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  • Misdiagnosed Rosacea


    Articles, References and Anecdotal Reports

    There are articles on rosacea that mention misdiagnosed rosacea. While this isn't a massive problem, nevertheless, here is a list of different sources that mention the subject, including (if you scroll below) many anecdotal reports of misdiagnosis. Misdiagnosis is what falls under the medical umbrella called 'medical error.' You should be aware that rosacea may be a catch all diagnosis for a number of skin conditions that present with erythema and/or pimples. The list of skin conditions that need to be differentiated from rosacea is massive. It is no wonder that misdiagnosis occasionally happens. There are reports coming out of China of using AI in computer aided diagnosis that may reduce the number of misdiagnosed rosacea in the future. 

    Add Your Report
    If you want to add your experience with misdiagnosis please post your anecdotal report in this thread, since we are not adding to this page any more anecdotal reports. If you scroll below we have over 100 anecdotal reports of misdiagnosis. More are being added as we find more or if you add your report to this thread

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    Articles and References from Reputable Authorities 

    "To the untrained eye, unusual skin presentations can cause confusion and alarm. They can also go misdiagnosed, often not getting the attention they require. This is because many skin conditions can seem similar in appearance to one another, says Shari Marchbein, board-certified dermatologist and clinical assistant professor of dermatology at New York University School of Medicine....Another common misdiagnosis is rosacea disguised as acne, says Estee Williams, a board-certified medical, cosmetic and surgical dermatologist and clinical professor in dermatology at Mount Sinai Medical Center in New York City." 
    4 Skin Conditions That Are Often Misdiagnosed, According to Dermatologists, BY ERIN NICOLE CELLETTI, Allure

    "Rosacea SKINsights sponsored by Galderma Laboratories [reveals] the lengths that women with rosacea would go to if they could get rid of their rosacea forever, and highlight the low awareness and complicated diagnosis path for this common condition. On average, women with rosacea waited at least seven months before receiving a correct diagnosis, and only half of respondents had ever heard of the condition upon the time of diagnosis. This reveals the high level of misunderstanding and confusion that surrounds rosacea..." Medical News Today

    "Currently, rosacea is only diagnosed by clinical symptoms and can be confused with other dermatological diseases such as acne."
    New Treatment or Diagnosis for Rosacea with Existing Approved Drugs
    Tech ID: 19149 / UC Case 2007-047-0
    University of California, San Diego
    Technology Transfer Office

    "Despite its apparent high incidence, the nosology of rosacea is not well established, and the term “rosacea” has been applied to patients and research subjects with a diverse set of clinical findings that may or may not be an integral part of this disorder. In addition to the diversity of clinical manifestations, the etiology and pathogenesis of rosacea are unknown, and there are no histologic or serologic markers."
    Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea

    ''Some physicians may not be aware of or recognize rosacea and may treat patients with rosacea inappropriately as if they had adult acne.''
    Dr. Jonathan Wilkin NRS Medical Advisory Board

    "Rosacea is a common dermatologic disorder. It is frequently overlooked or misdiagnosed, particularly when mild in nature."
    Rosacea: A Review of a Common Disorder by Carolyn Knox, IJAPA

    "Patients with rosacea frequently present with coexisting skin conditions, such as seborrheic dermatitis, acne, perioral dermatitis, and melasma, which may complicate diagnosis and treatment."
    Heather Roebuck, Nurse Pract. 2011 Jan 11.

    "A committee member, Dr. Mark Dahl, a dermatologist at the Mayo Clinic in Scottsdale, Ariz., said, ''This is a syndrome with lots of different elements that is easy to diagnose when all the elements are present,'' but not as easy when only one or two of the characteristics appear."
    PERSONAL HEALTH; Sometimes Rosy Cheeks Are Just Rosy Cheeks
    By JANE E. BRODY, New York Times, March 16, 2004

    "Rosacea is a complex and often misdiagnosed condition." The Rosacea Forum Moderated by Drs. Bernstein and Geronemus (site is down but you can view this statement in the Wayback Machine)

    "Whereas the classical subtypes of rosacea can be recognized quite well, the variants of rosacea may be overlooked or misdiagnosed." rosacea.dermis.net

    "Rosacea is often misdiagnosed as acne or discoid or systemic lupus erythematosus (SLE)." Christiane Northup, M.D.

    "Frequently misdiagnosed as adult acne, this chronic, progressive skin disorder affects millions." Recognizing and Managing Rosacea by Thalia Swinler, JSTOR

    "The last subtype, ocular rosacea, is common but often misdiagnosed." uspharmacist.com

    "The signs and symptoms of ocular rosacea in children may be frequently underdiagnosed or misdiagnosed..." NRS Rosacea Review, Summer 2008

    “It’s a condition that is often misdiagnosed and overdiagnosed. Sometimes a rosy cheek is just a rosy cheek.” Herbert Goodheart, M.D., a dermatologist in Poughkeepsie, N.Y., and author of “Acne for Dummies,” as quoted in the New York Times article

    "Dr. Jay points to the inherent dangers of misdiagnosis and inability to handle complications because of a limited understanding of cutaneous physiology."
    IPL: Wave of the future in rosacea therapy by John Nemec, Aug 1, 2006

    "...unusual manifestations of rosacea may be overlooked or misdiagnosed...."
    Rosacea: An Update
    Stanislaw A. Buechner
    Dermatology 2005;210:100-108 (DOI: 10.1159/000082564)

    "Rosacea is a skin condition as misunderstood as sensitive skin, and as frequently misdiagnosed." Dermilogica

    "Rosacea is a very common, but often misunderstood and misdiagnosed skin condition." skinlaboratory.com

    "Rosacea is a long lasting, non-scarring skin condition of the face that is often misdiagnosed as adult acne." Paul M. Friedman, MD

    "Rosacea is quite often misdiagnosed as any number of other skin disorders including acne." methodsofhealing.com

    "Often misdiagnosed as adult acne, allergy or eczema, Rosacea, if left untreated, tends to worsen over time...." Dana Anderson Skin Care

    "This present patient clearly had facial changes typical of acne rosacea, with erythema and telangiectasias of the cheeks, forehead, and nose. He had all the typical lid changes as well, including collarattes that are pathognomonic of staphylococcal blepharitis. Unfortunately, he had been misdiagnosed for several years…" Clinical Pearls by Janice A. Gault, p. 206

    "Due to the fact that lupus can cause a red rash across the nose and face, often in a butterfly pattern it can be confused with or misdiagnosed as rosacea. .." www.rosacea-treatment.net/

    "Dr. Callender also noted that rosacea is often misdiagnosed in patients of color, as clinicians may mistake the signs and symptoms of the condition for lupus – a systemic, autoimmune condition that commonly occurs as a “butterfly rash” involving the face."
    Treating acne and rosacea in people with skin of color - ihealthbulletin.com

    "...it's often overlooked in dark-skinned patients or misdiagnosed as lupus, which is marked by a red, butterfly-shaped rash in the center of the face,..." Shape May 2009

    "...the diagnosis of demodicosis is frequently masked by other skin diseases such as papulopustular or erythematotelangiectatic rosacea, seborrhoeic dermatitis, perioral dermatitis and contact dermatitis." Br J Dermatol. 2010 Feb 25.

    A Case of Precursor B-cell Lymphoblastic Lymphoma Misdiagnosed as Rosacea.
    Han EC, Kim DY, Chung JY, Chung HJ, Chung KY.
    Korean J Dermatol. 2008 Feb;46(2):264-267

    "It is when the first diagnosis and treatment don't work that dermatologists look deeper and often discover something called demodex." Microscopic menace may be cause of skin trouble, Jennifer Van Vrancken, Reporte, FOX 8 News: WVUE Live Stream

    "Busy doctors who cannot take a detailed history will frequently miss the diagnosis, complicated further by the fact that rosacea is a great mimic of other unrelated disorders that present with a “red face”. I have often seen classical cases of rosacea mistakenly diagnosed as acne vulgaris, lupus erythematosus, seborrheic dermatitis, contact dermatitis, and other inflammatory diseases." Albert Kligman, A Personal Critique on the State of Knowledge of Rosacea

    "Ocular rosacea is frequently misdiagnosed, particularly in the pediatric population." Eur J Ophthalmol. 2012 Jan 3:0. doi: 10.5301/ejo.5000103.

    A report, About some red faces, stated: "Diagnosis is based on different data: date and mode of appearance, characteristics of the erythema, functional signs, and associated systemic manifestations. A case of red face can have an infectious origin, caused by vascular, congenital, or acquired lesions, or be caused by photodermatosis, or be the main location of inflammatory dermatosis or collagenosis, but depending on the clinical context, many other diagnoses can be suggested."

    "Butterfly rash is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE), but it can also include a plethora of conditions. The case presented here is of a female with butterfly rash along with typical bright red discoloration of gingiva. The clinical, histopathological and biochemical investigations suggested the presence of rosacea."
    Contemp Clin Dent. 2012 Jul;3(3):356-8. doi: 10.4103/0976-237X.103637.
    Butterfly rash with periodontitis: A diagnostic dilemma.
    Aggarwal M, Mittal M, Dwivedi S, Vashisth P, Jaiswal D.

    "A 28-year-old female patient presented with extensive facial and ocular eruptions. She had a history of treatment with oral prednisolone due to the clinical diagnosis of lupus erythematosus (LE)....With the clinical diagnosis of severe oculofacial rosacea, she was successfully treated with oral doxycycline, steroid eye drops, and ocular lubricants. Histopathological features of skin biopsy were consistent with rosacea in the context of infection with Demodexfolliculorum.... Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE."
    J Ophthalmic Vis Res. 2017 Oct-Dec; 12(4): 429–433.doi:  10.4103/jovr.jovr_46_16
    PMCID: PMC5644412
    Severe Rosacea: A Case Report
    Ebrahim Shirzadeh, MD, Abbas Bagheri, MD, Mojtaba Fattahi Abdizadeh, PhD, and Mozhgan Rezaei Kanavi, MD

    Q: I was diagnosed with rosacea, but my skin isn’t responding to the rosacea treatments. In fact, it’s getting worse. Is it possible that I have both rosacea and acne?

    A: In a word, yes. For some patients, it is possible to have both rosacea and acne., Sue Chung , Patient Expert, Rosacea Misdiagnoses, Skin Health, Health Central

    "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."
    J Am Acad Dermatol. 2018 Sep 18;:
    Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience.
    Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Ta ylor SC

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    Anecdotal Reports of Misdiagnosis

    The following is a partial list of anecdotal reports either of misdiagnosing rosacea for another skin disease or vice versa:

    1. Bob reports his rosacea was misdiagnosed for discoid lupus

    2. Elizabeth's initial diagnosis of rosacea turned out to be KP

    3. Andrea says her initial diagnosis of rosacea may have turned out to be pellegra

    4. Jason was misdiagnosed numerous times and was unfortunately given steroids which he believes aggravated the condition.

    5. Kari was initially diagnosed with rosacea and later found out it was eczema.

    6. maxigee2002 said after six months of being treated for rosacea a doctor discovered she was misdiagnosed and actually had Pityrosporum Folliculitis

    7. gdybe was misdiagnosed with Crohn's disease and after six months of steroids developed rosacea.

    8. Ladonna was misdiagnosed with rosacea and it turned out to be Graves Disease. 

    9. Susan reports that she developed "a rash above my eye (below the eyebrow - a little on the lid itself). First he said it was "orbital dermatitis" and gave me topical cortisone and anti-biotics. Not sure it helped much, it seemed to go away on its own schedule, although the steroid may have lessened the itchiness. I went back and he prescribed Metrogel and more cortisone cream. He told me it was a form of rosacea."

    10. Tom says that 6 years before he was diagnosed with rosacea and treated and now says "This doctor does not think I have rosacea, instead 
    he thinks I have erythema." Tom says he thinks he might have KP. 

    11. DC says his physician misdiagnosed his dermatitis as rosacea. 

    12. NorthNova says he was misdiagnosed by dermatologists before he found out he had rosacea. 

    13. flareface reports that a dermatologist diagnosed her condition as "physiological flushing" and later she says a PA "misdiagnosed pretty much everything, gave me 3 different steroidal creams and sent me on my way." Later another derm diagnosed "contact allergy" on her eyes and prescribed a mild dose of cortisone cream for a couple days and it all cleared up. 

    14. redKen (see post #2) says his dermatologist misdiagnosed his rosacea for dermatitis. 

    15. nk104 says two dermatologists diagnosed rosacea. A third physician said it was not rosacea but neurodermitis. 

    16. Jonesy says his GP said he didn't have rosacea and later went to another physician who diagnosed urticaria. 

    17. RedFacedRedHead says her rosacea turned out to be KP.

    18. cliopatra25 says that for ten years she was misdiagnosed with acne when all the time she had rosacea. 

    19. vicky says "both my sisters was misdiagnosised collectively 10 times... and they have lupus...similar to my brother, he even had 2 positive ANA tests and thedoctor refused to treat him for lupus...... 

