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    • Related Articles The Spectrum and Sequelae of Acne in Black South Africans Seen in Tertiary Institutions. Skin Appendage Disord. 2018 Oct;4(4):301-303 Authors: Dlova NC, Mosam A, Tsoka-Gwegweni J Abstract
      Introduction: Acne is a chronic disorder of the pilosebaceous unit affecting all ethnic groups. It remains in the top 5 skin conditions seen worldwide. The paucity of data characterizing acne in South African Blacks led us to the documentation of types and sequelae of acne.
      Methods: This is a cross- sectional study describing the spectrum and variants of acne in 5 tertiary hospitals in the second most populous province in South Africa over 3 months (January 1 - March 31, 2015).
      Results: Out of 3,814 patients seen in tertiary dermatology clinics, 382 (10%) had a primary diagnosis of acne or rosacea, forming the fourth most common condition seen. Acne accounted for 361 (94.5%); acne vulgaris was the commonest subtype at 273 (75.6%), followed by steroid-induced acne 46 (12.7%), middle-age acne 6 (1.7%), acne excoriée 2 (0.6%), and "undefined" 34 (9.4%).
      Conclusion: The observation of steroid-induced acne as the second most common variant in Black patients underlines the need to enquire about steroid use and education about the complications of using steroid-containing skin-lightening creams. Treatment of postinflammatory hyperpigmentation should be part of the armamentarium for holistic acne treatment in Blacks, as it remains a major concern even after active acne has resolved.
      PMID: 30410901 [PubMed] {url} = URL to article
    • Related Articles Comprehensive Diagnosis and Planning for the Difficult Rhinoplasty Patient: Applications in Ultrasonography and Treatment of the Soft-Tissue Envelope. Facial Plast Surg. 2017 Oct;33(5):509-518 Authors: Kosins AM PMID: 28962057 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Body Piercing: A National Survey in France. Dermatology. 2018 Nov 07;:1-8 Authors: Kluger N, Misery L, Seité S, Taieb C Abstract
      BACKGROUND: There are no recent data available in France regarding body piercing (BP).
      OBJECTIVE: We examined the demographics, motivations, quality of life, cutaneous conditions, and cutaneous side effects after BP within the French population.
      METHODS: A representative sample of 5,000 individuals (aged 15 and over) from the general population responded to a survey online between April and August 2017. Data regarding demographics, BP characteristics (location, age at first piercing, hesitation, regrets, motivations, cutaneous side effects), tobacco, skin conditions (acne, contact eczema, atopic eczema, rosacea, psoriasis, vitiligo), and tattoos were collected. Respondents also filled an SF-12 quality of life questionnaire.
      RESULTS: Overall, 12% of the respondents reported at least one BP (women: 19.4%, men: 8.4%, p < 0.01). The prevalence was highest among those aged between 25 and 34 years (25.8%). Individuals with BP were more likely to smoke (p < 0.01). The most common body parts for piercings were the external part of the ear (42%), the navel (24%), the tongue (15%), and the nose (11%). Gender differences included localization (belly button and nose for women, eyebrows for men) and motivations (embellishment of the body for women, individuality and sexuality for men). A total of 33.6% of the study participants reported having skin problems after BP, primarily infection (44%). Individuals with BPs were more likely to report having contact eczema, atopic dermatitis, and acne. BP was associated with a lower mental quality of life score.
      CONCLUSION: This is the largest epidemiological study on BP in France to date. It allows us to draw a precise current snapshot of French indi viduals with BP.
      PMID: 30404090 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles [Not Available]. Ugeskr Laeger. 2016 Jan 25;178(4):V66927 Authors: Carlsen BC, Larsen HK, Hædersdal M PMID: 26815717 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles The microbiome in dermatology. Clin Dermatol. 2018 May - Jun;36(3):390-398 Authors: Musthaq S, Mazuy A, Jakus J Abstract
      The skin supports a delicate ecosystem of microbial elements. Although the skin typically acts as a barrier, these microbes interact with the internal body environment and imbalances from the "healthy" state that have been linked to several dermatologic diseases. Understanding the changes in microbial flora in disease states allows for the potential to treat by restoring equilibrium. With the rising popularity of holistic and natural consumerism, prebiotics, probiotics, symbiotic, and other therapies are under study to find alternative treatments to these skin disorders through manipulation or supplementation of the microbiome.
      PMID: 29908581 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles The relationship between inflammatory bowel disease and rosacea over the lifespan: A meta-analysis. Clin Res Hepatol Gastroenterol. 2018 Oct 30;: Authors: Han J, Liu T, Zhang M, Wang A Abstract
      BACKGROUNDS AND AIMS: It has been argued that the relationship between inflammatory bowel disease (IBD) and rosacea is bi-directional, but this hypothesis has not been explicitly tested. This systematic review examines the bi-directional prospective relationships between IBD and rosacea.
      METHODS: A comprehensive search through PubMed and EMBASE was undertaken for studies investigating the association between two mainly forms of IBD [ulcerative colitis (UC) and Crohn's disease (CD)] and rosacea published in English until Jan 2018. Reviewers assessed the eligibility of each report by exposure/outcome measurement and study design. Two sets of pooled risk estimates were calculated using fixed or random effects: the direction from IBD to rosacea and rosacea to IBD.
