[Idiopathic facial aseptic granuloma: A case report]. Arch Argent Pediatr. 2019 Feb 01;117(1):e56-e58 Authors: Garais JA, Bonetto VN, Frontino L, Salduna MD, Ruiz Lascano A Abstract
Idiopathic facial aseptic granuloma is a childhood condition characterized by asymptomatic erythematous-violaceous nodules, often confused with abscesses. Its pathogenesis is unknown, but some authors have postulated its relationship with infantile rosacea. We present a case of a patient with a clinical diagnosis of idiopathic facial aseptic granuloma, with ocular involvement and a good response to oral metronidazole treatment.
PMID: 30652457 [PubMed - in process] {url} = URL to article

Rosacea: Relative risk vs Absolute Risk of Malignant Comorbidities. J Am Acad Dermatol. 2019 Jan 14;: Authors: Tjahjono LA, Cline A, Huang WW, Fleischer AB, Feldman SR PMID: 30654083 [PubMed - as supplied by publisher] {url} = URL to article

Trigger, tripwire, flareup and flush. These are probably the four most common terms used when discussing rosacea. Because of poor communication and rosaceans not understanding what there terms actually mean much confusion results, adding to the already confusing dilemma of rosacea understanding. So to set the record: 

Flare up according to the NRS is "a more intense outbreak of redness, bumps or pimples.."  

Tripwire or Trigger is the same thing according to the NRS who uses these words interchangeably and states that both terms mean, "factors that may cause a rosacea sufferer to experience a flare-up—a more intense outbreak of redness, bumps or pimples. [1]

A medical dictionary source defines flush as: flush 1. transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. See also erythema. [2]

A blush is a flush usually caused by psychological factors. A flush can be caused by a any number of factors as noted above including psychological factors. 

The reason this is brought up is that while most rosaceans confuse flushing with a flare up there are rosaceans who report having a flare up of rosacea and DO NOT FLUSH. These ones are admittedly fewer in number, and flushing is usually associated with a flare up, but nevertheless demonstrates that flushing is not necessarily a rosacea flare up. One could flush or blush and the skin returns to normal in a rosacea sufferer. Flushing does not NECESSARILY mean a rosacea flare up and it only means that it MAY produce a rosacea flare up. Those who think flushing is rosacea is like thinking pimples mean you have rosacea (or for that matter, believing that erythema is rosacea). There is more to a diagnosis of rosacea than simply having pimples and erythema (see Diagnosis). For example, one could have erythema and have Atopic Dermatitis, not rosacea.  Flushing is one of the signs or symptoms usually associated with rosacea, but not necessarily required. Pimples are associated with rosacea but not necessarily required, i.e., Phenotype 2. Rosacea is always associated with redness or erythema.  Hopefully, if rosaceans understand these terms, trigger, tripwire, flareup and flush better, we will all be on the same page when we discuss rosacea. 

End Notes

[1] Coping With Rosacea, National Rosacea Society, page 1

[2] Dorland’s Illustrated Medical Dictionary

Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016. JAMA Dermatol. 2019 Jan 16;: Authors: Barbieri JS, Bhate K, Hartnett KP, Fleming-Dutra KE, Margolis DJ Abstract
Importance: Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events.
Objective: To characterize the temporal trends in the diagnoses most commonly associated with oral antibiotic prescription by dermatologists, as well as the duration of this use.
Design, Setting, and Participants: Repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. The setting was Optum Clinformatics Data Mart (Eden Prairie, Minnesota) deidentified commercial claims data. Participants were dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes.
Exposures: Claims for oral antibiotic prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were stratified into those of extended duration (>28 days) and those of short duration (≤28 days).
Main Outcomes and Measures: Frequency of antibiotic prescribing and associated diagnoses. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time.
Results: Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists, overall antibiotic prescribing among dermatologists decreased 36.6% (1.23 courses per 100 visits) from 3.36 (95% CI, 3.34-3.38) to 2.13 (95% CI, 2.12-2.14) courses per 100 visits with a dermatologist (prevalence rate ratio for annual change, 0.931; 95% CI, 0.930-0.932), with much of this decrease occurring among extended courses for acne and rosacea. Oral antibiotic use associated with surgical visits increased 69.6% (2.73 courses per 100 visits) from 3.92 (95% CI, 3.83-4.01) to 6.65 (95% CI, 6.57-6.74) courses per 100 visits associated with a surgical visit (prevalence rate ratio, 1.061; 95% CI, 1.059-1.063).
Conclusions and Relevance: Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use. In addition, the rising use of postoperative antibiotics after surgical visits is concerning and may put patients at unnecessary risk of adverse events. Future studies are needed to identify the value of this practice and the risk of adverse events.
PMID: 30649187 [PubMed - as supplied by publisher] {url} = URL to article

Exploring the potential for rosacea therapeutics of siRNA dispersion in topical emulsions. Exp Dermatol. 2019 Jan 16;: Authors: Colombo S, Harmankaya N, Water JJ, Bohr A Abstract
Rosacea is a prevalent skin condition dependent on the individual genetic profile. The current pharmacological management of this condition is mostly based on small molecule drugs predominately effective in ameliorating the inflammatory condition. Emerging molecular approaches could present an opportunity for managing rosacea conditions at transcriptomic level, and in the future allow personalized approaches. RNA medicines, such as small RNA interference (siRNA), could provide a flexible and applicable tool reaching this aim. However, the topical siRNA delivery by dermatological emulsions, commonly used in the daily management of rosacea, is still largely unexplored. Consequently, RNA interference application to rosacea was defined on molecular bases by genetic expression meta-data analysis. Based on this, an siRNA directed against TLR2 was designed and validated in vitro on murine macrophages and fibroblasts. Next, siRNA was dispersed in the continuous phase of emulsions and was characterized for commonly used dermatologic bases. Finally, the potential delivery performance of the topical emulsions was tested in vivo on healthy Balb/c mice. It was found that the interaction of siRNA with combination of excipients such as urea and glycerol, is likely to favor the siRNA delivery, inducing genetic silencing of TLR2. These findings provide a foundation for the future development of topical RNA-based dispersions for topical molecular medicines, by emphasizing on the formulation and therapeutic-based opportunities with dermatological treatments. This article is protected by copyright. All rights reserved.
PMID: 30650201 [PubMed - as supplied by publisher] {url} = URL to article