    20. Deb says, "I mentioned in another post that for years I was given things that were making the Rosacea worse, like retin-A and cortisone cream. I had mild rosacea then, so was misdiagnosed. For a while they thought it was Lupus since I also maintain a low-positive ANA. Their and my mistakes only made it worse, especially in the past few years." 

    21. Lisa M says, "I suffered from cystitis for years... and had to go on daily antibiotics for it for about 2 years. I also did saw a homeopath at
    the time and changed my lifestyle to no alcohol at all. I didn't know
    it at the time but I had rosacea (sadly totally misdiagnosed by
    several derms). 

    22. Mike says, "I also developed ocular rosacea a couple of years ago, after having facial rosacea for quite a few years. My first opthamologist misdiagnosed it, and treated me for months with steroids (mainly Tobradex) which ended up raising my IOP to a dangerous level. 

    23. Aurelia reports that "A teenage girl was given an "almost certain" diagnosis of ocular rosacea....The symptoms suffered by this girl did NOT match those of ocular rosacea and specialists later came up with a diagnosis of autoimmune Urticarial Vasculitis.

    24. Kerry reports that "I have found out today that I was yet again misdiagnosed and I don't have rosacea I have Lupus." 

    25. Sarah Smart says, "I am 12 weeks pregnant and my rosecea fulmins was horribly misdiagnosed by my derm (as shingles if you can imagine) and I spent 5 days in the hospital before they figured it out."Report.

    26. Kerry says, "I was misdiagnosed for 4 yrs by my gp as I have pretty severepsorisis on 60% of my body and scalp. They gave me a really strong steroid which has made my skin worse on my face.although it kept it under control. I found out 3 weeks ago i have rossacea and they
    stopped my steroids so my face has had a major eruption." 

    27. Ellen says, "my rosacea related blepharitis was misdiagnosed as seb derm." 

    28. sand7676 says, "I was misdiagnosed with acne I believe because of my skin tone. 

    29. Francois says that three derms diagnosed he had 'vascular dilation' and the last one said he had " 'Sebore' in Turkish. I looked at internet and I think it means 'Seborrhe'." 

    30. Kevin Forest says, "I've recently been diagnosed with rosacea after being misdiagnosed for ~2.5 years (errrrrr! derm aggerssion)."

    31. Joe says, "I've been misdiagnosed by numerous dermatologists who
    were in disbelieft that I would have rosacea at such a young age and
    assumed it was merely acne."

    32. Suzi LeBaron says, "I was misdiagnosed because it looked like
    rosacea -- including occular symptoms."

    33. Mike Lester says, "they called it seborrheic dermatitis, maybe rosacea. to be honest no one knew. many blood tests for lupus or something....Ive been going to doctors and doctors for my facial redness that ive had for over a year now. Well, they seem to have diagnosed me with ROSACEA!!!....I was checked for everything, lupus's, mastocytosis, carcinoids, tumors on the kidneys, brain tumors, and much, much more, some things some doctors have never even heard of. but it turns out i was misdiagnosed by the Mayo Clinic from the start, so we didnt need to go through months and months of stress, depression(which by the way i go to a psychologist now and am on PROZAC too).

    34. Stuart Clark says, "I too waited months for an appointment (on two separate occasions) and she completely misdiagnosed me." 

    35. Carol Voigt says, "I, too, was "misdiagnosed" for many years."

    36. Jeff says, "I got misdiagnosed by my previous dermatologist...So he gave me a steroid to apply twice a day, which of course, did not help. And by the time I had diagnosable rosacea..." 

    37. Eddie O'Neill says, "She said that I did NOT have bacterial conjunctivitis and had been misdiagnosed..."

    38. Chantal says, "in my early 20's (around 22-23), and was misdiagnosed for years (about 5) until the correct diagnosis of rosacea was made."

    39. Heather says, "My facial rosacea was misdiagnosed for MANY years (mainly an acne component with some redness)..."

    40. Jay Valof says, "2yrs ago i had septoplasty (deviated septum) nose surgery. soon after developed symptoms, was misdiagnosed as having asthma/allergy. 2 months ago derm. said in had rosacea..."

    41. jesseleigh says, " I just found out about a week ago I have rosacea, have been misdiagnosed with atopic dermatitis for ten years." 

    42. yoli says, "I was misdiagnosed for 2 years they thought I had dermatitis but in reality i don't itch but burn.... it took me 6 dermatologist in order to get diagnosed with Rosacea." 

    43. beecham says, "I was diagnosed in December 2007 with pustular rosacea by my new doctor, I was on oxytetracycline for about a year before with my previous doctor who had misdiagnosed me with perioral 
    dermatitis.... "

    44. LoriB says, "When I saw my general doctor while waiting for an appointment with a derm he misdiagnosed me as having acne vulgaris. He told me I don't have rosacea because my cheeks aren't red." 

    45. jodieginger says, "I was repeatedly misdiagnosed as having dermatitis and none of the derms seemed to care that I simultaneously had blepharitis simultaneously. "

    46. mineren says, "I have adult acne in addition to rosacea and
    was misdiagnosed a couple of times. "

    47. mythjedi says, "She stated that I had "contact dermatitis" and gave me doxycycline....but it wasn't long before transient, big, patchy red blotches began to form on my face and chest....I discovered that I was allergic to these pills, and I stopped taking them.... I have been
    off of the pills for six months...I went to a dermatologist and was diagnosed with rosacea..."

    48. Yvonne says, "My SD was misdiagnosed as rosacea." 

    49. Cassie Henderson says, "I was misdiagnosed by a blind derm and used hydrocotizone for three months. My rosacea went from a splotty red blotch on one cheek to an all over the face red hue very bumpy dry and ruddy looking. I then went to a derm who wasn't legally blind and started using metrogel and minocycline which helped for awhile."

    50. Keith on 07.15.09 at 12:43 pm says, "...I went to a highly accomplished and respected doctor in my area who diagnosed it as Rosacea so I guess thats what it is. Other Derms have said sundamage, Folliculitis, so it is still uncertain to me..." Scroll down to Comment # 91

    51. Lori said her acne was diagnosed as rosacea which later turned out to be also seborrhoeic dermatitis after she had taken Oracea for over a month. She was switched to Doxycycline at a higher dose and Finacea. See Comments #68, #84, #89, #93, #107, #114, #117, #123.

    52. raly says, ..."I've been "diagnosed" at different times as it being rosacea, folliculitis, sebderm or possibly just acne from both GPs and a dermatologist..." Scroll down to Post #9

    53. dan pacifik says, ".... After a second trip to the doctors, my doctor seemed to think it was rosacea so she prescribed me metro cream 0.75%....…I think! I pretty much used this for about 8 months....I went back to my doctor about this and she said it looked more like acne on my forehead....I am however skeptical over my doctors and derms diagnosis..." 

    54. kfoltz9 says, "I am a 25 year old female with what appears to be perioral dermatisis around my mouth. My family history only consists of Psoryasis and I have not had a personal experience with this. I am currently on Effexor XR. I use Aveda sensitive skin facial cleanser which does not contain any Petrolatum. I have not introduced any new cosmetic products into my regimen. The dermatologist I went to yesterday about this month-old rash (I have had one previous occurence, only less intense) did not even inspect the rash, asked me if I blushed easily or often (I do not, and told him that) and diagnosed Rosacea in about 3 seconds. 

    55. siliconmessiah says, "...I first went to the doctor on a "drop-in"-visit. One of them (a really shitty doctor actually) prescribed cortisone cream for my problems - I took it for a couple of weeks with no signs of getting better. I returned to a new doctor, a really good one I might add...she diagnosed me in one minute under the light of a lamp..." Scroll down to post #2

    56. brighteyes says, "It took me approximately 3 years (and 6 derms) to get an official diagnosis...." Scroll down to post #3

    57. Mistica says, "...So in my case, rosacea wasn't recognised immediately and even 10 and a half years on from the orginal diagnosis, the 'diagnosis' is continuing in some ways. It looks like rosacea ( no missing that!!) and it behaves like rosacea, ... but is it just Rosacea?..." Scroll down to post #8

    58. IJDVL reports, "Subsequently, the initial diagnosis of allergic conjunctivitis was revised by the ophthalmologists to ocular rosacea." *

    59. A 32-year-old woman had developed moderate swelling, erythema and papules of the central part of her face for 8 weeks. She started to apply various topical cosmetic products sold for acne that did not help. As one of her hobbies was outdoor biking she noticed that sun exposure aggravated her skin condition, also resulting in burning and stinging sensations. She consulted her general practitioner who prescribed prednicarbat cream for topical application on the affected regions. Whereas she observed a slight improvement of the skin condition during the first week, she later on suddenly developed a severe worsening with erythema, papules and many pustules. She presented to a dermatologist and was diagnosed with "steroid rosacea". She went off the steroid, started topical treatment with metronidazole 1% and oral treatment with metronidazole 500 mg twice daily for 2 weeks. After an initial worsening during the first 3 days the skin condition rapidly improved. She continued metronidazole 500 mg once daily for another 2 weeks and then stopped. The topical treatment was continued twice daily for altogether 4 weeks and then reduced to once daily for another 4 weeks. Besides, she applied sun screen whenever she was outside. She continued intermittent topical use of metronidazole 1%. She remained free of symptoms except of an intermittent slight centrofacial erythema. See case report #1 

    60. A 39-year-old woman was referred to a dermatology department because of worsening of her known rosacea. She had been suffering from rosacea for 3 years. After initial, short-term and intermittent oral therapy with tetracycline for periods of up to 3 weeks she had continued topical treatment with tretinoin without any problems for the last months. Suddenly, she developed an erythema of the face accompanied by strong burning that increased in the evening, decreased over night and was moderate at day time. She discontinued topical tretinoin therapy because she felt that the symptoms were caused by it. She presented to a dermatologist with a sharp erythema of the whole face with only solitary papules and pustules. Due to the patient's history and the clinical finding contact allergy was suspected. Patch testing revealed a sensitisation to cocamidopropyl betaine, a surfactant that is frequently added to shampoos and skin cleansing products. This substance could be identified in her skin cleanser. When she discontinued this product, the symptoms disappeared and the patient could continue her topical treatment.
    We recommend to precisely ask patients about all the topical drugs and cosmetics they use including skin cleansing products. Contact allergy can also occur in rosacea patients and may mislead patients and physicians. See Case Report #3

    61. A 56-year-old diabetic man presented erythematous papules and pustules on the neck and face who had developed since 3 months. He had been treated with topical corticosteroids for the same time period that resulted in progressive exacerbation. He additionally showed patches of hair loss in the beard area, erythema and scaling of the ears. Among various differential diagnoses the clinical picture reminded of stage II rosacea. Microscopial examination and culturing revealed Microsporum canis. He was diagnosed tinea incognito, a term that has been used to describe dermatophyte infections modified by corticosteroid treatment.
    This case report demonstrates that there is a number of other skin diseases that can mimic rosacea. (see Case Report #7)
    Gorani A, Schiera A, Oriani A: Case Report. Rosacea-like Tinea incognito. Mycoses 2002; 45: 135-137. 

    62. A Case of Precursor B-cell Lymphoblastic Lymphoma Misdiagnosed as Rosacea
    Han EC, Kim DY, Chung JY, Chung HJ, Chung KY.
    Korean J Dermatol. 2008 Feb;46(2):264-267

    63. Pete says, "...Had previously been misdiagnosed by my G.P. Had been treated with steroid creams for eczema...."

    64. shakti says, "...I had a horrible rash on my face which the Dr. (dermatologist) even took pictures of, but he said it was rosacea....Then a neurologist said I could have some sort of mild m.S..... I've recently had a "rosacea flare" swelling and redness around my eyes and upper cheeks, the tiredness has returned and so has pain in my bladder and gi tract...."

    65. belinda says, "After being misdiagnosed for 7 years, I had almost given up hope." published April 8, 2008

    66. mmee says, "...just wanted to say after many years of suffering with depression and social anxity because of a red face and not being able to get any information out of 3 dermatologists and about 5 GPs (they just said it was 'normal') . I've found out from a link on this website it must be Keratosis pilaris rubra faceii..." 

    67. Gem says, "A couple of months ago I developed a rash on my forehead and weas gicven a steroid cream for it that seemed to keep it under controlfor a while, then around 3 weeks ago it spread and looked angry, I went to the doctor who said it was acne the cream I was given just aggravated it, so I went back and was given another cream by a different doctor who still thought it was acne... this again aggravated it, so I started looking on the net for other ideas or medications that could help. I tried coconut oil and aloe vera topical and ingested, another trip to the GP I was given Tetracycline oral antibiotic but it was something like a 3 month course, ....I went to my doctor again today as my self treatment wasn't doing any good and I was told it looks like rosacea I've been given metronidazole gel and I've started the Tetracycline oral antibiotics again...." 

    68. ssaeed says, "...He diagnosed me initially with Seb Derm and prescribed Desonide cream for 3 weeks. I noticed my skin got a lot better and softer during this treatment although towards the end of the treatment I started getting small pus filled acne bumps on my nose and cheek, about the size of a pore. When I saw the doc after the 3 week Desonide treatment he told me I may have symptoms of Rosacea and started me off on a treatment of Metrogel once a day and Oracea once a day in the morning." 