      RESULTS: Five publications on 13 separate study results involving 5,051,356 participants were eligible for this meta-analysis. A total of 6 outcomes established the direction of association from IBD to rosacea, and 7 outcomes examined the direction of association from rosacea to IBD. Compared to a non-rosacea population, the pooled RR (95% CI) for overall IBD, UC and CD were 1.32 (1.18-1.49), 1.19 (1.02-1.38) and 1.52 (1.25-1.84), respectively (P < 0.05). Meanwhile, the summary RR (95% CI) of rosacea in overall IBD, UC and CD patients were 1.66 (1.50-1.84), 1.69 (1.48-1.93) and 2.08 (1.26-3.46), respectively (P < 0.05).
      CONCLUSION: Our meta-analysis confirmed a significant bi-directional association in occurrence of IBD and rosacea. Future studies should specifically investigate possible shared pathophysiological mechanisms between the two disorders.
      PMID: 30389397 [PubMed - as supplied by publisher] {url} = URL to article
    • Thanks Apurva, and also thanks for your article on co-existence. 
    • Dear Admin, Thank you for the information of posting article. I did not know about that. Next time I will copy and paste my article in the given space.
    • Hi Apurva,  I was reluctant to download a docx file since it is an odd way of posting instead of simply copying and pasting your document into the post?  I checked to see if your file contained any viruses or malware by using VirusTotal and it passed, so I opened the file and I am copying and pasting your article here for the benefit of everyone else not having to go through this process. It might be best to simply write your posts. Here is the contents of your article below:  begin article___________ Co-existence of Rosacea, Seborrheic dermatitis and Blepharitis
      There have been a lot of reports on accounting other chronic skin conditions with rosacea and it is true that you can have multiple conditions simultaneously with rosacea.
      I have experienced rosacea, seborrheic dermatitis and blepharitis together with the combination of erythema and telangiectasia. The very first time this condition appeared as a lesion on half part of nose and cheek and then covered the other part of the face with having scaly torn skin and inflamed eyes.
      After years of my experience and dealing with these conditions, the symptoms include :
      Swollen flushed skin, visible dilated blood vessels with stinging and burning sensation on face.
      SD can cause skin scaly and flaky and can burn with itch and appears mostly on front hair line,forehead and eyebrows that if you itch the flaky and crusty skin falls off like dandruff.
      Blepharitis usually involves upper eyelid and causes inflamed eyelids, teary red eyes and the most important visual aspect is greasy dandruff like scales form on eyelashes covering half of it.
      The conditions can go beyond your cheeks and nose and affect earlobes and chin area and can cause flaky and rough chin area with small bumps.
      The flare ups can last anywhere from few minutes to one day or to one month and they again come back but when it goes you can feel the temperature decrease but it can leave red bumps that looks like acne but gradually the red appearance goes with time but it waxes and wanes.
      Co-existence :
      The occurrence of other chronic inflammatory diseases like seborrheic dermatitis and blepharitis are common in patients with rosacea and the good news is, the treatment of other condition does not aggravate the signs and symptoms of rosacea and lessen the flare ups in the meantime.
      Blepharitis is an inflammation of the eyelids in which the base of the eyelids are swollen and red and flaky greasy like crusts occur around the eyelashes with frequently mildly sticking eyelids and flaky dandruff of eyebrows sometimes called seborrheic blepharitis.(1)
      It is reported that demodex can worsen the condition of rosacea but it can also aggravate the condition of seborrheic blepharitis.(2)
      SD can typically occur as rash on the face and a sheet of lesion on back and middle chest area and middle and underneath breast lines. The underlying cause of seborrhoeic dermatitis is not clear, but a type of yeast called Malassezia furfur is involved.(3) I will emphasize these conditions thoroughly in later posts but for now I will explain the treatment I had with these three conditions :
      When my doctors diagnosed these three conditions, first they prescribed me low dose oral doxycycline capsules (100mg) daily at night.
      1.    Doxycycline is an antibiotic used for treating bacterial infections.The drug is also sold under the brand names Oracea, Doryx, Monodox, Periostat, and Vibramycin. Doxycycline is in a class of medications called tetracyclines, and it's a broad-spectrum antibiotic, it works against a wide range of bacteria.This medication is used to prevent malaria and treat a wide range of infections, including: skin infection.(4,5)
           Side effects: stomach upset, constipation, nausea, heavy head.
      2.    You can apply topical metronidazole gel 0.75% on the affected skin area.  Apply a thin layer of gel once or twice daily.I used to apply once at night daily.
      It is an antibiotic and it works by decreasing redness and inflammation by stopping the growth of certain bacteria and parasites.This antibiotic treats only certain bacterial and parasitic infections. It will not work for viral infections. (6)
            Side effects : burning and eye irritation if it gets close to the eyes.
      3.     Ketoconazole 2 % and Zinc pyrithione 1 % (Shampoo) for the fungal and yeast infections of the skin. Ketoconazole an active ingredient works by interfering and weakening with the formation of the fungal cell membrane. It better works with seborrheic dermatitis and blepharitis. Thoroughly apply on wet hair and massage and leave it for 5 minutes and then rinse it out. It does not make lather like other shampoos. Take a drop on finger, rub it and apply gently on eyelashes on tightly closed eyes and rinse it properly. With 8 weeks of proper use twice in a week completely cured me with SD and blepharitis.
