea patients and LL37-induced rosacea-like mouse models. Immunofluorescence analysis revealed co-localization of ADAMDEC1 and macrophages in patient and mouse biopsies. In cellular experiment, the expression of ADAMDEC1 was prominently elevated in M1 but not M2 macrophages. Knocking down of ADAMDEC1 significantly blunted M1 polarization in macrophages induced from human monocytes and THP-1 cell lines. Furthermore, silencing of Adamdec1 in LL-37-induced mouse model also suppressed the expression of M1 signature genes such as IL-6, iNOS and TNF-α, resulting in attenuated rosacea-like phenotype and inflammation. Taken together, our results demonstrate that ADAMDEC1 plays a pro-inflammatory role in rosacea via modulating the M1 polarization of macrophages. PMID: 31627897 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles An Open-Label, Intra-Individual Study to Evaluate a Regimen of Three Cosmetic Products Combined with Medical Treatment of Rosacea: Cutaneous Tolerability and Effect on Hydration. Dermatol Ther (Heidelb). 2019 Oct 17;: Authors: Santoro F, Lachmann N Abstract INTRODUCTION: Although rosacea management includes general skincare, previous studies have not evaluated comprehensive skincare regimens as adjuvants to other treatments. METHODS: The primary objective of this open-label, intra-individual study of subjects with rosacea was to evaluate the cutaneous tolerability of a regimen consisting of Cetaphil PRO Redness Control Day Moisturizing Cream (once daily in the morning), Cetaphil PRO Redness Control Night Repair Cream (once daily in the evening) and Cetaphil PRO Redness Control Facial Wash (foam once in the morning and once in the evening). Secondary objectives were to evaluate the effect on transepidermal water loss (TEWL) and cutaneous hydration and to determine the subjects' evaluation of efficacy, tolerability and future use. A dermatologist examined subjects and measured TEWL and cutaneous hydration on day (D) 0, D7 and D21, when subjects ranked symptoms. Subjects completed a questionnaire on D21. RESULTS: The per-protocol population consisted of 42 subjects receiving treatment for rosacea. Eleven subjects developed adverse events, none of which were considered to be related to the skincare products. Five subjects showed signs or symptoms that were potentially associated with the skincare products that might suggest poor cutaneous tolerability; these were generally mild. TEWL decreased significantly by a mean of 17% on D7 and a mean of 28% on D21 compared with baseline (both P < 0.001). Skin hydration increased significantly by a mean of 5% on D7 (P = 0.008) and a mean of 10% on D21 (P < 0.001) compared with baseline. Subjects reported that the regimen was pleasant (98%) and effective (95%) and that it offered various benefits; 90% of subjects reported that they would like to continue to use the regimen and would buy the products. CONCLUSION: The skincare regimen improved skin hydration and skin barrier function in subjects receiving medical treatment for rosacea and was well tolerated. FUNDING: Galderma S.A. PMID: 31625112 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Dermoscopy in the differential diagnosis between malar rash of systemic lupus erythematosus and erythematotelangiectatic rosacea: an observational study. Lupus. 2019 Oct 16;:961203319882493 Authors: Errichetti E, Lallas A, De Marchi G, Apalla Z, Zabotti A, De Vita S, Stinco G Abstract BACKGROUND: Malar rash is one of the three cutaneous diagnostic criteria of systemic lupus erythematosus (SLE). Although its clinical recognition is often straightforward, the differential diagnosis with erythematotelangiectatic rosacea may sometimes be challenging. OBJECTIVE: To describe dermoscopic features of SLE malar rash and investigate the accuracy of dermoscopy for the differential diagnosis with erythematotelangiectatic rosacea. METHODS: A representative dermoscopic image of target areas was evaluated for the presence of specific features. Fisher's test was used to compare their prevalence between the two cohorts, and accuracy parameters (specificity, sensitivity, and positive and negative