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  1. Dermatol Ther (Heidelb). 2021 Oct 18. doi: 10.1007/s13555-021-00613-w. Online ahead of print. ABSTRACT INTRODUCTION: Depression and anxiety are common among people with rosacea. However, the exact magnitude of the prevalence rate and odds ratios (ORs) for depression and anxiety, respectively, in rosacea patients is unclear, and no systematic review or meta-analysis of published data has yet been performed. We therefore performed as systematic review and meta-analysis to determine the prevalence rates and ORs for depression and anxiety in rosacea patients. METHODS: We performed a systematic search of the PubMed, Embase and Medline databases for all observational studies published up to October 2020 that reported the prevalence rates and ORs for depression and anxiety in patients with rosacea. The primary outcome measures were prevalence rates and ORs for depression and anxiety in patients with rosacea. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS: A total of 14 studies involving 14,134,021 patients with rosacea were included in the systematic review and meta-analysis. The pooled prevalence of depression was 19.6% (95% confidence interval [CI] 15.0-24.3%) and that of anxiety was 15.6% (95% CI 11.8-19.3%). The prevalence of depression and anxiety was significantly lower in studies using clinical criteria to diagnose depression and anxiety (9.2 and 10.2%, respectively) than in those studies using screening tools (26.2% [P < 0.01] and 22.7% [P = 0.03], respectively). The methodological quality of the included studies greatly contributed to the heterogeneity. Patients with rosacea were more likely to experience depression (OR 2.21, 95% CI 1.79-2.72) and anxiety (OR 2.31, 95% CI 1.56-3.44) than healthy controls. CONCLUSIONS: This systematic review and meta-analysis indicates that patients with rosacea are at a higher risk of experiencing depression and anxiety. More efforts are warranted to recognize and manage depression and anxiety in patients with rosacea. PMID:34657997 | DOI:10.1007/s13555-021-00613-w {url} = URL to article
  2. Postepy Dermatol Alergol. 2021 Aug;38(4):590-596. doi: 10.5114/ada.2021.108917. Epub 2021 Sep 17. ABSTRACT INTRODUCTION: Inflammation, immune system disorders, Demodex infestation, neurovascular dysregulation and oxidative stress are thought to be contributory factors in the pathogenesis of rosacea. AIM: To evaluate the presence of Demodex mites, the morphologic features of the nailfold capillaries, and the systemic oxidative stress status in patients with rosacea. MATERIAL AND METHODS: Thirty-one patients diagnosed with rosacea and 37 healthy age- and gender-matched subjects were included in this prospective case-control study. The presence of Demodex infestation, the findings of nailfold capillaroscopy (NFC), and the status of systemic oxidative stress measured by total oxidant capacity (TOC), total antioxidant capacity (TAC) and oxidative stress index (OSI) were evaluated. RESULTS: Demodex infestation rates were significantly higher in rosacea patients than in controls (p = 0.001). Increases in the diameters of the capillaries and the presence of avascular areas and crossing and abnormal structures were significantly more common in rosacea patients than in the healthy controls (p < 0.01, p = 0.016, p = 0.02, p < 0.001, respectively), and hairpin structures were significantly less common in rosacea patients than in the controls (p < 0.001). The presence of crossing capillaries was positively correlated with higher TOC levels (p = 0.05), while abnormal structures were found to be correlated with lower levels of TAC (p = 0.045). CONCLUSIONS: Oxidative status and NFC may play diagnostic and prognostic roles in rosacea, which should be confirmed by studies with larger sample sizes. PMID:34658699 | PMC:PMC8501418 | DOI:10.5114/ada.2021.108917 {url} = URL to article
  3. J Eur Acad Dermatol Venereol. 2021 Oct 17. doi: 10.1111/jdv.17758. Online ahead of print. ABSTRACT Few studies have investigated the relationship between rosacea and upper gastrointestinal (GI) disorders, with two studies reporting conflicting data that patients with rosacea are at higher risk for gastroesophageal reflux disease (GERD).1, 2 Here, we conducted a case-control study to investigate a potential relationship between rosacea and GI disorders with a focus on the upper GI tract defined as the esophagus, stomach, and small intestine. PMID:34661953 | DOI:10.1111/jdv.17758 {url} = URL to article