            Side effects : itchy and dry scalp
      4.    If you have dermatitis on your chest and breast lines and back, you can use the composition of Boric acid and  Clotrimazole cream together. It works by reducing inflammation and inhibiting the growth of fungi.
      Apply a thin layer of this base and rub until it absorbs completely twice or thrice daily. I applied this on my front              and back area for four to five days and it worked wonder and the lesions gradually disappeared.
      Note : before taking any above medication consult your doctor or physician and alcohol should not be consumed during any medication it can worsen the condition of rosacea and if you are pregnant or on breast-feeding and any other condition like diabetes or heart problem, take this medications as directed by your doctor.
      Instead relying on oral and topical steroids my doctor prescribed me with bacterial and fungal medications because taking steroids for SD and blepharitis can exacerbate the condition of rosacea and relying on antibiotics and anti-fungal treatments can lessen the condition of SD and blepharitis and keep the rosacea at bay. References :
      https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis.(1)
      http://eyewiki.aao.org/Blepharitis.(2)
      http://www.londoneyeunit.co.uk/services/blepharitis/.(3)
      https://www.everydayhealth.com/drugs/doxycycline.(4)
      https://www.webmd.com/drugs/2/drug-8648-7073/doxycycline-hyclate-oral/doxycycline-oral/details.(5)
      https://www.webmd.com/drugs/2/drug-6426/metro
        end article_________________  
    • article.docx   Administrator Note: Read the next post that explains the above. 
    • Association between rosacea severity and relative muscle mass: A cross-sectional study. J Dermatol. 2018 Oct 31;: Authors: Nam JH, Yang J, Park J, Seo JH, Chang Y, Ryu S, Kim WS Abstract
      Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross-sectional study was conducted on subjects who attended a skin check-up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86-38.40%, 38.41-43.44% and 43.45-80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (Ptrend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22-26.20) and 4.43 (1.12-17.55), respectively (Ptrend = 0.03). This association was present in women with marginal significance (Ptrend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation.
      PMID: 30379346 [PubMed - as supplied by publisher] {url} = URL to article
    • Thanks so much for your post, very detailed and informative and without a doubt will help many. 
    • Here are some treatment options for demodex skin mites.   I did the combined 2 week oral therapy with Oral Ivermectin * Oral Metronidazole. It worked after years of being misdiagnosed with acne (bacterial) and "allergic conjunctivitis" and given quite a variety of useless antibiotics, retinoids and prescription benzoyl peroxide that didn't work.  8+ months after this treatment my skin and eyes are still clear - first time in many years. This oral prescription treatment was published in the May 2013 issue of the International Journal of Infectious Diseases. The combined 2 drug treatment was more effective than oral Ivermectin alone.

      Using the more effective 2 drug combined treatment (from paper) based on body weight for the oral Ivermectin:
      1. Two doses of oral Ivermectin one week apart. Each weekly dose is 200 micrograms Ivermectin per kilogram of body weight. My doctor rounded the dose up some since they tablets are 3 mg - that avoided having to break tablets. Worked out to 12 mg per dose for me. Take on an empty stomach with a large glass of water.
      2. Oral Metronidazole, 250 mg. three times a day for two weeks. Do not drink alcohol while taking oral Metronidazole and for 72 hours after taking the last tablet.

      I didn't have any problems with either drug. Although, the first dose of Ivermectin did make me sleepy. Got a great 2 hour nap out of it.  Cost:  With insurance copay just $13.03 or about $52 full retail. Here's some links to the May 2013 Journal of Infectious Diseases article:

      Summary of results:
      https://www.ncbi.nlm.nih.gov/pubmed/23294870

      Full Journal Article:
      https://www.sciencedirect.com/scienc...0197121201315X

      It may be wiser to try the Ivermectin first instead of the Roacutane. Roacutane shuts down the oil glands which will reduce the oil eating mite population by starving some of them. But Roacutane will not kill all of the mites. A lot of people seem to have rebound problems after completing the Roacutane treatment. Roacutane also has a lot of serious side effects. Roacutane treatment takes months longer as well. Additional topical treatments effective against demodex skin mites:
      A tea tree oil facial cleanser and overnight tea tree oil moisture cream or tea tree oil ointment can also provide topical support to kill the mites, especially at night. The male mites come out on the skin surface at night to mate. Tea Tree oil can kill the mites or at the very least ruin their love life.