    69. Ladonna says, "...my husband took me to the dermatologist and she said it was Rosacea and couldnt be anything but....So he took me to many doctors, and finally a wonderful doctor took a shot in the dark blood test and discovered my problem. Later more involved tests and scans confirmed it. I was Hyperthyroid...specifically Graves Disease..."

    70. DylanG says, "... I finally got an appointment with a dermatologist for my rosacea. After waiting about half a year, I go to the appointment. The dermatologist walks in, doesn't even look at my face and says "There's nothing I can do about redness. Some people just have red skin". Then, to top it off, he gave me cream for acne - something which I could care less about - that has the side effect of making your face red. I was out of his office in practically two minutes with about twenty tiny tubes of acne medication I had no need for. ..." Scroll to Post #22

    71. Donna says, "I got results back from labs and xray..i do NOT have sarcoidosis…but still not sure what i have …i have granulomas popping out on parts of my body and my face is still not clear. I am going to a conference of doctors on the 16th to get their opinions. I was originally diagnosed with Granulomateous rosacea so lets see what opinions i get." Post #146

    72. liangjuany says, "I saw another doctor today and was told what I had was not rosacea but pityriasis rosea instead." 

    73. huiness says, "another derms who told me I had acne, or folliculitis etc. When I finally decided to go back to Derm #2, he then diagnosed me with rosacea.....went to Derm #14809348. He agreed with the rosacea diagnosis but said that this was probably steroid induced...."

    74. mrsmoof says, "1st dermatologist thought I had dermititis.....Well, I went to a 2nd dermatologist and told her my story, symptoms.....within minutes she said it was Rosacea...." Scroll to Post #43 

    75. "My wife was diagosed by a local Dermatologist as having Rocacea. He only did a visual inspection without any actual skin testing. He was sure it was Rocacea and prescribed an expensive cream which she would have to use for who knows how many years. Luckily she had a severe reaction to the cream, and discontinued it. She visitited her home country of Russia and was treated by a specialist. He told her she didn’t have Rocacea but had Demodex. She had one treatment by the doctor and her face is still clear after 6 months. Always get a second opinion." J Noble on 01.12.10 at 7:11 am Post #215 

    76. spuggylegs says, "I think it took about 10 mins for a NHS dermatologist to tell me that I didnt have rosacea. She looked at my skin said there was no visible erythema or papules and pustules to suggest rosacea, and that I needed to stop "reading stuff on the internet". I had to actually ask for a blood test to rule out lupus etc!!!!! I asked my GP if he could send me for a second opinion but he refused. The problem is that there is a lot of inequality in the NHS...and as someone who lives in a deprived area, healthcare is usually not as good as those who live in more affluent areas. (but thats another story). Well I still carried on "reading stuff on the internet" : ) and decided the only way forward was to go private..even though i couldnt really afford it. So travelled from the north east to London, and got so stressed, as we got lost a few times, and London is not the friendliest of places. By the time I had got to see the derm I was having a major flush....so after reading my medical notes, asking about family members who may have rosacea,, symptons, and looking at my skin, he diagnosed rosacea. From what i can remember the consultation lasted about 30 mins." Scroll to Post #50

    77. Rachelle C says, "My doctor diagnosed me with rosacea, delusional paristosis. The medications for these did no good. Then another dermatolgist with an allergist diagnosed me with demodex (skin mite) allergy." Scroll to Post no. 77 on 05.04.10 at 1:00 AM

    78. Girrlock Holmes says, "…I was finally diagnosed hypothyroid, insulin resistant and PCOS, and my doctor also thinks my symptoms fit with fibromyalgia…I saw a dermatologist who said it was not Rosacea but offered no info on what it could be. Then I saw an allergist and he said the derm had no basis for saying it was not Rosacea; it looked like it to him. So you see I have no clear diagnosis. I am waiting for a different derm to see me but it will not be for another 2 months…"

    79. "Terri Flynn, a 63-year-old part-time receptionist from Texas....Two different evaluators told her she had "dry eye" and prescribed artificial tears and various eye medications, while one also suggested she have her bottom eyelids lifted to help retain the moisture in her eyes....She made an appointment with a dermatologist, who "took one look at me and said, 'Yes, it's rosacea." NRS Rosacea Review Spring 2010

    80. GNR reports, "...I was told I had Perioral dermatitis because there was an outbreak near my nose....Began to notice a swelling under my right eye and a red path beneath extending up the temple. It became hot and sensitive and flares when I workout with weights. Told "hmm don't know what that is, it's not rosacea (my fear was that it was) but try rozex cream to see if it goes." It didn't. Didn't change. Had a second opinion. Same as the first. "Don't know, looks like it might be fungul. Leave it until you see a dermatologist." Began to a sore eye, a few pains and watering. Went back to the second opinion to ge this checked was given a scrip for kenocomb ointment for fungus....out of desparation I went to another gp explained the whole story again. He checked the skin, told me it wasn't rosacea that it looked like a fungus infection try Nizoral 2%. Hmmm. Later that day I had an appointment with a new dermatologist who told me that I actually had seborrhec dermatitis...this sounded right as all the systems relate, rash on chest, dry skin in eyebrows, dandruff...funny I'd never connected these things and either had anyone else.
    He then checked the rash thing on the right side of my face and temple and told me it was rosacea. I asked about the pain in the eye, watery, and he said not connected. Gave me a print of what to expect with rosacea and out the door I went..."

    81. comicraven reports, "I had been misdiagnosed for a while - everything from shingles to testing for lupus - and was finally properly diagnosed about 6 months ago..."

    82. koki says, "OK according to dermatologist # 4 , again I dont have rosacea, I explained my symptoms and he said it sounds more like an allergic reaction and when he examined my face he said it was more like eczema/seborrheic dermatitis and gave me some diflucan. ....I am glad most derms say is not rosacea..."

    83. stb09 says, "In May 2004, I developed a pimple on my nose that left a red mark on it for, what must've been a solid YEAR after it cleared up. I was thorougly convinced this was a scar, and went to several dermatologists to find proper treatment. Such begins my ongoing battle (and subsequent HATRED) for all dermatologists.

    The first one I saw told me that it was a mole....
    I sought a second opinion. This one told me it was a scar, and could only be removed by a plasic surgeon. He took my $100, and gave me the number of a plastic surgeon.

    The plastic surgeon (who was once a dermatologist) was convinced it was a pimple still, and simply lanced it and dug around in it, ultimately making it worse....

    The fourth and final dermatologist perscribed me a prescription in January of 2005 for my back acne/oily skin. He agreed with ME that whatever was on my nose was inflammed and most likely a sebacous cyst. He injected it with cortisone, and that made a tremendous difference, and today there's not a mark to be found. This is the same dermatologist that dismissed my concerns of facial redness and never spoke a word about Rosacea in spite of my ruddy complexion that I was, at the time, unaware of....I was at a new branch of my college and went to the local dermatologist to seek treatment. He told me it was probably a scar and gave me the number of a laser surgeon FOUR hours away that "might" be able to help me.

    THIS is the first time a doctor has mentioned the word "Rosacea" to me. He explained that I had a ruddy complexion, and thus, the red spot on my nose was more noticable. He went on to state that people with my complexion "could be candidates for Roscea later in life." and encouraged me to stay out of the sun......I finally decided to see a dermatologist to rule Rosacea in or out so I could get on with my life one way or the other. I went back to the local dermatologist, who had told me that someone with my complexion might be a candidate for Rosacea later in life, and was told absolutely nothing new.

    He once again told me that, maybe I'd have it one day, and maybe not. I asked him if I should try avoiding "triggers" and he said that I shouldn't bother. Because it probably wouldn't help. I asked if there was any treatment, because I've since learned Rosacea is best treated early on. He said that any creams he could give me would most likely not do anything at all for me, and would be a waste of my money. The entire visit was quite ambiguous.

    I asked him what "Pre-rosacea" was, and what the difference was between that, and a normal ruddy complexion. He told me that, in his opinion, there wasn't one. As he considers anyone with a ruddy complexion at risk for developing Rosacea, and THAT he considers to be "pre-Rosacea."

    Before I left, I asked him for a definitive answer one way or the other, and he told me NO, I do not have Rosacea.....To the point of the original thread, I'd like to determine what it is I have. The doctor seems sure it's not Rosacea, but as evidenced by my ongoing battle with Dermatologists prior, I believe if I went to 10 Dermatologists I would receive 10 different opinions. Rosacea, ruddy complexion, acne, allergic rash, facial blushing, too much Niacin, high blood pressure, lupus...

    these people don't know anything, and with no insurance I'm not going to waste $100 a visit to find out precisely nothing.

    84. Ontarian says, "I was diagnosed with seborrheic dermatitis on my face about 5 years ago. The diagnosis was made by a dermatologist. Soon after, the dermatitis completely disappeared for a loooong time. Then, I suddenly got a red patch on my right cheek five years later, more precisely in February of 2006. It has slowly spread to my entire right cheek. It got worse in the summer. This whole time I thought I had seb. dermatitis. My family dr. said my face was dermatitic and prescribed hydrocortisone. It didn’t help. In August of 2006 I went to my dermatologist. This time, he said I had rosacea. I was shocked. I was not flushing like crazy (except maybe when I played soccer in +35 C degrees outside). My symptoms started as a small red patch on my right cheek, this could not be rosacea. I went to see another dermatologist (an old dude who thinks rosacea is a proper diagnosis only when your face is swollen like a balloon and when you are covered with pustules).
    So, now I have two doctors thinking I don’t have rosacea, and one doctor thinking I do." Posted: Tue Oct 17, 2006 1:34 pm (scroll down to find the post)

    85. Jen says, "Since I have stopped the med I was diagnosed with Perioral Dermititis and now as of yesteday the derm tells me I have acne.....The derm said I have almost all the face disorders (rosacea, acne, perioral dermititis, seb derm)....

    86. jhelli1 says, "I've been to four different doctors in the past and have gotten four different diagnosis. The last one was rosacea. Yesterday, I went to a fifth doctor and was told that I have..........eczema!

    87. fedup says, "....I went to this dermatologist maybe 2-3 times a year over about a 4 year period, every appointment he seemed to have absolutely no idea what was going on, or what he had prescribed/said the last time, he took a look at my scalp, says "its folliculitus" (the way he said it, every time, was as if it was a breakthrough and he figured out some giant mystery, even though he said the same thing last time....and sent me home with a prescription for Ceftin 500mg 2x a day for 2 weeks (insanely strong antibiotic, I know now..).....Made an appointment with a new dermatologist (roughly 2 years ago), after explaining the antibiotic fiasco, he told me my old doctor probably shouldnt be practicing medicine. He took about 10 seconds to diagnose me, looked at my scalp, and simply said "you have inflammatory rosacea."

    88. mutantfrog says, "...I always grumble to myself about rosacea...but if it turns out that I never had rosacea but instead have had an autoimmune disorder...well it's scary I'd rather take rosacea. I swear to god I'll never complain about 'rosacea' again..." Post #10 22nd July 2010, 07:40 PM

    89. quixotic_pessimist says, "Anyway, I had been seeing a dermatologist during this time period for acne that I have had for about 3 years, and he never mentioned anything about the red complexion of my nose. One time I voiced my concerns, and he pretty much dismissed them, saying that he didn't think my nose looked red. During my last meeting with him, I was a bit more belligerent (in that I brought up the grievances that I have with my red nose a few times). He then nonchalantly throws out that it is possible that I have Rosacea. How is it that I had been visiting this doctor for 3 years with the same red nose, but it is not until now that he suggests that I might have Rosacea? I don't get it."

    90. CHI_GUY says, "...First doc said, sebborhea/eczema. He gave me many different things, to list a few....Second doc, new one, diagnosed perioral derm. She gave me tetracycline. 500mg x2/day for the first month. She exclaimed that the previous doctor was treating the wrong thing, because I brought all my old meds in to show her...."

    91. Natasha says, "I have just been diagnosed with Rosacea....a week ago the doctor wrongly diagnosed excema..."

    92. hesperidianblue says, " I was going to 7 dermatologist till 2 of them agreed that is rosacea other wasn`t shore what is it often they thought it was atopic dermatitis."

    93. misdiagnosed says, "During this whole ordeal, I have seen a dermatologist (in OH) 2x. THe first time she tried to convince me it was “in my head” and reluctantly prescribed an antibiotic for adult acne. 8 weeks later, she seemed a little more open to the fact that it could be demodex and prescribed metrogel. Last week, I asked for metronidozale in a pill format because the lotion only does so much. She agreed to call it in. It is helping, but I have good and bad days, depending on the “hatching” cycle." #385 misdiagnosed on 10.08.10 at 12:45 AM

    94. Maureen says, "I have had this now for about I would say 2 years when I was told I had rosacea and lupus. Now a new dermatologist tells me no it's dermographism,..."