  4. Cureus. 2021 Aug 31;13(8):e17617. doi: 10.7759/cureus.17617. eCollection 2021 Aug. ABSTRACT BACKGROUND: The multifactorial nature of rosacea and chronic spontaneous urticaria (CSU) pathogenesis complicates the achievement of satisfactory treatment outcomes. 13C urea breath test (UBT) has been identified as an accurate, non-invasive, and quick procedure to detect the presence of Helicobacter pylori (H. pylori) with high sensitivity and specificity. OBJECTIVE: In this study, we aim to assess the correlation between H. pylori infection and rosacea and CSU patients. METHODS: A cross-sectional, observational study was conducted on patients with rosacea and CSU in the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. History and physical examination were performed by a dermatologist. H. pylori 13C-UBT detection was performed in all subjects. RESULTS: In total, 114 patients were included in this current study, with 41 rosacea and 73 urticaria patients. The vast majority of our subjects were females (96.5%). The mean (±SD) age was 42.3 (±12.7). More than half (58.8%) of the examined samples were positive for 13C-UBT; however, positive results were significantly higher in the rosacea patients (73.2%) compared to the urticaria group (50.7%), with a p-value of 0.019. CONCLUSION: Our findings underline the significant association of H. pylori with rosacea and CSU regardless of the presence or absence of gastrointestinal symptoms. We thus recommend the inclusion of H. pylori testing in the routine workup of CSU and rosacea patients. PMID:34646668 | PMC:PMC8483814 | DOI:10.7759/cureus.17617 {url} = URL to article
  5. Acta Derm Venereol. 2021 Oct 13. doi: 10.2340/actadv.v101.356. Online ahead of print. ABSTRACT Rosacea, a chronic condition usually recognized by its visible presentation, can be accompanied by invisible symptoms, such as burning and stinging. This aim of this review is to gather the most recent evidence on burning and stinging, in order to further emphasize the need to address these symptoms. Inflammatory pathways can explain both the signs and symptoms of rosacea, but available treatments are still evaluated primarily on their ability to treat visible signs. Recent evidence also highlights the adverse impact of symptoms, particularly burning and stinging, on quality of life. Despite an increasing understanding of symptoms and their impact, the management of burning and stinging as part of rosacea treatment has not been widely investigated. Clinicians often underestimate the impact of these symptoms and do not routinely include them as part of management. Available therapies for rosacea have the potential to treat beyond signs, and improve burning and stinging symptoms in parallel. Further investigation is needed to better understand these benefits and to optimize the management of rosacea. PMID:34643244 | DOI:10.2340/actadv.v101.356 {url} = URL to article More Information on Burning and Stinging in Rosacea
  6. Clin Cosmet Investig Dermatol. 2021 Oct 2;14:1393-1400. doi: 10.2147/CCID.S322876. eCollection 2021. ABSTRACT PURPOSE: Although acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany. PATIENTS AND METHODS: Within the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests. RESULTS: Mean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76-2.07), contact dermatitis (OR = 1.74; CI: 1.08-2.81), rosacea (OR = 1.74; CI: 1.40-2.15), pyoderma (OR = 1.58; 1.22-2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27-1.71), hand eczema (OR = 1.34; CI: 1.00-1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09-1.51), tinea pedis (OR = 1.27; CI: 1.10-1.47), spider veins (OR = 1.26; CI: 1.16-1.38) and telangiectasia (OR = 1.15; CI: 1.02-1.30). CONCLUSION: These data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts. PMID:34629884 | PMC:PMC8495148 | DOI:10.2147/CCID.S322876 {url} = URL to article
  7. Arch Soc Esp Oftalmol (Engl Ed). 2021 Oct;96(10):556-560. doi: 10.1016/j.oftale.2020.07.008. Epub 2021 Sep 24. ABSTRACT Idiopathic facial aseptic granuloma (IFAG) is a recently described and rare condition. It is considered a form of infantile granulomatous rosacea. IFAG with facial and eyelid nodules is very rare. A description is presented of three cases of IFAG eyelid nodules. They concern healthy children with no history of trauma. Biopsy examination revealed non-caseating inflammatory granulomas. Different medical treatments have been tried that seem to accelerate its healing, although its tendency is spontaneous resolution within several months. Painless recurrent eyelid nodules can be confused with chalazion. The diagnosis of IFAG should be considered in chronic eyelid nodules. PMID:34620487 | DOI:10.1016/j.oftale.2020.07.008 {url} = URL to article
  8. Skin Appendage Disord. 2021 Aug;7(5):382-386. doi: 10.1159/000514565. Epub 2021 Apr 26. ABSTRACT INTRODUCTION: Scalp rosacea is scarcely reported in the literature, but it is probably not uncommon. Trichoscopic findings have not been specifically established for this entity. CASE PRESENTATION: We report 4 cases of chronic scalp rosacea with trichoscopic evidence of peripilar scaling that resolved without scarring after treatment. DISCUSSION/CONCLUSION: Chronic and persistent inflammation around the isthmus produced in scalp rosacea may form peripilar scaling resembling that found in lichen planopilaris. PMID:34604328 | PMC:PMC8436626 | DOI:10.1159/000514565 {url} = URL to article