      Tea Tree Oil cleansers:

      1. The Body Shop Tea Tree Skin Clearing Facial Wash (liquid). Available from The Body Shop store or online, or Amazon.
      2. The Body Shop Tea Tree Clearing Foaming Cleanser. Available from The Body Shop store or online, or Amazon.
      3. Desert Essence Thoroughly Clean Face Wash - Available at Kroger, Sprouts, Amazon
      4. Tranquil Eyes 1% (or 2%) Gentle Formula Tea Tree Eyelid and Facial Cleanser by eyeEco - Available at Amazon

      Tea Tree Oil Moisturizer or Ointment - 5% Tea Tree Oil is a good minimum
      1. Desert Essence Tea Tree Oil Skin Ointment - Available at Sprouts, Amazon
      2. Derma e Tea Tree and Vitamin E Relief Cream - Available at Sprouts, Amazon
      3. The Body Shop Tea Tree Night Lotion

      Warning: Tea Tree Oil should never be used at full strength - it can burn and it can be toxic if ingested. It should be diluted with another carrier oil like grapeseed oil or castor oil to no stronger than 50% - even that may be too strong for sensitive skin. 5-10% is the strongest that most face washes or night cremes will contain.

      Hypochlorous acid sprays can also help. Hypochlorous acid is a mild acid and a natural antiseptic, the same as made by the human body in response to a cut or scrape. It kills mites especially in the nymph stage. (Heyedrate and Occusoft are 2 brands available from Amazon). Spray face and eyelids and let dry prior to putting on the nightly moisturizer/ointment. If your face feels itchy in the middle of the night, spray again.

      Borax Treatments:
      Borax DIY shampoo (1 TBSP of 20 Mule Team Borax (grocery store laundry aisle) per cup of hot water, mix in hot water and stir, cool and pour in a clean shampoo bottle) can also be used to wash hair and face. Borax shampoo is a no lather shampoos, use the same as you would any shampoo. Borax kills the mites. Demodex skin mites may also cause what appears to be body acne as well as tchy skin.  The mites can make your skin itch - this borax soak will soothe the skin by killing the mites.  Borax bath soaks can be very helpful in treating demodex that has spread to other parts of the body.  Bath body soak below is for a standard 5 foot bathtub: 1. Start filling tub with pleasantly warm bath water.  Do not make the water too hot as that can over heat you. 2. Add 1 cup 20 Mule Team Borax (available in the laundry aisle at most grocery stores about $5.50 per box). 3.  Add 1 cup Dr. Teal's Epsom Salts (Coconut Oil version is good to aid skin moisture). 4.  Swish water to dissolve the Borax and the Epsom Salts. 5.  Soak for 30 minutes.  Wash your hair and face too and let the solution stay on the face and hair while you soak. 6.  Shower after soaking, rinsing hair too, conditioning hair if needed.
       
    • Related Articles Nasal tip schwannoma mimicking rhinophyma. BMJ Case Rep. 2017 Dec 20;2017: Authors: Geyton T, Henderson AH, Morris J, McDonald S PMID: 29269374 [PubMed - indexed for MEDLINE] {url} = URL to article
    • [FEATURES OF ROSACEA PATHOGENESIS IN PERIMENOPAUSAL WOMEN]. Georgian Med News. 2018 Sep;(282):99-102 Authors: Tsiskarishvili T, Katsitadze A, Tsiskarishvili NV, Mgebrishvili E, Tsiskarishvili NI Abstract
      In patients with rosacea, the monitoring of blood melatonin in the menopausal period, as one of the criteria for assessing the severity of the disease, seems appropriate and pathogenetically justified. The aim of this study was determination of blood melatonin, VEGF, IL-8 concentration in perimenopausal period of women suffering by rosacea. 43 to 65 years old 15 women with various clinical manifestations of rosacea, and severe climacteric syndrome were under observation. The control group consisted of 15 female patients with rosacea but without climacteric syndrome. Melatonin, VEGF,IL-8 level in serum were determined by ELISA (IBL - international - reagent), the results were expressed in pg/ml).As the results of the study showed, the concentration of vasoactive peptides in patients with rosacea differes significantly from those in the control group. Increase the concentration of cytokinesin in the blood of patients with rosacea indicate that they are playing significant role in the pathogenesis of rosaceaAccording to the results of the study, the concentration of melatonin was reduced in all patients with rosacea (the main group). The degree of reduction was in direct correlation with the severity of climacteric syndrome (11,6÷1,5 pg/ml at a rate of ≥ 20,0 pg/ml). In the control group, the melatonin concentration was approaching to the norm (19.1 pg/ml). Statistical analysis of received data revealed the correlation in between of the severity of dermatosis and changes in lipid metabolism and concentration of melatonin (R = 0,91; p <0,05) in the main group of patients (with rosacea and climacteric period). Thus, on the basis of the obtained results it can be concluded that the inclusion of melatonin-containing preparations in prescription for rosacea patients having climacteric syndrome pathogenetically is justified.
      PMID: 30358550 [PubMed - in process] {url} = URL to article
    • Leo Pharma has announced it is purchasing Finacea, as well as other dermatological treatments from Bayer according to this news release. 
    • Nasdaq reports "Aclaris Therapeutics to Acquire Worldwide Rights to RHOFADE® from Allergan." Aclaris originally owned Rhofade and sold it to Allergan and is now buying it back. 
    • Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea In Women. JAMA Dermatol. 2018 Oct 17;: Authors: Li S, Chen ML, Drucker AM, Cho E, Geng H, Qureshi AA, Li WQ Abstract
      Importance: Caffeine is known to decrease vasodilation and have immunosuppressant effects, which may potentially decrease the risk of rosacea. However, the heat from coffee may be a trigger for rosacea flares. The relationship between the risk of rosacea and caffeine intake, including coffee consumption, is poorly understood.