    95. francois can says, "I just cant believe. Today I went to see a derm. She looked at my face closely with a tool like a magnifier and said I misdiagnosed myself. She said rosacea has 4 components and someone has to have at least 3 of them to be diagnosed rosacea.....She said I have a
    condition associated with neurovascular dilaiton..."

    96. LarsMM says, "...First I went to a regular doctor and even though he ran a few tests he couldn't tell me wheat the problem was. He told me I shouldn't worry since the redness was at that time "barley noticeable". At the end of the third summer (2010) I went to another doctor and got the same response. After this visit I got somewhat frustrated since I was well aware that I had not been this red a few years earlier, as a result I started reading online and came across rosacea. I got an appointment with a dermatologist and she confirmed that I had stage one rosacea...."

    97. 444 says, "...my doctor has failed on many occasions to diagnose me properly probably due to my young age at the time and has disregarded any possiblilty of rosacea since the beggining....'

    98. claire says, "...I am 34 years old and I was wrongly diagnosed 7 years ago. I have gradually seen since then my skin get progressively worse, it is now in its advanced stages. ..." #41 claire on 05.16.09 at 8:16 PM

    99. Rachelle C says, "My doctor diagnosed me with rosacea, delusional paristosis. The medications for these did no good. Then another dermatolgist with an allergist diagnosed me with demodex (skin mite) allergy. Since I have very many allergies, this was a good bet. I treat itchy and red areas with tea tree oil and have managed to reielve my problem almost completely. The dermatologist also thinks a monthly treament with Kwellada-P would help further." #76 Rachelle C. on 05.04.10 at 1:00 AM

    100. findingaway says, "So I am no further forward...I still don't really know what it is I'm dealing with... Rosacea, SD, KP. All?" 

    101. Just an update and to show the importance of knowing what you have, I saw a Rosacea specialist with 20 years of treating and research under his belt, and made the appointment saying "Trying to treat Rosacea" as the reason. The second I came in he was confused and wondered where the Rosacea patient was. He looked at me and told me I absolutely do not have Rosacea, he's seen thousands of cases over decades and it's simply not it. And it's not caused by being choked, ever. It was thinned skin due to Steroid Creams, and thankfully, he caught that because the General Practitioner who 'diagnosed' me with Rosacea prescribed steroid cream. The most alarming was that the general practitioner gave me Metrogel which I understand is meant to help Pimples, and I have absolutely zero of those. AlenaCena post no 68

    102. I've been to dermatologists in three different countries starting when I was 16, and I'm now 41. When I first started going to them, they didn't know a lot about eczema and dermatitis and the treatment course was antibiotics and cortozone creams. (Not much has changed) Even then I knew foods and hormones were triggers or the cause of the skin eruptions. I've had dermatologists tell me it's not rosacea and dermatologists tell me it is. One things for certain out of the more than 30 dermatologists I've seen in my life time, no two have had the same things to say. However last time I was at one, she did look up patronizing and say, yes we now know hormones can affect eczema...as if her telling me that made a whit of difference to what I have already known. In the UK, where they have now said it is rosacea, I have had no other tests. The dermatologists I've seen refuse to accept other countries diagnosis of food allergies. They refuse to take into consideration what I'm saying, about my upper eye lid cracking (it's been cracking there my whole life, so much so I've a deep scar) and the bubbling around my eyes, and over my brows. In the end, I think a they've learnt mo about the what some skin problems are, they seem to have bunched the rest as rosacea. Which appears to me to be a blanket term, covering a huge amount of things. Melania post no 66

    103. I had a misdiagnosed case of demodex for many years. It was misdiagnosed as bacterial acne/hormonal acne and "allergic conjunctivitis". None of the treatment my 4 dermatologists prescribed ever worked. It turned into a really bad case of ocular rosacea. Early this year, I took the 2 week Oral Ivermectin + Oral Metronidazole treatment. It worked. ElaineA post no 2 