predictive values) were evaluated. RESULTS: Twenty-eight patients were included in the analysis, of which 13 had SLE malar rash and 15 erythematotelangiectatic rosacea. The main dermoscopic features of malar rash were reddish/salmon-coloured follicular dots surrounded by white halos ('inverse strawberry' pattern), being present in 53.9% of the cases, while network-like vessels (vascular polygons) turned out to be the main feature of erythematotelangiectatic rosacea, with a prevalence of 93.3%. The comparative analysis showed that the 'inverse strawberry' pattern was significantly more common in SLE malar rash, with a specificity of 86.7%, while vascular polygons were significantly more frequent in rosacea, with a specificity of 92.3%. CONCLUSION: Dermoscopy may be a useful support to distinguish SLE malar rash and erythematotelangiectatic rosacea by showing peculiar features. PMID: 31619142 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Immunohistochemical Evaluation of Matrix Metalloproteinases-1, -9, Transient Receptor Potential Vanilloid Type 1, and CD117 in Granulomatous Rosacea Compared with Non-granulomatous Rosacea. Acta Derm Venereol. 2019 Oct 17;: Authors: Park JB, Suh KS, Jang JY, Seong SH, Yang MH, Kang JS, Jang MS PMID: 31620803 [PubMed - as supplied by publisher] {url} = URL to article
    • Coffee and Skin - Considerations Beyond the Caffeine Perspective. J Am Acad Dermatol. 2019 Oct 14;: Authors: Bray ER, Kirsner RS, Issa NT PMID: 31622642 [PubMed - as supplied by publisher] {url} = URL to article
    • Clinical diagnosis through paintworks observation Rev Med Inst Mex Seguro Soc. 2019 Jul 31;57(2):113-117 Authors: Zamudio-Martínez G, Zamudio-Martínez A Abstract Despite of the important technological advances which today allow a precise diagnosis through genetic or imaging studies, one of the fundamental pillars of medical diagnosis is, and always will be, patient examination. The visual identification of the signs that distinguish a disease is still important to make a clinical diagnosis. These very same examination skills and the knowledge on the disorders’ appearance, as well as the technical abilities of the artists that once painted pictures, allow us to diagnose a rosacea among Rembrandt’s self-portraits, or Marfan’s syndrome amidst Egon Schiele’s elongated figures. It is possible to find diseases represented in paintworks from long before someone ever described them in a book, longer even before someone considered them illnesses. PMID: 31618566 [PubMed - as supplied by publisher] {url} = URL to article
    • Aclaris has now sold Rhofade to EPI Health, LLC.  
    • "Aclaris Therapeutics, Inc. (Nasdaq: ACRS), a physician-led biopharmaceutical company focused on immuno-inflammatory diseases, today announced it has divested RHOFADE® (oxymetazoline hydrochloride) cream, 1% (RHOFADE) and related intellectual property assets to EPI Health, LLC (EPI Health). The divestiture of RHOFADE is a key component of Aclaris’ recently announced strategic plan to refocus resources on the development of its immuno-inflammatory development programs." GlobalNewswire, Inc, October 10, 2019 "Allergan developed and brought RHOFADE to market in 2017 after acquiring the drug as part of its 2011 acquisition of Vicept Therapeutics, Inc., a company established by certain members of the current senior management team of Aclaris." Business Insider, October 15. 2018 Aclaris owned Rhofade and sold it to Allergan and bought it back on October 2018.  The new owner, EPI Health, states on its website, "EPI Health is continually expanding our prescription product line to offer healthcare professionals and patients new and better options to treat skin conditions." EPI Health's president, John A. Donofrio, joined EPI Health in March of 2019. image courtesy of EPI Health, LLC  