      Objective: To determine the association between the risk of incident rosacea and caffeine intake, including coffee consumption.
      Design, Setting, and Participants: This cohort study included 82 737 women in the Nurses' Health Study II (NHS II), a prospective cohort established in 1989, with follow-up conducted biennially between 1991 and 2005. All analysis took place between June 2017 and June 2018.
      Exposures: Data on coffee, tea, soda, and chocolate consumption were collected every 4 years during follow-up.
      Main Outcomes and Measures: Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005.
      Results: A total of 82 737 women responded to the question regarding a diagnosis of rosacea in 2005 in NHS II and were included in the final analysis (mean [SD] age at study entry, 50.5 [4.6] years). During 1 120 051 person-years of follow-up, we identified 4945 incident cases of rosacea. After adjustment for other risk factors, we found an inverse association between increased caffeine intake and risk of rosacea (hazard ratio for the highest quintile of caffeine intake vs the lowest, 0.76; 95% CI, 0.69-0.84; P < .001 for trend). A significant inverse association with risk of rosacea was also observed for caffeinated coffee consumption (HR, 0.77 for those who consumed ≥4 servings/d vs those who consumed <1/mo; 95% CI, 0.69-0.87; P < .001 for trend), but not for decaffeinated coffee (HR, 0.80; 95% CI, 0.56-1.14; P = .39 for trend). Further analyses found that increased caffeine intake from foods other than coffee (tea, soda, and chocolate) was not significantly associated with decreased risk of rosacea.
      Conclusions and Relevance: Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes.
      PMID: 30347034 [PubMed - as supplied by publisher] {url} = URL to article
    • The role of phosphodiesterase 4 in the pathophysiology of atopic dermatitis and the perspective for its inhibition. Exp Dermatol. 2018 Oct 17;: Authors: Guttman-Yassky E, Hanifin JM, Boguniewicz M, Wollenberg A, Bissonnette R, Purohit V, Kilty I, Tallman AM, Zielinski MA Abstract
      Atopic dermatitis (AD) is a highly prevalent, chronic inflammatory skin disease that affects children and adults. The pathophysiology of AD is complex and involves skin barrier and immune dysfunction. Many immune cytokine pathways are amplified in AD, including T helper (Th) 2, Th22, Th17 and Th1. Current treatment guidelines recommend topical medications as initial therapy; however, until recently, only two drug classes were available: topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs). Several limitations are associated with these agents. TCSs can cause a wide range of adverse effects, including skin atrophy, telangiectasia, rosacea and acne. TCIs can cause burning and stinging, and the prescribing information lists a boxed warning for a theoretical risk for malignancy. Novel medications with new mechanisms of action are necessary to provide better long-term control of AD. Phosphodiesterase 4 (PDE4) regulates cyclic adenosine monophosphate in cells and has been shown to be involved in the pathophysiology of AD, making it an attractive therapeutic target. Several PDE4 inhibitors are in clinical development for use in the treatment of AD, including crisaborole, which recently became the first topical PDE4 inhibitor approved for treatment of mild to moderate AD. This review will further describe the pathophysiology of AD, explain the possible role of PDE4 in AD and review PDE4 inhibitors currently approved or being investigated for use in AD. This article is protected by copyright. All rights reserved.
      PMID: 30332502 [PubMed - as supplied by publisher] {url} = URL to article
    • Besides still taking the Lutein/Zeazanthin treatment, I use the ZZ cream about four or five nights a week on some red spots, however, in addition, before I do apply the ZZ cream,  I have been applying a small amount (half teaspoon) of 3% hydrogen peroxide from Walmart (57 cents a bottle) to some red spots and let this dry before applying the ZZ cream. I have noticed when applying the 3% hydrogen peroxide it doesn't sting but after it dries and deeply penetrates the skin I get some stinging which is odd to me but indicates it is finding something down deeper in my skin to work on. The results have been good so I am updating my photos below today: 
    • Related Articles Integrating the Integumentary System with the Arts: A Review of Dermatologic Findings in Artwork. J Clin Aesthet Dermatol. 2018 Sep;11(9):21-27 Authors: Om A, Om A Abstract
      The objectives of this review are to demonstrate that portraits, in their visual reflections of subjects faces and expressions, offer significant representations relevant to the field of dermatology and bring attention to an underappreciated aesthetic of dermatological conditions. The review comprises paintings that purposefully or inadvertently depict dermatological conditions. The findings were substantiated by searching PubMed using the keywords art, painting, and dermatology, as well as combinations of these terms. The "Notable Notes" section of JAMA Dermatology proved especially useful. The review is subdivided by disease category, including portraits that display infectious diseases, neoplastic conditions, genetic dermatoses, rosacea and/or acne, and autoimmune disorders. The breadth of examples of dermatology represented in art suggest that portraits might serve as an unintentional atlas of dermatological conditions. By implication, it seems that the arts might be more interconnected to the sciences than traditionally acknowledged.
      PMID: 30319727 [PubMed] {url} = URL to article
    • The toxic edge-A novel treatment for refractory erythema and flushing of rosacea. Lasers Surg Med. 2018 Oct 12;: Authors: Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O Abstract
      PURPOSE: Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea.