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    • Health Sci Rep. 2023 Sep 25;6(9):e1576. doi: 10.1002/hsr2.1576. eCollection 2023 Sep. ABSTRACT BACKGROUND AND AIM: Metabolic syndrome (MetS) is a well-known noncommunicable disease that plays a significant role in emerging other chronic disorders and following complications. MetS is also involved in the pathophysiology of numerous dermatological diseases. We aim to evaluate the association of MetS with the most prevalent dermatological diseases. METHODS: A systematic search was carried out on PubMed, Science Direct, Web of Science, Cochrane, as well as the Google Scholar search engine. Only English case-control studies regarding MetS and any skin disease from the beginning of 2010 up to November 15, 2022, were selected. The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS: A total of 37 studies (13,830 participants) met the inclusion criteria. According to our result, patients with psoriasis, hidradenitis suppurativa (HS), vitiligo, androgenetic alopecia (AGA), and lichen planus (LP) have a higher chance of having MetS compared to the general population. Furthermore, people with seborrheic dermatitis (SED) and rosacea are more prone to insulin resistance, high blood pressure (BP), and higher blood lipids. After pooling data, the meta-analysis revealed a significant association between MetS and skin diseases (pooled odds ratio [OR]: 3.28, 95% confidence interval: 2.62-4.10). Concerning the type of disease, MetS has been correlated with AGA (OR: 11.86), HS (OR: 4.46), LP (OR: 3.79), and SED (OR: 2.45). Psoriasis also showed a significant association but with high heterogeneity (OR: 2.89). Moreover, skin diseases and MetS are strongly associated in Spain (OR: 5.25) and Thailand (OR: 11.86). Regarding the metaregression model, the effect size was reduced with increasing age (OR: 0.965), while the size increased with AGA (OR: 3.064). CONCLUSIONS: MetS is closely associated with skin complications. Dermatologists and other multidisciplinary teams should be cautious while treating these patients to prevent severe complications resulting from MetS. PMID:37752973 | PMC:PMC10519158 | DOI:10.1002/hsr2.1576 {url} = URL to article
    • Skin Res Technol. 2023 Sep;29(9):e13411. doi: 10.1111/srt.13411. NO ABSTRACT PMID:37753697 | DOI:10.1111/srt.13411 {url} = URL to article
    • JMIR Dermatol. 2023 Sep 25;6:e49070. doi: 10.2196/49070. ABSTRACT Case reports serve many functions in the medical literature. We explore patient demographics in case reports for common inflammatory skin diseases. PMID:37747769 | DOI:10.2196/49070 {url} = URL to article
    • Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2023 Aug;31(Special Issue 1):881-886. doi: 10.32687/0869-866X-2023-31-s1-881-886. ABSTRACT Currently, there is an urgent need for global research to develop a modern comprehensive study of rosacea, including its pathogenesis, risk factors, association of rosacea subtypes with concomitant diseases. The most relevant research studies the role of immunity and microorganisms in the pathogenesis of rosacea. To elucidate the features of the comorbidity of rosacea and somatic diseases, studies in various populations with detailed clinical data and a longer follow-up period are important. At the same time, it is important to understand the relationship between the severity and severity of various clinical symptoms of rosacea, the mechanisms that regulate the progression of the process, the combination of rosacea subtypes and the course of the disease in association with other forms of pathological disorders. PMID:37742268 | DOI:10.32687/0869-866X-2023-31-s1-881-886 {url} = URL to article
    • Cureus. 2023 Sep 17;15(9):e45391. doi: 10.7759/cureus.45391. eCollection 2023 Sep. ABSTRACT Granulomatous rosacea is a chronic inflammatory skin disease. We present the case of a 30-year-old woman with a three-month history of erythematous monomorphic papules and nodules on the cheeks and forehead. Histopathological examinations revealed tuberculoid granulomas with multinucleated giant cells. Granulomatous rosacea should be differentiated from other similar granulomatous skin diseases such as cutaneous sarcoidosis and Lupus miliaris disseminates faciei. PMID:37724096 | PMC:PMC10505268 | DOI:10.7759/cureus.45391 {url} = URL to article
    • Front Med (Lausanne). 2023 Sep 1;10:1239869. doi: 10.3389/fmed.2023.1239869. eCollection 2023. ABSTRACT BACKGROUND: Steroid-induced rosacea is a severe withdrawal reaction which can occur after the frequent and excessive topical use of steroids on the face. The Janus kinase (JAK)-signal transducers and activators of transcription signaling pathway is involved in many biological processes and may play a role in the development of steroid-induced rosacea. OBJECTIVE: To observe the efficacy and safety of the JAK1 inhibitor abrocitinib in the treatment of steroid-induced rosacea. METHODS: Four Chinese female patients were treated with orally-administered abrocitinib, a selective JAK1 inhibitor with a good safety profile, for steroid-induced rosacea. RESULTS: Abrocitinib treatment resulted in improved skin condition and lowered Dermatology Life Quality Index scores in each of the four patients. No discomfort was reported and no adverse effects were observed. CONCLUSION: The JAK1 inhibitor abrocitinib is a promising potential treatment for steroid-induced rosacea. PMID:37724178 | PMC:PMC10505430 | DOI:10.3389/fmed.2023.1239869 {url} = URL to article
    • Front Immunol. 2023 Aug 24;14:1211953. doi: 10.3389/fimmu.2023.1211953. eCollection 2023. ABSTRACT INTRODUCTION: Rosacea, a widespread chronic skin condition, may be influenced by macrophages, key immune cells in the skin, although their exact role is not yet fully understood. This review delves into the function of macrophages, their potential contribution to rosacea pathogenesis, current treatments, and promising macrophage-targeted therapies. It concludes by identifying knowledge gaps and potential areas for future rosacea research. METHOD: Leveraging systematic and narrative literature review techniques, we conducted a comprehensive search of databases such as PubMed, Embase, and Web of Science. Utilizing keywords like "rosacea" and "macrophages", we targeted English articles from the last 5 years (2018-2023). We manually checked reference lists of relevant articles for additional studies. We included only articles emphasizing macrophages' role in rosacea and/or the development of related therapies and published within the specified timeframe. RESULTS: The systematic search of electronic databases yielded a total of 4,263 articles. After applying the inclusion and exclusion criteria, 156 articles were selected for inclusion in this review. These articles included original research studies, review articles, and clinical trials that focused on the role of macrophages in rosacea and/or the development of macrophage-targeted therapies for the disease. The selected articles provided a comprehensive and up-to-date overview of the current state of research on macrophages in rosacea, including their function in the skin, the potential mechanisms through which they may contribute to rosacea pathogenesis, and the current treatments and therapies available for the disease. Additionally, the articles identified gaps in knowledge regarding the role of macrophages in rosacea and suggested potential areas for future research. CONCLUSION: This literature review emphasizes the important role that macrophages, vital immune cells in the skin, may play in the pathogenesis of rosacea, a common chronic inflammatory skin disorder. The selected studies suggest potential mechanisms by which these cells might contribute to rosacea progression, although these mechanisms are not yet fully understood. The studies also spotlight current rosacea treatments and illuminate the promising potential of new macrophage-focused therapies. Despite these insights, significant gaps persist in our understanding of the precise role of macrophages in rosacea. Future research in this area could provide further insights into the pathogenesis of rosacea and contribute to the development of more effective, targeted therapeutic strategies. PMID:37691916 | PMC:PMC10484341 | DOI:10.3389/fimmu.2023.1211953 {url} = URL to article
    • Arch Soc Esp Oftalmol (Engl Ed). 2023 Sep 9:S2173-5794(23)00149-4. doi: 10.1016/j.oftale.2023.09.001. Online ahead of print. ABSTRACT Rosacea is a chronic and inflammatory disease that primarily affects the skin, although more than half of cases also present with ocular symptoms ranging from blepharitis to conjunctivitis and keratitis. It represents a frequent reason for consultation with a psychosocial impact, affecting quality of life, and requires management involving ophthalmologists, dermatologists, and primary care physicians. For this paper, a search was conducted in several databases, including Medline, Embase, Cochrane, and Google Scholar, using the MeSH term "rosacea" in conjunction with other relevant keywords such as "ocular rosacea", "management", "treatment", and "guidelines". Available articles were reviewed. International and local guidelines recommend initiating the management of rosacea with lifestyle changes, including ocular hygiene and avoidance of triggers. Topical or oral treatment is recommended as the next step, with topical cyclosporine, topical azithromycin, topical tacrolimus, and oral doxycycline being the treatments most supported by evidence. Combination treatments are also recommended. Current management guidelines mainly focus on cutaneous manifestations, generating few guidelines on ophthalmologic treatment, and most recommendations are issued by experts. This work compares local and international treatment guidelines for rosacea, as well as other available medical literature, and suggests a practical and interdisciplinary treatment scheme for ocular involvement based on the reviewed bibliography. PMID:37696488 | DOI:10.1016/j.oftale.2023.09.001 {url} = URL to article
    • Nutrients. 2023 Aug 30;15(17):3803. doi: 10.3390/nu15173803. ABSTRACT BACKGROUND: Previous cross-sectional studies have failed to definitively establish a causal relationship between serum 25-hydroxyvitamin D (25OHD) concentrations and the onset of rosacea. OBJECTIVE: To investigate the potential association between serum 25OHD levels, vitamin D receptor (VDR) polymorphisms, and the risk of developing incident rosacea. METHODS: This cross-sectional population-based cohort study utilizing 370,209 individuals from the UK Biobank. Cox proportional hazard regression models and two-sample Mendelian randomization (MR) analyses were applied to explore the causative relationship between 25OHD and incident rosacea. RESULTS: Our findings revealed that elevated levels of serum 25OHD were inversely correlated with the risk of incident rosacea. Specifically, compared to participants with 25OHD levels below 25 nmol/L, the multivariate-adjusted HR for incident rosacea was 0.81 (95% CI: 0.70, 0.94) in those with 25OHD levels exceeding 50 nmol/L. Further, in comparison to individuals with serum 25OHD less than 25 nmol/L and the rs731236 (TaqI) AA allele, those with serum 25OHD higher than 75 nmol/L and the TaqI GG allele had a multivariate-adjusted HR of 0.51 (95% CI 0.32 to 0.81) for developing rosacea. Results from the MR study supported a significant association, with each standard deviation increase in serum 25OHD concentrations correlating to a 23% reduced risk of rosacea (HR = 0.77, 95% CI: 0.63, 0.93). CONCLUSIONS: The findings of this cohort study indicate an inverse association between increased concentrations of serum 25OHD and the risk of developing incident rosacea. While our results highlight the potential protective role of vitamin D, the definitive efficacy of vitamin D supplementation as a preventive strategy against rosacea requires further investigation. PMID:37686836 | PMC:PMC10489658 | DOI:10.3390/nu15173803 {url} = URL to article
    • Sci Rep. 2023 Sep 9;13(1):14910. doi: 10.1038/s41598-023-42073-6. ABSTRACT The association between rosacea and inflammatory bowel disease (IBD) has been studied in previous observational studies. It is unclear, however, whether the association is causal or not. Independent genetic variants for IBD were chosen as instruments from published Genome-wide association studies (GWAS) studies involving 38,155 cases with an IBD diagnosis and 48,485 controls in order to investigate the causal effect of IBD on rosacea. Summarized data for rosacea were gathered from various GWAS studies that included 1195 cases and 211,139 controls without rosacea. Reverse-direction Mendelian randomization (MR) analysis was done to investigate the relationship between genetically proxied rosacea and IBD. With the use of the inverse variance-weighted (IVW), MR-Egger, and weighted median approaches, a 2-sample Mendelian randomization study was carried out. Analysis of heterogeneity and sensitivity was performed to examine the pleiotropy and robustness of effect estimates. The forward-direction of the MR study was to reveal that genetic predisposition to IBD including its two main subtypes: Crohn's disease (CD) and ulcerative colitis (UC) was associated with an increased risk of rosacea. The reverse-direction MR analyses did not demonstrate that a genetic predisposition to rosacea was associated with total IBD, UC and CD. Our findings provided evidence for a causal impact of IBD, UC, and CD on rosacea, but not vice versa. The elevated incidence of rosacea in patients with IBD should be recognized by doctors to make an early diagnosis and initiate specialized therapy. PMID:37689807 | PMC:PMC10492847 | DOI:10.1038/s41598-023-42073-6 {url} = URL to article
    • Clin Ter. 2023 Sep-Oct;174(5):404-411. doi: 10.7417/CT.2023.2457. ABSTRACT BACKGROUND: Understanding the connection between skin lesions and the pathology of internal organs and body systems that may have caused them is a prerequisite for successful cosmetic therapy. AIM: The aim of this study was to analyze the influence of a patient's somatic pathology on the manifestation of skin abnormalities. MATERIALS AND METHODS: The study was conducted according to a "case-control" design and was accompanied by a retrospective study of outpatient records of patients with the disease (group 1) and patients without it (control group). It is aimed at revealing the connection between a patient's skin manifestations and somatic pathology, as well as the effectiveness of therapeutic measures for the correction of such a condition. RESULTS: Patients with acne and rosacea have a statistically signi-ficantly higher incidence of gastrointestinal diseases (in particular, gastritis caused by Helicobacter), diabetes mellitus, vitamin and micronutrient deficiencies, which significantly affects the effectiveness of their treatment and quality of life. In such chronic dermatoses, disruption of intestinal microbiocenosis can be considered as a co-morbid condition. Hyperpigmentation of patients' skin was caused by hormonal dysfunction (hyperestrogenism) and was accompanied by vitamin D deficiency. CONCLUSIONS: In cosmetology practice, therapy of dermatoses should be individualized and based on the analysis of the course of the disease, considering the diagnosed dysfunctions of certain organs or systems that cause skin pathological changes, as well as the preva-lence and severity of dermatosis, presence of comorbid background and mental disorders. A holistic approach in the therapy of dermatoses involving a dermatologist, a psychologist, a cosmetologist, and specialized clinicians will ensure their effective treatment. PMID:37674449 | DOI:10.7417/CT.2023.2457 {url} = URL to article
    • Front Pain Res (Lausanne). 2023 Aug 22;4:1273636. doi: 10.3389/fpain.2023.1273636. eCollection 2023. NO ABSTRACT PMID:37674769 | PMC:PMC10478075 | DOI:10.3389/fpain.2023.1273636 {url} = URL to article
    • Pediatr Dermatol. 2023 Sep 5. doi: 10.1111/pde.15420. Online ahead of print. ABSTRACT Aseptic facial granuloma is a rare pediatric disease, presenting with asymptomatic facial nodules on the cheeks or the eyelids and may represent a form of granulomatous rosacea in children. In this retrospective case series, 12 children with aseptic facial granuloma were treated with oral macrolides (erythromycin or roxithromycin) resulting in a healing of the lesions within a mean treatment time of 5.25 months with no recurrences. The treatment was mainly well tolerated. Oral macrolides may be effective in the treatment of patients with aseptic facial granuloma. PMID:37667982 | DOI:10.1111/pde.15420 {url} = URL to article