    • Related Articles Skin changes in the obese patient. J Am Acad Dermatol. 2019 Nov;81(5):1037-1057 Authors: Hirt PA, Castillo DE, Yosipovitch G, Keri JE Abstract Obesity is a worldwide major public health problem with an alarmingly increasing prevalence over the past 2 decades. The consequences of obesity in the skin are underestimated. In this paper, we review the effect of obesity on the skin, including how increased body mass index affects skin physiology, skin barrier, collagen structure, and wound healing. Obesity also affects sebaceous and sweat glands and causes circulatory and lymphatic changes. Common skin manifestations related to obesity include acanthosis nigricans, acrochordons, keratosis pilaris, striae distensae, cellulite, and plantar hyperkeratosis. Obesity has metabolic effects, such as causing hyperandrogenism and gout, which in turn are associated with cutaneous manifestations. Furthermore, obesity is associated with an increased incidence of bacterial and Candida skin infections, as well as onychomycosis, inflammatory skin diseases, and chronic dermatoses like hidradenitis suppurativa, psoriasis, and rosacea. The association between atopic dermatitis and obesity and the increased risk of skin cancer among obese patients is debatable. Obesity is also related to rare skin conditions and to premature hair graying. As physicians, understanding these clinical signs and the underlying systemic disorders will facilitate earlier diagnoses for better treatment and avoidance of sequelae. PMID: 31610857 [PubMed - in process] {url} = URL to article
    • The efficacy and safety of permethrin 2.5% with tea tree oil gel on rosacea treatment: A double-blind, controlled clinical trial. J Cosmet Dermatol. 2019 Oct 15;: Authors: Ebneyamin E, Mansouri P, Rajabi M, Qomi M, Asgharian R, Azizian Z Abstract BACKGROUND: Rosacea is a chronic skin condition that typically affects the face and it results in redness and inflammation. The main risk factors of this disease are Demodex folliculorum, living in the pilosebaceous units. AIMS: To evaluate the efficacy and safty of permethrin 2.5% in combination with tea tree oil (TTO) topical gel versus placebo on Demodex density (Dd) and clinical manifestation using standard skin surface biopsy (SSSB) in rosacea patients. PATIENT/METHODS: In this double-blind, randomized clinical trial, 47 papulopustular rosacea patients were enrolled, with 35 patients finishing the 12 weeks of treatment. Each patient used permethrin 2.5% with TTO on one side of the face and a placebo on the other, twice daily for 12 weeks. SSSB, photography and clinical rosacea scores according to National Rosacea Society, as well as adverse drug reaction (ADRs) were reported at the baseline, 2nd, 5th, 8th, and 12th weeks. RESULTS: A total of 47 patients were enrolled with papulopustular rosacea, and 35 patients finished the study. The effects of permethrin 2.5% with TTO gel on mite density were significant at week 5, 8, 12 (P value = .001). Clinical features and global assessments showed papules, pustules and nontransient erythema had improvement in drug group after 12 weeks (P values <.05). The improvement of burning and stinging and dry appearance was greater than the placebo gel (P value <.05). Itching in placebo group was significantly more than other group (P value = .002). CONCLUSION: Administration of permethrin 2.5% with TTO gel demonstrated good efficacy and safety in rosacea. This topical gel inhibited the inflammatory effects of rosacea and reduced Demodex mite. PMID: 31613050 [PubMed - as supplied by publisher] {url} = URL to article
    • I have with my care controlled or you can say remitted the condition of rosacea. It is less exacerbating and only bothers in fall and winter and I have control over it at many times but how stress and less sleep can relapse the condition of rosacea when it is already in control, I have experienced. The dilation of blood capillaries start showing and the erythematic condition characterized by flushing is more prevalent when there were less signs. So the things you can do are take more antioxidants since stress means if you go beyond it is cellular stress which changes the skin resident proteins and immune cells and do the things which help alleviate stress so that you can have good sound sleep because again less sleep means increasing the oxidative stress. Antioxidants and good sleep are the main things you can count on.