      METHODS: A retrospective review of16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 U of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument.
      RESULTS: The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping.
      CONCLUSION: Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
      PMID: 30311683 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Effects of combined oral doxycycline and topical cyclosporine treatment on ocular signs, symptoms, and tear film parameters in rosacea patients. Arq Bras Oftalmol. 2018 Oct 08;: Authors: Bilgin B, Karadag AS Abstract
      PURPOSE: This study reports the effects of combined use of oral doxycycline and topical cyclosporine on ocular signs, symptoms, and tear film parameters in rosacea patients.
      METHODS: Fifty-four right eyes of 54 patients were included in this study. All patients underwent full ophthalmologic examination-including best corrected visual acuity measurement, slit-lamp anterior segment and fundus examination, tear film break-up time, and Schirmer test-before treatment and six months post-treatment. Patients were divided into two treatment groups. The first group was treated with oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. The second group received topical 0.05% cyclosporine emulsion drops twice daily for six months in addition to the oral doxycycline treatment regimen. All patients received preservati ve-free artificial tear drops, warm compress, eyelash cleaning, and topical corticosteroid drops three times daily for one month.
      RESULTS: A significant improvement in ocular signs and symptoms was recorded for all patients in groups 1 and 2 after treatment. There was not a significant difference in terms of itching, burning, meibomian gland inspissation, corneal neovascularization, and conjunctival hyperemia score changes between groups 1 and 2. The increases in Schirmer test and break-up time scores were significantly higher in group 2 than in group 1.
      CONCLUSIONS: Our results support the finding that topical cyclosporine in addition to the standard regimen improves tear function, as shown by Schirmer test and break-up time scores, in ocular rosacea patients.
      PMID: 30304088 [PubMed - as supplied by publisher] {url} = URL to article
    • smart2005ct, That is such good news you are seeing Percy Lehmann, MD, who volunteers on the RRDi MAC. Keep us posted on your progress.     
    • Hello Brady! Greetings from Wuppertal Germany! I have succeeded with God help and the CEO of my bank to land in Germany at the door of prof. dr. Percy Lehmann at Helios Clinic. Keep the fingers crossed for me. Very interesting report. I have the feeling that for the very first time they got it that we are all unique and different and we need unique treatments. Also I am so glad that they have realized how big the psyhological burden is for Rosaceans and how Rosacea can destroy your social life. I cant wait for better days and a new life and the the same thing for all of us. Keep in touch. Hugs. PS: I am glad to be connected on LinkedIn with two of the authors of this report Dr. Anthony Bewley and Prof. Dr. Uwe Gieler
    • Related Articles Trends in utilization of topical medications for treatment of rosacea in the United States (2005-2014) - a cohort analysis. J Am Acad Dermatol. 2018 Oct 01;: Authors: Lev-Tov H, Rill JS, Liu G, Kirby JS PMID: 30287319 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Acute localised exanthematous pustulosis due to metronidazole. J Eur Acad Dermatol Venereol. 2018 Oct 05;: Authors: Kostaki M, Polydorou D, Adamou E, Chasapi V, Antoniou C, Stratigos A Abstract
      Dear Editor, a 78-year-old male patient known for hypertension consulted for a pustular eruption of the face of acute onset. The patient was receiving oral metronidazole as a treatment for rosacea and reported the sudden development of multiple pustules on the face 2 days after the initiation metronidazole. Physical examination revealed the presence of multiple minuscule, non-follicular pustules of the face on an erythematous, edematous background (Fig.1). This article is protected by copyright. All rights reserved.
      PMID: 30288796 [PubMed - as supplied by publisher] {url} = URL to article
    • Brimonidine displays anti-inflammatory properties in the skin through the modulation of the vascular barrier function. Exp Dermatol. 2018 Oct 05;: Authors: Bertino B, Blanchet-Réthoré S, Thibaut de Ménonville S, Reynier P, Méhul B, Bogouch A, Gamboa B, Dugaret AS, Zugaj D, Petit L, Roquet M, Piwnica D, Vial E, Bourdès V, Voegel JJ, Nonne C Abstract
      BACKGROUND: Rosacea is a chronic inflammatory skin disease. Characteristic vascular changes in rosacea skin include enlarged, dilated vessels of the upper dermis and blood flow increase. Brimonidine is approved for symptomatic relief of the erythema of rosacea. It acts by selectively binding to α2-adrenergic receptors present on smooth muscle in the peripheral vasculature, resulting in transient local vasoconstriction.
      OBJECTIVES: To provide further evidence of the anti-inflammatory potential of brimonidine across preclinical models of skin inflammation and its ability to decrease the neutrophil infiltration in human skin after ultraviolet light exposure.
      METHODS: The anti-inflammatory properties of brimonidine through modulation of the vascular barrier function were assessed using in vivo neurogenic vasodilation and acute inflammatory models and a well-described in vitro transmigration assay. A clinical study assessed the neutrophil infiltration in human skin after exposure to UV in 37 healthy Caucasian male subjects.