    • Int J Dermatol. 2023 Sep 4. doi: 10.1111/ijd.16824. Online ahead of print. NO ABSTRACT PMID:37664996 | DOI:10.1111/ijd.16824 {url} = URL to article
    • Clin Exp Dermatol. 2023 Sep 4:llad307. doi: 10.1093/ced/llad307. Online ahead of print. ABSTRACT Rosacea is a common chronic inflammatory skin disease with a complex etiology and major psychological impact, rendering patients susceptible to misinformation. We aimed to assess the content of rosacea-related misinformation online. A formal review of PubMed was performed, using the terms 'rosacea' AND 'misinformation' OR 'disinformation' OR 'conspiracy theory', along with informal Google searches using combinations of these terms, and further targeted searches on Twitter, Facebook, Instagram, and TikTok. Key areas of misinformation identified in the search included mislabelling as adult acne; falsehoods about rosacea only occurring in older adults or in individuals with lightly pigmented skin; incorrect causes such as make-up or diet; and misleading 'cures', some of which may lead to exacerbation of the underlying rosacea. Dermatologists must be aware of the large amounts of rosacea misinformation trending online and be prepared to counteract them with evidence to optimize patient care. PMID:37665965 | DOI:10.1093/ced/llad307 {url} = URL to article
    • J Am Acad Dermatol. 2023 Sep 2:S0190-9622(23)02655-5. doi: 10.1016/j.jaad.2023.08.071. Online ahead of print. NO ABSTRACT PMID:37666419 | DOI:10.1016/j.jaad.2023.08.071 {url} = URL to article
    • Drug Des Devel Ther. 2023 Aug 25;17:2573-2591. doi: 10.2147/DDDT.S427530. eCollection 2023. ABSTRACT In 1982, the Food and Drug Administration (FDA) of the United States of America approved isotretinoin (13-cis-retinoic acid), a retinoid derivative of vitamin A, to treat severe recalcitrant acne vulgaris. Apart from its prescribed use for severe acne, evidence suggests that isotretinoin is commonly used off-label to treat mild-to-moderate acne, inflammatory skin conditions, genodermatoses, skin cancer, and other skin disorders. This is due to its anti-inflammatory, immunomodulatory, and antineoplastic properties. Some "off-label" use is successful, while others are ineffective. Therefore, this information is essential to clinicians for deciding on the appropriate use of isotretinoin. In this article, we aim to review the most updated evidence-based data about the use of oral isotretinoin in dermatology. PMID:37649956 | PMC:PMC10464604 | DOI:10.2147/DDDT.S427530 {url} = URL to article
    • Neurol Sci. 2023 Aug 30. doi: 10.1007/s10072-023-07039-6. Online ahead of print. NO ABSTRACT PMID:37646978 | DOI:10.1007/s10072-023-07039-6 {url} = URL to article
    • J Eur Acad Dermatol Venereol. 2023 Aug 29. doi: 10.1111/jdv.19477. Online ahead of print. ABSTRACT BACKGROUND: Acne fulminans (AF) is a rare severe acne entity. Although occasionally reported, it is unclear whether AF development is associated with oral isotretinoin treatment. OBJECTIVES: To investigate the occurrence of isotretinoin-associated AF, clinical characteristics and prognosis at follow-up. METHODS: An international, multicentre, retrospective study was performed in eight hospitals following the call of the EADV Task Force on Acne, Rosacea and Hidradenitis Suppurativa (ARHS). Characteristics of patients treated with isotretinoin before the development of AF (isotretinoin-associated acne fulminans, IAF) were compared with non-IAF (NAF). RESULTS: Forty-nine patients diagnosed with AF from 2008 to 2022 were included (mean age 16.4 years, SD 2.9, 77.6% male). Αrthralgias/arthritis occurred in 11 patients (22.9%). AF occurred without any previous acne treatment in 26.5% of the patients. Overall, 28 patients (57.1%) developed AF after oral isotretinoin intake (IAF group), while the remaining 21 patients (42.9%) developed AF without previous oral isotretinoin administration (NAF group). IAF occurred after a median duration of isotretinoin treatment of 45 days (IQR: 30, 90). Patients with IAF were more frequently male compared to patients with NAF (89.3% vs. 61.9%, respectively, p = 0.023). There were no differences in patients with IAF versus NAF in patient age, the duration of pre-existing acne, a family history of AF, the distribution of AF lesions or the presence of systemic symptoms or arthralgias. Regarding the management of AF, patients with IAF were treated more frequently with prednisolone (96.2%) compared to those with NAF (70%; p = 0.033) and less frequently with isotretinoin (32.1%) compared to NAF (85.7%; p < 0.001). At a median follow-up of 2.2 years, 76.4% of patients were free of AF and scarring was present in all patients. CONCLUSIONS: No specific clinical or demographic characteristics of IAF compared with NAF could be detected, a fact that does not support IAF as a district clinical entity. PMID:37643921 | DOI:10.1111/jdv.19477 {url} = URL to article
    • J Clin Aesthet Dermatol. 2023 Aug;16(8):27-33. ABSTRACT OBJECTIVE: We sought to assess the long-term safety and tolerability of microencapsulated benzoyl peroxide cream, 5% (E-BPO cream, 5%), in subjects with rosacea. Efficacy and tolerability have been previously demonstrated in two 12-week, randomized, double-blind, vehicle-controlled Phase III trials. METHODS: In this open-label extension study (NCT03564145; clinicaltrials.gov), all subjects from the initial placebo-controlled Phase III trials could receive E-BPO cream, 5%, for up to an additional 40 weeks, up to a total of 52 weeks of E-BPO cream, 5%, exposure. If a subject was assessed at study visits as "clear" or "almost clear" using the 5-point Investigator Global Assessment (IGA) scale (IGA 0 or 1), E-BPO cream, 5%, was not dispensed. If a subject was assessed as "mild to severe" (IGA 2+), E-BPO cream, 5%, was applied daily until they reached "clear" or "almost clear." RESULTS: The safety and tolerability profile for E-BPO cream, 5%, was similar to that reported in the Phase III studies. Five subjects (0.9%) discontinued study drug due to treatment-related adverse events, and 17 subjects (3.2%) experienced an adverse event considered related to study drug. IGA success after 40 weeks of active treatment was 66.5 percent for subjects continuing from the Phase III vehicle group (n=172) and 67.6 percent for subjects who continued Phase III E-BPO cream, 5% (n=363). The study ended early in accordance with the protocol. LIMITATIONS: Safety and tolerability of E-BPO were not compared with those of unencapsulated BPO. CONCLUSION: E-BPO cream, 5%, showed a favorable safety and tolerability profile during this 40-week, open-label extension study. PMID:37636251 | PMC:PMC10452482 {url} = URL to article
    • J Clin Aesthet Dermatol. 2023 Aug;16(8):34-40. ABSTRACT OBJECTIVE: A new formulation of benzoyl peroxide (E-BPO cream, 5%) entraps benzoyl peroxide (BPO) in silica microcapsules. This study assesses the efficacy, safety, and tolerability of E-BPO cream, 5%, in rosacea in two Phase III clinical trials. METHODS: In two 12-week, randomized, double-blind, vehicle cream-controlled Phase III trials, 733 subjects at least 18 years old with moderate to severe rosacea were randomized (2:1) to once-daily E-BPO cream, 5%, or vehicle. RESULTS: In Study 1, the proportion of subjects achieving IGA clear/almost clear at Week 12 was 43.5 percent for E-BPO cream, 5%, and 16.1 percent for vehicle. In Study 2, the respective values were 50.1 percent and 25.9 percent. In Study 1, the decrease in lesion count from baseline to Week 12 was -17.4 for E-BPO cream, 5%, versus -9.5 for vehicle. In Study 2, the respective values were -20.3 and -13.3 (all P<0.001). The difference was also significant at Week 2. There were no treatment-related serious adverse events; 1.4 percent of subjects (1.8% E-BPO cream, 5%, 0.4% vehicle) discontinued due to adverse events. Assessed local tolerability was found to be similar among subjects in both E-BPO and vehicle. E-BPO was not compared with unencapsulated BPO. CONCLUSION: E-BPO is an effective and well tolerated treatment for rosacea. Clinicaltrials.gov Identifiers: NCT03564119, NCT03448939. PMID:37636253 | PMC:PMC10452484 {url} = URL to article
    • J Am Acad Dermatol. 2023 Aug 26:S0190-9622(23)02634-8. doi: 10.1016/j.jaad.2023.08.055. Online ahead of print. NO ABSTRACT PMID:37640245 | DOI:10.1016/j.jaad.2023.08.055 {url} = URL to article
    • Biomedicines. 2023 Jul 31;11(8):2153. doi: 10.3390/biomedicines11082153. ABSTRACT Rosacea is a chronic inflammatory skin disease characterized by recurrent erythema, flushing, telangiectasia, papules, pustules, and phymatous changes in the central area of the face. Patients with this condition often experience a significant negative impact on their quality of life, self-esteem, and overall well-being. Despite its prevalence, the pathogenesis of rosacea is not yet fully understood. Recent research advances are reshaping our understanding of the underlying mechanisms of rosacea, and treatment options based on the pathophysiological perspective hold promise to improve patient outcomes and reduce incidence. In this comprehensive review, we investigate the pathogenesis of rosacea in depth, with a focus on emerging and novel mechanisms, and provide an up-to-date overview of therapeutic strategies that target the diverse pathogenic mechanisms of rosacea. Lastly, we discuss potential future research directions aimed at enhancing our understanding of the condition and developing effective treatments. PMID:37626650 | PMC:PMC10452301 | DOI:10.3390/biomedicines11082153 {url} = URL to article
    • Antioxidants (Basel). 2023 Jul 27;12(8):1503. doi: 10.3390/antiox12081503. ABSTRACT Skin conditions are a significant cause of fatal and nonfatal disease burdens globally, ranging from mild irritations to debilitating diseases. Oxidative stress, which is an imbalance between reactive oxygen species and the cells' ability to repair damage, is implicated in various skin diseases. Antioxidants have been studied for their potential benefits in dermatologic health, but the evidence is limited and conflicting. Herein, we conducted a systematic review of controlled trials, meta-analyses, and Cochrane review articles to evaluate the current evidence on the utility of antioxidant supplementation for adjunct prevention and treatment of skin disease and to provide a comprehensive assessment of their role in promoting dermatologic health. The Cochrane Library, PubMed, EMBASE, and Epistemonikos databases were queried. Eligibility criteria included (1) primary focus on nanoparticle utility for skin cancer; (2) includes measurable outcomes data with robust comparators; (3) includes a number of human subjects or cell-line types, where applicable; (4) English language; and (5) archived as full-text journal articles. A total of 55 articles met the eligibility criteria for the present review. Qualitative analysis revealed that topical and oral antioxidant supplementation has demonstrated preliminary efficacy in reducing sunburns, depigmentation, and photoaging. Dietary exogenous antioxidants (namely vitamins A, C, and E) have shown chemopreventive effects against skin cancer. Antioxidant supplementation has also shown efficacy in treating non-cancer dermatoses, including rosacea, psoriasis, atopic dermatitis, and acne vulgaris. While further studies are needed to validate these findings on a larger scale, antioxidant supplementation holds promise for improving skin health and preventing skin diseases. PMID:37627498 | PMC:PMC10451863 | DOI:10.3390/antiox12081503 {url} = URL to article
    • Skin Res Technol. 2023 Aug;29(8):e13427. doi: 10.1111/srt.13427. ABSTRACT INTRODUCTION: The Flash-lamp pulsed dye laser (FPDL) is nowadays considered the most precise laser currently on the market for treating superficial vascular lesions. In this study, we gathered data from 10 years of experience regarding dye laser treatment of patients presenting vascular malformations such as telangiectasia, rhinophyma, port-wine stain, cherry and spider angioma and vascular tumours. METHODS: Subjects were enrolled from 2013 to 2023 based on the vascular anomalies they presented. They underwent different treatment sessions with the FPDL device. RESULTS: The age-range distribution by vascular anomaly confirmed that haemangiomas are typical in children while rhinophyma is a condition very common in older adults. A difference in sex distribution showed that pathologies such as telangiectasias typically affect women whereas rhinophyma is more frequent in men. Most of the treatments interested the face area but no permanent side effects were registered. CONCLUSIONS: Our 10 years of experience with FPDL demonstrated good results in a wide range of applications for the treatment of different vascular anomalies. The absence of long-term side effects and bearable pain during the treatment makes it a valuable solution for the resolution of benign tumours also in very young patients. PMID:37632184 | PMC:PMC10397371 | DOI:10.1111/srt.13427 {url} = URL to article
    • Cutis. 2023 Jul;112(1):5-6. doi: 10.12788/cutis.0802. NO ABSTRACT PMID:37611294 | DOI:10.12788/cutis.0802 {url} = URL to article
    • Fundam Clin Pharmacol. 2023 Aug 23. doi: 10.1111/fcp.12944. Online ahead of print. ABSTRACT BACKGROUND: Although brimonidine is currently used in the clinical treatment of glaucoma and rosacea, research of the deep sedative effect on animals after systemic administration is reported firstly and has shown promising results. METHODS: The median effective dose (ED50 ), the median lethal dose (LD50 ), and the therapeutic index of brimonidine for deep sedation and formalin stimulation assay were determined by various animal experiments. The effect of synergistic anesthesia in rabbits with brimonidine and chloral hydrate was preliminarily evaluated. RESULTS: The ED50 of brimonidine for highly effective sedation by intraperitoneal injection in rats was calculated to be 2.05 mg kg-1 with a 95% confidence interval (CI) of 1.87 to 2.25 mg kg-1 . The ED50 of brimonidine for deep sedation by intravenous and intrarectal injection in rabbits was calculated to be 0.087 mg kg-1 with a 95% CI of 0.084 to 0.091 mg kg-1 and 1.65 mg kg-1 with a 95% CI of 1.43 to 1.91 mg kg-1 , respectively. The LD50 of intraperitoneal brimonidine injection in rats was calculated to be 468 mg kg-1 with a 95% CI of 441 to 497 mg kg-1 and a therapeutic index of 228. Brimonidine has a certain analgesic and heart rate lowering effects. CONCLUSION: The results confirmed that brimonidine has deep sedation and analgesic effects after systemic administration and has high safety. It can be used in combination with other types of sedative drugs to achieve better effects. PMID:37612481 | DOI:10.1111/fcp.12944 {url} = URL to article
    • J Cosmet Dermatol. 2023 Aug 21. doi: 10.1111/jocd.15962. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a chronic inflammatory disease usually associated with persistent erythema and periodic flushing. This disease is difficult to treat, and the outcomes are often unsatisfactory and prone to recurrence. In recent years, botulinum toxin has been used as a new treatment for rosacea; however, its efficacy and safety remain under discussion. Although a systematic review of the effectiveness and safety of botulinum toxin has been previously conducted by other researchers, our systematic review and meta-analysis evaluate the efficacy of botulinum toxin from a more comprehensive and detailed perspective to provide evidence for clinicians. METHODS: Any study using botulinum toxin for the treatment of rosacea was considered for the analysis. RESULTS: A total of 22 studies were included, 9 of which were randomized controlled trials involving 720 subjects. After treatment, all studies showed varying degrees of improvement in patient signs and symptoms along with reduced Clinician's Erythema Assessment (CEA) scores. The improvement was maintained for several months, and the adverse effects were mild and self-limiting. CONCLUSION: Botulinum toxin may be an effective treatment for patients with rosacea; however, further clinical evidence is needed to confirm its long-term efficacy and side effects. The study was preregistered with Prospero (CRD42022358911). PMID:37605478 | DOI:10.1111/jocd.15962 {url} = URL to article