    • Related Articles Gnathophyma. Skinmed. 2018;16(1):45 Authors: Kumar P, Das A PMID: 29551113 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Well-Circumscribed Localized-Rhinophyma as a Very Rare Presentation of Rhinophyma. Iran J Otorhinolaryngol. 2019 Sep;31(106):323-326 Authors: Kavoussi H, Ramezani M, Ahmadaghaei F, Ghorbani I, Eftekhari Pirouz H, Kavoussi R Abstract Introduction: Rhinophyma is an uncommon subtype of rosacea, the clinical diagnosis of which is straightforward. However, localized, especially well-circumscribed, rhinophyma is a very rare condition, which requires a paraclinical assessment to be accurately diagnosed. Case Report: We report a 48-year-old male patient who presented with a well-circumscribed and dark red tumoral mass of 28 mm in diameter and smooth consistency in the right nasal ala. The patient had no former and concomitant characteristic skin lesions on the other part of his face. Histopathology and immunohistochemistry assessments documented the diagnosis of rhinophyma. Conclusion: To the best of our knowledge, this is the first case report of well-circumscribed localized rhinophyma. This lesion can be treated by CO2 laser in a fast and efficient manner with esthetically satisfactory outcome and no significant complications. PMID: 31598502 [PubMed] {url} = URL to article
    • "All the cases, spreading rose petals on their face, at the end of the treatment show a decrease of the redness as well, and their “facies” exhibit a dark pinkish colour, that correspond to a real flesh-coloured appearance, that reveals a complete status of good health and remission of the syndrome." Our Dermatology Online, Letter to the Editor Rosacea treated with rose petals: a calembour that affffords intriguing results Piotr Brzezinski, Lorenzo Martini Since obtaining rose petals is without a doubt an easy task for most rosaceans worldwide, we should be able to easily confirm if this treatment works. Please post your results in this thread.  Thayers Alcohol-free Rose Petal Witch Hazel with Aloe Vera Thayers Natural Remedies Alcohol-Free Rose Petal Witch Hazel Facial Mist Toner
    • There is a new cosmetic version of the ZZ cream now available on Amazon which is priced at $39 with free shipping until November 16, 2019. After this date the price goes up to $49. To learn more about this and what the difference is between the cosmetic ZZ cream and the original ZZ click here.  I haven't used the ZZ cream for probably around nine months. I tried the horse paste because there were so many who raved about the success they were having with it and I must say, it is just as good or better than Soolantra. I just received a new shipment of the Cosmetic ZZ cream and must say this is an improved version and works much better and I have always preferred using the original ZZ cream over any other topical treatment for rosacea. Within a week my red spots have cleared up. I highly recommend you try a three month supply of the Cosmetic ZZ cream or at the very least one jar to see if your rosacea improves. If it does, you have demodectic rosacea. 
    • Related Articles Association of rosacea with inflammatory bowel disease: A MOOSE-compliant meta-analysis. Medicine (Baltimore). 2019 Oct;98(41):e16448 Authors: Wang FY, Chi CC Abstract Rosacea has been reported with several systemic comorbidities, but its relationship with inflammatory bowel disease (IBD) is unclear. Thus, our objective is to conduct a meta-analysis on the association of rosacea with IBD.We conduct a meta-analysis and searched MEDLINE, CENTRAL, and Embase databases for case-controlled and cohort studies that assessed the association of rosacea with IBD from inception to July 2nd, 2018. Two authors independently selected studies, extracted data, and assessed the risk of bias of included studies. Disagreement was resolved by discussion. We performed random-effects model meta-analysis to obtain the pooled risk estimates for Crohn disease (CD) and ulcerative colitis (UC) in patients with rosacea.We included three case-control and three cohort studies. The risk of bias of included studies was generally low. The meta-analysis on case-control studies showed marginally increased odds of CD (pooled odds ratio (OR) 1.30, 95% confidence interval (CI) 0.99-1.69) and a significantly increased odds of UC (pooled OR 1.64, 95% CI 1.43-1.89) in patients with rosacea. The meta-analysis on cohort studies demonstrated significant increased risk of CD (pooled hazard ratio (HR) 1.58, 95% CI 1.14-2.20) and UC (pooled HR 1.18, 95% CI 1.01-1.37) in patients with rosacea.The evidence indicates an association of rosacea with IBD. If patients with rosacea suffer from prolonged abdominal pain, diarrhea, and bloody stool, referral to gastroenterologists may be considered. PMID: 31593075 [PubMed - in process] {url} = URL to article
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