      RESULTS: In vitro, brimonidine affects the transmigration of human neutrophils through the endothelial barrier by modulating adhesion molecules. In vivo, in the mouse, topical treatment with brimonidine, used at a vasoconstrictive dose, confirmed its anti-inflammatory properties and prevented leukocyte recruitment (rolling and adhesion) mediated by endothelial cells. Topical pre-treatment with brimonidine tartrate 0.33% gel once a day for four days significantly prevented neutrophil infiltration by 53.9% in human skin after exposure to UV light.
      CONCLUSION: Results from in vitro, in vivo and from a clinical study indicate that brimonidine impacts acute inflammation of the skin by interfering with neurogenic activation and/or recruitment of neutrophils. This article is protected by copyright. All rights reserved.
      PMID: 30290018 [PubMed - as supplied by publisher] {url} = URL to article
    • Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea. J Cosmet Laser Ther. 2018 Oct 04;:1-6 Authors: Kim BY, Moon HR, Ryu HJ Abstract
      BACKGROUND: Laser and light-based therapies have often been used successfully to treat rosacea. Recently, short-pulsed intense pulsed light (IPL) that emitted pulse durations down to 0.5 ms was found to be effective for rosacea treatment.
      OBJECTIVE: This study evaluated the efficacy of short-pulsed IPL in the treatment of rosacea compared with pulsed dye laser (PDL) using same pulse duration and fluence.
      MATERIALS AND METHODS: Nine patients with rosacea were enrolled in a randomized, split-face trial. Each treatment consisted of four sessions at three-week intervals and followed up until three weeks after the last treatment. Efficacy was assessed by erythema, melanin index, physician's subjective evaluation, and patient's satisfaction.
      RESULTS: The mean change in erythema index was -4.93 ± 1.59 for the short-pulsed IPL group and -4.27 ± 1.23 for the PDL group. The mean change in melanin index was -2.52 ± 2.45 for the short-pulsed IPL group and -1.95 ± 1.41 for the PDL group. There was no significant difference in either melanin or erythema index between short-pulsed IPL and PDL treatments, and there were no noticeable adverse events.
      CONCLUSIONS: There was no significant difference between PDL and short-pulsed IPL treatment using the same energies and pulse. Both PDL and short-pulsed IPL were satisfactory and safe for rosacea treatment.
      PMID: 30285506 [PubMed - as supplied by publisher] {url} = URL to article
    • Galderma has released a report, Rosacea: Beyond the visible, which is an "An open letter to doctors treating rosacea," answering seven questions proposed  about treating rosacea. Galderma sponsored a 'global survey of rosacea burden' of 710 rosaceans and 554 doctors which is used as data for the report with the stated goal of achieving total clearance (IGA 0). The report acknowledges, "Although we can’t yet promise ‘clear’ to all people, current treatments are now getting more people to ‘clear’, with combined therapy or even with monotherapy. By aiming for ‘clear’ (IGA 0) we can help free more people from their rosacea burden." One statement that explains rosacea best in the report is, "Ultimately, rosacea is a subjective and entirely individual experience." While we try to categorize rosacea into phenotypes and treatment protocols, there is no one treatment that works for everyone. 
    • Related Articles Toll-like receptor signaling induces the expression of lympho-epithelial Kazal-type inhibitor in epidermal keratinocytes. J Dermatol Sci. 2018 Sep 15;: Authors: Sugimoto S, Morizane S, Nomura H, Kobashi M, Sugihara S, Iwatsuki K Abstract
      BACKGROUND: Lympho-epithelial Kazal-type inhibitor (LEKTI) tightly controls the activities of serine proteases such as kallikrein-related peptidase (KLK) 5 and KLK7 in the epidermis. LEKTI is known to be an essential molecule for the epidermal skin barrier, as demonstrated by SPINK5 nonsense mutation, which results in Netherton syndrome. Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns or damage-associated molecular patterns and produce inflammatory cytokines, chemokines, and antimicrobial peptides. However, the effect of TLR signaling on the expression of LEKTI is not clear.
      OBJECTIVE: To investigate whether TLR signaling can affect expression of LEKTI in epidermal keratinocytes.
      METHODS: We stimulated a panel of TLR ligands and investigated the expression of LEKTI in normal human epidermal keratinocytes (NHEKs). We further measured trypsin or chymotrypsin-like serine protease activity in NHEK cultured media under stimulation with TLR3 ligand, poly (I:C). Immunostaining for LEKTI was performed using skin samples from skin infectious diseases.
      RESULTS: TLR1/2, 3, 5, and 2/6 ligands induced the expression of LEKTI in NHEKs. The trypsin or chymotrypsin-like serine protease activity in NHEKs was up-regulated with the stimulation of poly (I:C). The gene expressions of KLK6, KLK10, KLK11, and KLK13 were also increased by poly (I:C). An immunohistochemical analysis demonstrated that the expression of LEKTI was up-regulated in the lesions of varicella, pyoderma, and rosacea.
      CONCLUSIONS: TLR signaling induces the expression of LEKTI in epidermal keratinocytes, which might contribute to the control of aberrant serine protease activities in inflammatory skin diseases.