    • J Dermatolog Treat. 2023 Dec;34(1):2244616. doi: 10.1080/09546634.2023.2244616. NO ABSTRACT PMID:37605482 | DOI:10.1080/09546634.2023.2244616 {url} = URL to article
    • J Eur Acad Dermatol Venereol. 2023 Aug 22. doi: 10.1111/jdv.19449. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a common chronic inflammatory skin condition that is often refractory to treatment, with frequent relapses. Alterations in the skin immunological response and Demodex mite infestation are the primary aetiologic factors targeted for treatment. Transient receptor potential cation channel subfamily V member 1 (TRPV1) is a nociceptive cation channel that plays a role in cutaneous neurogenic pain and can be activated by various rosacea triggers. OBJECTIVES: We investigated the effects of TRPV1 modulation in rosacea, focussing on Demodex mite colonization and cutaneous neurogenic inflammation. METHODS: We examined mRNA expression levels according to Demodex population counts. An in vitro study using capsazepine as a TRPV1 antagonist was performed to assess the influence of TRPV1 in keratinocytes. A rosacea-like mouse model was generated by the injection of the 37-amino acid C-terminal cathelicidin peptide (LL37), and changes in the skin, dorsal root ganglion (DRG) and ears were examined. RESULTS: Increased Demodex mite population counts were associated with increased expression levels of TRPV1, tropomyosin receptor kinase A (TrkA) and nerve growth factor (NGF), and these levels could be reduced by capsazepine treatment in keratinocytes. In an in vivo study, the downstream effects of TRPV1 activation were investigated in the skin, DRG and ears of the rosacea-like mouse model. CONCLUSIONS: The findings of this study are instrumental for understanding the underlying causes of rosacea and could potentially lead to the development of new treatments targeting the NGF-TrkA-TRPV1 pathway. The identification of this pathway as a therapeutic target could represent a major breakthrough for rosacea research, potentially resulting in more effective and targeted rosacea treatments. This study contributes to an improved understanding of rosacea pathophysiology, which may lead to the development of more effective treatments in the future. PMID:37606610 | DOI:10.1111/jdv.19449 {url} = URL to article
    • JAAD Case Rep. 2023 Jun 15;38:102-104. doi: 10.1016/j.jdcr.2023.06.004. eCollection 2023 Aug. NO ABSTRACT PMID:37600738 | PMC:PMC10433285 | DOI:10.1016/j.jdcr.2023.06.004 {url} = URL to article
    • Indian J Ophthalmol. 2023 Sep;71(9):3272. doi: 10.4103/0301-4738.383879. ABSTRACT [This corrects the article DOI: 10.4103/IJO.IJO_2983_22]. PMID:37602633 | DOI:10.4103/0301-4738.383879 {url} = URL to article
    • Br J Dermatol. 2023 Aug 19:ljad277. doi: 10.1093/bjd/ljad277. Online ahead of print. NO ABSTRACT PMID:37596936 | DOI:10.1093/bjd/ljad277 {url} = URL to article
    • Dermatologie (Heidelb). 2023 Sep;74(9):715-724. doi: 10.1007/s00105-023-05197-4. Epub 2023 Aug 18. ABSTRACT Rosacea is a common chronic inflammatory dermatosis of the face, clinically characterized by erythema, telangiectasia, papules, pustules, and rhinophyma. In January 2022, the updated guideline on rosacea was published. Groundbreaking innovations include the new clinical classification according to phenotypes, extended diagnostic and therapeutic recommendations for ocular rosacea and implications of the gut microbiome on rosacea. Furthermore, the guideline encompasses a new chapter on the psychosocial aspects of rosacea and detailed recommendations for approved and off-label therapies. PMID:37594512 | DOI:10.1007/s00105-023-05197-4 {url} = URL to article
    • Ann Dermatol Venereol. 2023 Sep;150(3):199-201. doi: 10.1016/j.annder.2023.05.004. Epub 2023 Aug 16. ABSTRACT BACKGROUND: Ocular rosacea is an underdiagnosed form of rosacea that may occur without typical cutaneous signs of rosacea. Manifestations include blepharitis, lid margin telangiectasias, and scleritis. A systematic comparison of treatment options for ocular rosacea in children is lacking. METHODS: A systematic review was conducted according to the PRISMA guidelines on treatment for pediatric ocular rosacea. RESULTS: Eleven articles were included, representing 135 patients with a mean age of 5 years, of whom 69% (n = 75/108) were female. 55% (n = 55/99) exhibited ocular symptoms prior to cutaneous symptoms. Most patients (83%, n = 34/41) experienced a delay in diagnosis (mean 27 months, range 2-120 months). Doxycycline was the most frequently reported treatment (25%, n = 33/135). A complete response was achieved in 33% of patients treated with doxycycline (n = 10/30), while 53% (n = 16/30) achieved a partial response. Erythromycin was used in 20% of cases (n = 26/135), with a complete response in 58% (n = 15/26) and partial response in 42% (n = 11/26). Metronidazole was used in 14% of patients (n = 19/135), with a complete response being reported in 79% (n = 15/19) and partial response in 21% (n = 4/19). CONCLUSION: Systemic antibiotics, led by doxycycline, were the most commonly reported treatment modalities for pediatric ocular rosacea. Increased awareness of ocular rosacea in this population is crucial for earlier diagnosis. PMID:37596128 | DOI:10.1016/j.annder.2023.05.004 {url} = URL to article
    • J Cutan Med Surg. 2023 Aug 17:12034754231194017. doi: 10.1177/12034754231194017. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a chronic inflammatory disorder that can adversely affect the patient's quality of life (QOL). However, few studies have examined the association between the psychological burden and willingness to pay (WTP) with rosacea features and severity. OBJECTIVES: The study aimed to determine the overall psychological burden and WTP among Korean rosacea patients and identify factors that may contribute, such as patient demographics, clinical features, and rosacea severity. METHODS: This prospective cross-sectional study recruited Koreans with rosacea. All were asked to complete a questionnaire on their demographics, rosacea-related symptoms, self-rated severity, dermatology life quality index (DLQI), and WTP. The clinical features were assessed by a board-certified dermatologist. The investigator's global assessment and global flushing severity score (GFSS) were used to determine the clinical severity of rosacea. Multiple regression analysis was conducted to identify factors contributing to the psychological burden and WTP. RESULTS: Out of 201 rosacea patients, 147 (73.1%) were female, and 54 (26.9%) males, with a median age of 50.1 years. Their median DLQI score was 8 (interquartile range [IQR]): 4.0-13.0). The median WTP per month for the control of rosacea was $100, with relative WTP (WTP/household income per month x 100) being 3.3%. According to the multiple regression model, phymatous change (β = .153, p = .030), DLQI score (β = .152, P = .045), and GFSS (β = .154, P = .041) contributed most to the WTP. CONCLUSION: Rosacea patients experience substantial psychological and economic burdens. More vigorous treatment should be performed for those with phyma and severe flushing whose QOL is most severely affected. PMID:37587799 | DOI:10.1177/12034754231194017 {url} = URL to article
    • Dermatol Online J. 2023 Jun 15;29(3). doi: 10.5070/D329361439. NO ABSTRACT PMID:37591279 | DOI:10.5070/D329361439 {url} = URL to article
    • Clin Dermatol. 2023 Aug 15:S0738-081X(23)00088-3. doi: 10.1016/j.clindermatol.2023.08.009. Online ahead of print. NO ABSTRACT PMID:37591470 | DOI:10.1016/j.clindermatol.2023.08.009 {url} = URL to article
    • Clin Dermatol. 2023 Sep 14:S0738-081X(23)00081-0. doi: 10.1016/j.clindermatol.2023.08.002. Online ahead of print. ABSTRACT Eyelid dermatitis may present with a variety of clinical findings including erythema, pruritus, and edema, and it has a wide differential. Allergic contact dermatitis due to allergen sources in personal care products, cosmetics, and fragrances is a leading cause of eyelid dermatitis and may be challenging to diagnose by clinical examination alone. Expanded patch testing, in addition to careful inspection of the surrounding skin for additional areas of involvement and clinical clues, remains an important tool in differentiating allergic contact dermatitis from other relevant etiologies of eyelid dermatitis including irritant contact dermatitis, atopic dermatitis, seborrheic dermatitis, and rosacea. We present a practical approach to the management of eyelid dermatitis including the use of a topical anti-inflammatory for long-term control of eyelid findings. Further diagnostic workup may be warranted in patients with refractory eyelid dermatitis. PMID:37574152 | DOI:10.1016/j.clindermatol.2023.08.002 {url} = URL to article
    • Clin Dermatol. 2023 Aug 11:S0738-081X(23)00083-4. doi: 10.1016/j.clindermatol.2023.08.004. Online ahead of print. ABSTRACT Chronic eyelid and ocular itch affect many patients seeking dermatologic or ophthalmologic care and have a high burden on patient quality of life. Clinicians should consider the broad range of possible diagnoses when approaching the patient with itch of the eyes or eyelids lasting more than 6 weeks. Allergic conjunctivitis and allergic contact dermatitis are the most common causes of chronic itch of the eyes and eyelids, respectively. Other diagnoses to consider include atopic dermatitis, xerosis, neurogenic itch, dry eye syndrome, seborrheic dermatitis, blepharitis, rosacea, lichen simplex chronicus, and papulosquamous disorders. If no organic cause can be elucidated, diagnoses of psychogenic pruritus or chronic pruritus of unknown origin may be considered. Herein, we discuss the possible etiologies of chronic eyelid and ocular itch inclusive of clinical presentation, diagnostic considerations, and current therapies. PMID:37574153 | DOI:10.1016/j.clindermatol.2023.08.004 {url} = URL to article
    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a182. ABSTRACT INTRODUCTION: Few studies have evaluated the histopathological characteristics of clinical rosacea subtypes in detail. OBJECTIVES: To assess rosacea histopathological features in correspondence to clinical subgroups. METHODS: The histopathological findings of 204 rosacea patients were analyzed retrospectively and were compared among clinical subtypes. RESULTS: Thirt-Two Percent of patients were male and 68% were female. Seventy-three patients had erythematotelangiectatic rosacea (ETR) and 110 had papulopustular rosacea (PPR), 12 were ETR + PPR, 4 ocular, 2 phymatous, and 3 had Morbihan's edema. Perivascular and perifollicular lymphohistiocytic infiltration, perifollicular exocytosis, follicular spongiosis, and ectatic vessels were almost found in all subtypes. Solar elastosis was higher in ETR. Spongiosis, exocytosis of inflammatory cells into epidermis, acanthosis, and granulomatous reaction were higher in PPR. Inflammatory cells exocytosis was more in PPR and phymatous. Demodex folliculorum was identified in 27% of ETR, 33.6% of PPR, 50% of phymatous, one ocular patient, and none of Morbihan edema. Demodex brevis were found in 5% of ETR, 3% of PPR, and 50% of phymatous. Demodex brevis not folliculorum was more in phymatous. Spongiosis was the most common finding in ocular rosacea. CONCLUSIONS: Spongiosis, exocytosis of inflammatory cells, and granulomatous reactions were more in PPR. Solar elastosis was more in ETR. Histopathological findings were compatible with clinical subgroups. PMID:37557115 | DOI:10.5826/dpc.1303a182 {url} = URL to article
    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a168. ABSTRACT INTRODUCTION: Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES: To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS: Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS: Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS: The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events. PMID:37557136 | DOI:10.5826/dpc.1303a168 {url} = URL to article
    • Dermatol Pract Concept. 2023 Jul 1;13(3). doi: 10.5826/dpc.1303a131. ABSTRACT INTRODUCTION: Superficial folliculitis of the scalp (SFS) is a common complaint in clinical practice, and initial presentation may be difficult to differentiate as they may appear very similar to each other. OBJECTIVES: The aim of this thesis is to describe the pathologies that occur clinically as folliculitis of the scalp, identify their causes and characteristics and create a standardized classification. METHODS: This is a retrospective clinical, dermoscopic and histopathological study over 10 years of dermatologic consultations. Only individuals with a confirmed diagnosis of SFS (updated diagnostic criteria or biopsy) were included. RESULTS: In this review, we describe the various clinical features of different causes of SFS in ninety-nine cases and divided into infectious due to fungus, bacteria, or virus and inflammatory conditions such as rosacea, acneiform eruption and Ofuji syndrome. CONCLUSIONS: The clinician must differentiate SFS from other underlying scarring disorders to prevent poorer outcomes. We created an algorithm to help the clinician reach a proper diagnosis. PMID:37557142 | DOI:10.5826/dpc.1303a131 {url} = URL to article
    • J Drugs Dermatol. 2023 Aug 1;22(8):838-839. doi: 10.36849/jdd.7103. ABSTRACT Improved patient-physician relationships (PPR) are associated with better patient satisfaction and disease outcomes, however, there is limited literature assessing how PPR affects adherence in dermatology. We recruited 30 subjects with a clinical diagnosis of rosacea. Subjects were instructed to use ivermectin 1% cream once daily for 3 months and adherence was measured using the Medication Event Monitoring System cap. The Patient-Doctor Relationship Questionnaire (PDRQ-9), a validated questionnaire assessing patients&rsquo; perceived strength of the relationship with their doctor, was completed. Mean adherence for all subjects over three months of the study was 62%. PDRQ-9 scores positively correlated with adherence rates for 3 months of treatment (r(26)=0.52; P=0.006). The perceived strength of the PPR may have a role in patients&rsquo; adherence to their medications. Improving the PPR, through empathy and effective communication, may facilitate better medication adherence and treatment outcomes.&nbsp;Perche PO, Singh R, Cook MK, et al. The patient-physician relationship and adherence: observations from a clinical study. J Drugs Dermatol. 2023;22(8):838-839. doi:10.36849/JDD.7103. PMID:37556519 | DOI:10.36849/jdd.7103 {url} = URL to article
    • JAAD Case Rep. 2023 Jun 29;39:14-16. doi: 10.1016/j.jdcr.2023.06.028. eCollection 2023 Sep. NO ABSTRACT PMID:37554359 | PMC:PMC10404599 | DOI:10.1016/j.jdcr.2023.06.028 {url} = URL to article
    • Eur J Pediatr. 2023 Aug 9. doi: 10.1007/s00431-023-05083-0. Online ahead of print. ABSTRACT Rosacea is a facial inflammatory disorder that shows an increasing incidence with age. While rosacea is common > 60 years of age, pediatric rosacea is uncommon. Diagnostic criteria are based on clinical symptoms. Laboratory investigations and histopathology are only needed to exclude other differential diagnoses. There are several subtypes such as erythemato-telangiectatic, papulo-pustular, periorificial, and granulomatous variants. In contrast to adult rosacea, phymatous subtypes do not belong to pediatric rosacea. A special subtype seen in infants and children is an idiopathic facial aseptic granuloma. Genetic and environmental factors contribute to its pathogenesis. Treatment options are in analogy to adult rosacea classified into topical and systemic drugs. In the case of oral tetracyclines, discoloration of teeth and impairment of enamel are possible adverse events. CONCLUSION: Pediatric rosacea belongs to the rosacea spectrum but has peculiarities compared to the adult subtype. WHAT IS KNOWN: • Rosacea is a chronic inflammatory disorder different from acne. • Rosacea gets more common with advanced age. WHAT IS NEW: • Pediatric rosacea is an uncommon subtype with peculiar clinical presentation. • Demodicosis is very rare in immunocompetent children. PMID:37555972 | DOI:10.1007/s00431-023-05083-0 {url} = URL to article