      PMID: 30270115 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Unilateral Facial Telangiectasia Macularis Eruptiva Perstansmimicking as Rosacea. Indian Dermatol Online J. 2018 Sep-Oct;9(5):351-353 Authors: Sinha P, Sinha A, Raman DK, Sood A PMID: 30258811 [PubMed] {url} = URL to article
    • Related Articles Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol. 2018 Sep 26;: Authors: Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Castellanos-González M, Pugnaire MA, Grimalt R, Hermosa-Gelbard A, Bernárdez C, Molina-Ruiz AM, Ormaechea-Pérez N, Fernández-Crehuet P, Vaño-Galván S Abstract
      BACKGROUND: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology.
      AIM: To identify possible environmental and hormonal factors related to FFA.
      METHODS: We conducted a multicentre case-control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease.
      RESULTS: For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06-2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06-2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11-2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05-2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07-3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11-23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7-80.9) or antiageing creams (OR = 1.84; 95% CI 1.04-3.23).
      CONCLUSIONS: FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.
      PMID: 30259544 [PubMed - as supplied by publisher] {url} = URL to article
    • Bloomberg reports, "Nestle said Thursday it would consider new owners for its dermatological business, a unit with $2.8 billion in annual revenue that Chief Executive Officer Mark Schneider said may no longer fit with the company’s overall strategy of focusing on products such as coffee, water and pet food." [1] Nestle owns Galderma, which is part of its 'dermatological business' or 'Nestlé Skin Health.' As David Pascoe puts it, "Lets hope that a pharma with deep pockets emerges, one that sees value in the assets of Galderma and further sees a future in developing new treatments that help rosacea sufferers." [2] Rosacea sufferers usually are very much aware of Galderma's Soolantra, Oracea, Mirvaso and Metrogel (Metrocream). We shall wait and see what happens.  End Notes [1] Nestle's Step Away From Skin Health Reignites L'Oreal Sale Talk
      By Thomas Mulier  and Corinne Gretler, Bloomberg [2] Galderma for sale – why we need the right buyer, by David Pascoe, Rosacea Support Group
    • Related Articles First Report of Concomitant Tinea Faciei and Pityriasis Folliculorum: A Dermatomicrobiological Rarity. Cureus. 2018 Jul 20;10(7):e3017 Authors: Vanam HP, Mohanram K, K SRR, Poojari SS, P R A, Kandi V Abstract
      Tinea faciei (TF) is a common dermatomicrobiological condition caused by dermatophytes involving the skin of the face but not the mustache and beard (Tinea barbae). It poses a diagnostic dilemma with its atypical clinical presentation. Pityriasis folliculorum (PF) is a dermatological condition that results in rosacea-like skin eruptions. It was previously associated with a human ectoparasitic infestation. Demodex mites (Demodex folliculorum) is a group of obligate parasites that live on the skin of mammals. These mites have been associated with various dermatological disorders, clinically termed as demodicosis. Insects have been described as potential vectors that can carry various microorganisms and especially spores of fungi. Hence, infestation by such insects may aggravate the already present skin condition, leading to secondary infections. There has been a change in the trend of dermatophytosis worldwide and infections caused by Trichophyton mentagrophytesvar.interdigitale (T. interdigitale) are increasing. Hence, there is an urgent need for a thorough investigation of an infectious etiology among various skin disorders. This is the first report of concomitant Tinea faciei and Pityriasis folliculorum involving facial skin.
      PMID: 30254806 [PubMed] {url} = URL to article
    • Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review. Ophthalmic Plast Reconstr Surg. 2018 Sep 24;: Authors: Boparai RS, Levin AM, Lelli GJ Abstract
      PURPOSE: To assess the effectiveness of treatments for Morbihan disease.
      METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was performed on April 1, 2018, using PubMed, Google Scholar, and Excerpta Medica dataBASE with terms used to describe Morbihan disease, including "Morbihan Disease," "Morbihan Syndrome," "lymphedema rosacea," and "lymphedematous rosacea". Case reports or case series were included if they fulfilled the following criteria: published in English, peer-reviewed, and reported Morbihan disease.
      RESULTS: A total of 89 patients-87 patients from 49 articles and 2 cases from the authors' institution-were included in the final analysis. The median age of patients was 51 years (range: 14-79), and 66 of 89 (74%) patients were men. Male gender correlated with lack of complete response to treatment (odds ratio: 0.25; 95% confidence interval: 0.06-0.97; p = 0.02), while presence of papules or pustules correlated with complete response to treatment (odds ratio: 4.07; 95% confidence interval: 1.04-17.68; p = 0.03). Longer antibiotic duration correlated with response to treatment (p = 0.03), favoring complete over partial response (p= 0.02). Mean antibiotic duration in patients who responded was 4.43 months (standard deviation: 3.49), with complete responders requiring 6.50 months (standard deviation: 4.57). Oral corticosteroids, isotretinoins, and combination therapies did not correlate with treatment response.
      CONCLUSIONS: The presence of papules and pustules correlates with a complete response to treatment, while male gender correlates with a partial response. Patients may benefit from 4- to 6-month duration of tetracycline-based antibiotics. Prospective studies are needed to assess the impact of antibiotic and isotretinoin dose and duration on treatment response.
      PMID: 30252748 [PubMed - as supplied by publisher] {url} = URL to article
    • 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
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