    • J Cosmet Dermatol. 2023 Aug 7. doi: 10.1111/jocd.15923. Online ahead of print. ABSTRACT BACKGROUND: Topical azelaic acid (AA) is indicated for acne and rosacea, but there is some evidence for its use for other dermatological conditions. AIMS: To assess the effectiveness and safety of topical AA for acne vulgaris, rosacea, hyperpigmentation/melasma, and skin aging. METHODS: RCTs of at least 6 weeks' treatment duration were eligible for inclusion. Databases including MEDLINE, Embase, CINAHL, and ClinicalTrials.gov were searched up to December 2022. Two reviewers were involved in all stages of the systematic review process. RESULTS: Forty-three RCTs met the inclusion criteria. Meta-analyses within 20 rosacea studies demonstrated that erythema severity, inflammatory lesion counts, overall improvement, and treatment success (achieving skin clarity) were significantly improved with AA compared with vehicle after 12 weeks. AA was more effective than metronidazole 0.75% for improved erythema severity, overall improvement, and inflammatory lesion counts. Sixteen acne studies suggest that AA is more effective than vehicle for improving global assessments and reducing acne severity. AA 20% also significantly reduced more lesions than erythromycin gel. Within seven melasma studies, AA 20% was significantly better than vehicle for both severity and global improvement. AA 20% demonstrated significantly better results compared with hydroquinone 2% for global improvement. Very few significant differences between AA and comparators were observed for commonly reported adverse events. No eligible RCTs were found that evaluated skin aging. CONCLUSIONS: AA is more effective than vehicle for rosacea, acne and melasma. Comparisons between AA and other treatments were often equivalent. Where there is equivalence, AA may be a good option for some clinical situations. RCT evidence is needed to evaluate the effectiveness of AA on skin aging. PMID:37550898 | DOI:10.1111/jocd.15923 {url} = URL to article
    • Clin Cosmet Investig Dermatol. 2023 Jul 25;16:1949-1954. doi: 10.2147/CCID.S417070. eCollection 2023. ABSTRACT Morbihan disease is a rare entity involving the upper two-thirds of the face and characterized by chronic erythematous edema, which is recalcitrant to the traditional therapy of rosacea. We report a case of Morbihan disease effectively treated with macro-focused high-intensity focus ultrasound (MF-HIFU). After MF-HIFU treatment, an obvious reduction in swelling was observed with decreased erythema and hyperalgesia. In addition, in-vitro experiments were conducted to measure the actual temperature of the skin tissue under the epidermis. The results of the in-vitro experiments showed that the temperature plateau in the skin sample was reached at approximately 42°C after 5-min treatment or longer. MF-HIFU might be a promising energy-based therapy for Morbihan disease. PMID:37519942 | PMC:PMC10386836 | DOI:10.2147/CCID.S417070 {url} = URL to article
    • Skin Res Technol. 2023 Jul;29(7):e13409. doi: 10.1111/srt.13409. NO ABSTRACT PMID:37522510 | DOI:10.1111/srt.13409 {url} = URL to article
    • J Am Acad Dermatol. 2023 Jul 29:S0190-9622(23)02412-X. doi: 10.1016/j.jaad.2023.07.1019. Online ahead of print. NO ABSTRACT PMID:37524168 | DOI:10.1016/j.jaad.2023.07.1019 {url} = URL to article
    • Antibiotics (Basel). 2023 Jul 5;12(7):1152. doi: 10.3390/antibiotics12071152. ABSTRACT Tetracycline-class drugs are frequently used in dermatology for their anti-inflammatory properties to treat skin diseases such as acne, rosacea, and hidradenitis suppurativa (HS). The American Academy of Dermatology (AAD) clinical guidelines do not offer guidance regarding the co-administration of food with tetracycline-class drugs. The objectives of this study were to review the available evidence regarding whether taking tetracycline-class drugs with food decreases systemic absorption and is associated with an impact on clinical efficacy. A literature search was conducted using the PubMed database between February to May 2023 using the keywords "tetracycline-class drugs", "pharmacokinetics", "absorption", and "dermatology". Inclusion criteria included articles written in English and relevant to the absorption and efficacy of tetracycline-class drugs. This search yielded 131 articles written between 1977 to 2022, of which 29 met the criteria for review. United States Food and Drug Administration (FDA)-approved prescribing information for oral formulations of tetracycline, doxycycline, minocycline, and sarecycline were reviewed. Systemic absorption of tetracycline decreased when co-administered with food. Systemic absorption of oral doxycycline and minocycline was variable with food co-administration. The impact on bioavailability varied with the drug formulation and dosage. The absorption of oral sarecycline decreased when administered with food. Sarecycline is the only oral antibiotic where population pharmacokinetic studies demonstrated limited or no impact of food intake on clinical efficacy. There are no available data for other tetracycline-class drugs in dermatology. If patients find it more tolerable to take doxycycline, minocycline, and sarecycline with food to avoid gastrointestinal distress, this may merit consideration to encourage patient adherence. Since the impact of food intake on absorption varied with the dosage form of doxycycline and minocycline, consulting the appropriate package insert may give clinicians additional insight into differences in the various formulations. PMID:37508248 | PMC:PMC10376323 | DOI:10.3390/antibiotics12071152 {url} = URL to article
    • Metabolites. 2023 Jun 30;13(7):811. doi: 10.3390/metabo13070811. ABSTRACT Posterior blepharitis and dry eye are common disorders with meibomian gland dysfunction (MGD), a principal driver of their pathophysiology. Meibomian gland dysfunction is increasingly prevalent in older populations with contributory hormonal imbalances. The abnormal meibum in MGD has been documented to have an excess of cholesterol with a resultant disruption of the lipid layer of the tear film. This leads to tear film instability due to the inadequate trapping of the aqueous portion of the tear film with resultant evaporative dry eye. Significant morbidity may follow MGD with ocular surface inflammation disrupting both social and work function. Rosacea is a common chronic inflammatory condition of the central face but can have ocular and systemic inflammatory associations. It is especially prevalent in North European populations and can have onset at any age, but commonly presents between thirty and fifty years of age. In ocular rosacea, MGD is a recognised manifestation as is dyslipidaemia. Ocular rosacea can predate cutaneous disease. As yet, there is no directly reported evidence of the efficacy of the early identification and treatment of ocular rosacea with associated dyslipidaemia and systemic inflammation. We posit that MGD in ocular rosacea sufferers may be a marker for dysregulated cholesterol synthesis and inflammation, and that statins maybe a potential therapy. This article introduces potential strategies to utilise ocular rosacea MGD as a possible marker for ophthalmologists, cardiologists, and primary healthcare physicians to treat rosacea-associated dyslipidaemia and systemic inflammation. This could aid in overall cardiovascular morbidity and mortality control for rosacea sufferers, potentially at an earlier age, while also addressing their tear film de-stabilisation through cholesterol lowering and inflammation reduction. PMID:37512518 | PMC:PMC10384312 | DOI:10.3390/metabo13070811 {url} = URL to article
    • Evid Based Complement Alternat Med. 2023 Jul 19;2023:9768280. doi: 10.1155/2023/9768280. eCollection 2023. ABSTRACT [This retracts the article DOI: 10.1155/2022/3335074.]. PMID:37501827 | PMC:PMC10371531 | DOI:10.1155/2023/9768280 {url} = URL to article
    • Cornea. 2023 Jul 27. doi: 10.1097/ICO.0000000000003345. Online ahead of print. ABSTRACT PURPOSE: The effect of skin lipids on the formation and stability of the human tear film was investigated. METHODS: Skin swab substances (SSSs) were applied to the eyes of volunteers and studied using fluorescein or with TearView, which records infrared emissivity showing tear film integrity in real time. Results were compared with similar experiments using castor oil, freshly collected meibum, or acetic acid, which simulated the low pH of the skin. RESULTS: Fluorescein and TearView results were comparable. TearView showed the natural unaltered tear film over the whole eye, instant changes to the tear film, and meibomian gland activity. Minimal amounts of SSS destroyed the integrity of the film and caused pain. Corneal epithelial damage could be detected. TearView showed that SSS stimulated meibomian gland secretion if applied directly to the posterior eyelid margin. Excess meibum had no effect on the tear film spread or integrity. Castor oil formed floating lenses on the tear film which were spread by a blink but then condensed back toward themselves. There was no pain or surface damage with these oils. CONCLUSIONS: SSS contamination of the ocular surface disrupts the tear film, causes stinging, and fluorescein staining of the corneal epithelial cells after a blink. SSS stimulates meibomian gland activity. It is possible that various ocular conditions associated with dry eye, such as blepharitis and ocular rosacea, may compromise a meibomian lipid barrier of the eye lid margin. Skin lipids would then have access to the ocular surface and cause dry eye symptoms. PMID:37506368 | DOI:10.1097/ICO.0000000000003345 {url} = URL to article
    • Clin Cosmet Investig Dermatol. 2023 Jul 20;16:1865-1869. doi: 10.2147/CCID.S419756. eCollection 2023. ABSTRACT Periorificial dermatitis (PD) is an inflammatory disorder of the facial skin that mainly occurs around the mouth and manifests as erythema, papules, pustules, scales and other lesions. Special attention is needed in the clinical diagnosis of PD to distinguish it from acne, seborrheic dermatitis (SD), granulomatous rosacea (GR), sarcoidosis and childhood granulomatous periorificial dermatitis (CGPD). We used reflectance confocal microscopy (RCM) images of a patient with PD to assist in the diagnosis of PD. RCM of PD showed slight oedema of the spinous layer. Numerous dendritic cells, scattered hair follicular keratotic plugging and hair follicle dilatation were observed. The dilation and congestion of superficial dermis blood vessels, an increasing vascular density and accelerated blood flow, and a greater abundance of infiltrated inflammatory cells were also detected. PMID:37492464 | PMC:PMC10364813 | DOI:10.2147/CCID.S419756 {url} = URL to article
    • Skin Pharmacol Physiol. 2023 Jul 25. doi: 10.1159/000533190. Online ahead of print. ABSTRACT INTRODUCTION: Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. METHODS: In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 seconds/area) for six weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after six weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p-values were calculated using the Wilcoxon signed rank test. RESULTS: Twelve subjects (ETR, n=3; ETR and PPR, n=9) completed the study. DLQI was significantly improved after six weeks (p=0.007). On the CAP-treated side, lesions (p=0.007) and erythema size (p=0.041) were significantly reduced compared to the control. IGA (p=0.2) and skin redness intensity (p=0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. CONCLUSION: CAP is a promising new treatment of rosacea, especially for PPR. PMID:37490882 | DOI:10.1159/000533190 {url} = URL to article
    • J Am Acad Dermatol. 2023 Jul 22:S0190-9622(23)02394-0. doi: 10.1016/j.jaad.2023.07.1008. Online ahead of print. NO ABSTRACT PMID:37487834 | DOI:10.1016/j.jaad.2023.07.1008 {url} = URL to article
    • Scand J Gastroenterol. 2023 Jul 21:1-7. doi: 10.1080/00365521.2023.2236263. Online ahead of print. ABSTRACT OBJECTIVES: The current knowledge on the associations between coeliac disease and different skin diseases is contradictory and the patient's perspective on the burden of these is lacking. This study aimed to investigate patient-reported frequency, severity and quality of life effects of skin disorders in coeliac disease patients compared to controls and moreover to study the impacts of gluten-free diet on these skin diseases. MATERIALS AND METHODS: A study questionnaire designed for the purposes of this study and a validated Dermatology Life Quality Index (DLQI) questionnaire were posted to 600 adult members of the Finnish Coeliac Society and 1173 matched controls. Responses from 327 coeliac disease patients and 382 non-coeliac controls were compared. RESULTS: Coeliac disease patients were shown to be at no increased risk of atopic dermatitis, acne, rosacea, psoriasis, alopecia areata, vitiligo or chronic urticaria. The severity of these skin diseases did not differ between study groups, but the risk for at least moderate effects on quality of life caused by dermatological diseases was increased among those with coeliac disease. Positive response from gluten-free diet was most commonly experienced by coeliac disease patients with atopic dermatitis. CONCLUSIONS: Even though the risk for skin diseases was shown not to be increased among coeliac disease patients, there is still an increased burden related to experienced skin symptoms among these patients, which non-dermatologists treating coeliac disease patients should acknowledge. PMID:37477901 | DOI:10.1080/00365521.2023.2236263 {url} = URL to article
    • Mol Pharm. 2023 Aug 7;20(8):3804-3828. doi: 10.1021/acs.molpharmaceut.3c00324. Epub 2023 Jul 21. ABSTRACT Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies. PMID:37478169 | DOI:10.1021/acs.molpharmaceut.3c00324 {url} = URL to article
    • J Cosmet Dermatol. 2023 Jul 19. doi: 10.1111/jocd.15878. Online ahead of print. ABSTRACT BACKGROUND: Although rosacea and seborrheic dermatitis share some symptoms of sensitive skin, whether they respond differently to lactic acid sting and capsaicin tests, common tests for diagnosis of sensitive skin, is unknown. OBJECTIVES: To reveal the cutaneous responses to lactic acid sting (LAST) and capsaicin test (CAT) in females with either rosacea vs. seborrheic dermatitis. METHODS: A total of 60 patients with rosacea, 20 patients with seborrheic dermatitis and 40 normal controls were enrolled in the study. Their skin sensitivity to stimuli were evaluated following topical application of either 10% lactic acid solution or 0.001% capsaicin solution. Transepidermal water loss (TEWL) rates and erythema indexes were also measured on the face. RESULTS: In comparison to normal controls, the positive rate to either LAST or CAT was significantly higher in subjects with rosacea (p < 0.001), but not in that with seborrheic dermatitis. Similarly, individuals with rosacea displayed a higher positive rate to both LAST and CAT than those with seborrheic dermatitis and normal controls (p < 0.001). In parallel, the LAST scores and CAT scores in individuals with rosacea were significantly higher than in that with either seborrheic dermatitis or normal controls (p < 0.001). The baseline TEWL rates and erythema indexes were higher in individual with rosacea than in normal controls (p < 0.001). But the baseline TEWL rates and erythema indexes did not differ significantly between subjects with rosacea and that with seborrheic dermatitis. Moreover, LAST scores and CAT scores correlated positively with TEWL (p < 0.0001). TEWL rates were higher in CAT positive than in CAT negative subjects (p < 0.0001). Finally, erythema index correlated positively with CAT scores (p < 0.0001), but not with LAST scores (p = 0.0842). CONCLUSIONS: Skin responses to LAST and CAT differ between individuals with rosacea and those with seborrheic dermatitis, possibly due to the differences in epidermal permeability barrier and the neurovascular hyperreactivity. The higher LAST and CAT scores, as well as positive rates of both LAST and CAT can be attributable to inferior permeability barrier and the neurovascular hyperreactivity in subjects with rosacea. PMID:37464957 | DOI:10.1111/jocd.15878 {url} = URL to article
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