  9. J Cosmet Dermatol. 2021 Sep 28. doi: 10.1111/jocd.14483. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a chronic inflammatory skin disease that affects people's life quality. It has been found to be related to many detrimental factors including ultraviolet exposure. However, the association between alcohol consumption and rosacea has long been debated. AIMS: To elucidate this association, we conducted a systematic review and meta-analysis. METHODS: We performed a systematic search of the literature published before February 16, 2021 on PubMed, Embase, and the Cochrane database and used a meta-analytic approach to calculate the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). RESULTS: Finally, 14 eligible studies were identified, and alcohol consumption was not found to be a risk factor for rosacea. However, in subgroup analysis, alcohol consumption increased the risk of phymatous rosacea (PhR) and the pooled OR was 4.17 (95% CI = 1.76-9.91). CONCLUSION: Overall, our study showed that alcohol consumption was a risk factor in phymatous rosacea (PhR). More studies of rosacea investigating sex distribution, alcohol intake levels, and types of alcoholic beverages consumed are needed in the future. PMID:34582097 | DOI:10.1111/jocd.14483 {url} = URL to article More information on Alcohol and Rosacea
  10. Br J Dermatol. 2021 Sep 28. doi: 10.1111/bjd.20768. Online ahead of print. ABSTRACT Rosacea is a chronic, symptomatic and potentially disfiguring inflammatory skin condition with high prevalence, particularly among women.1 Quantitative research into the psychosocial factors associated with rosacea has consistently reported the presence of anxiety, depression, decreased quality of life and feelings of stigmatisation.2,3 Such factors may be challenging to identify in clinical practice, since the objective severity of a visible difference does not always correlate with the lived experience.4. PMID:34582568 | DOI:10.1111/bjd.20768 {url} = URL to article
  11. Life (Basel). 2021 Sep 14;11(9):962. doi: 10.3390/life11090962. ABSTRACT Many relatively common chronic inflammatory skin diseases manifest on the face (seborrheic dermatitis, rosacea, acne, perioral/periorificial dermatitis, periocular dermatitis, etc.), thereby significantly impairing patient appearance and quality of life. Given the yet unexplained pathogenesis and numerous factors involved, these diseases often present therapeutic challenges. The term "microbiome" comprises the totality of microorganisms (microbiota), their genomes, and environmental factors in a particular environment. Changes in human skin microbiota composition and/or functionality are believed to trigger immune dysregulation, and consequently an inflammatory response, thereby playing a potentially significant role in the clinical manifestations and treatment of these diseases. Although cultivation methods have traditionally been used in studies of bacterial microbiome species, a large number of bacterial strains cannot be grown in the laboratory. Since standard culture-dependent methods detect fewer than 1% of all bacterial species, a metagenomic approach could be used to detect bacteria that cannot be cultivated. The skin microbiome exhibits spatial distribution associated with the microenvironment (sebaceous, moist, and dry areas). However, although disturbance of the skin microbiome can lead to a number of pathological conditions and diseases, it is still not clear whether skin diseases result from change in the microbiome or cause such a change. Thus far, the skin microbiome has been studied in atopic dermatitis, seborrheic dermatitis, psoriasis, acne, and rosacea. Studies on the possible association between changes in the microbiome and their association with skin diseases have improved the understanding of disease development, diagnostics, and therapeutics. The identification of the bacterial markers associated with particular inflammatory skin diseases would significantly accelerate the diagnostics and reduce treatment costs. Microbiota research and determination could facilitate the identification of potential causes of skin diseases that cannot be detected by simpler methods, thereby contributing to the design and development of more effective therapies. PMID:34575111 | DOI:10.3390/life11090962 {url} = URL to article
  12. J Invest Dermatol. 2021 Sep 23:S0022-202X(21)01313-0. doi: 10.1016/j.jid.2021.04.024. Online ahead of print. ABSTRACT Microbes and commensal mites contribute to the development of inflammation and neurovascular dysregulation in rosacea. Cathelicidin family proteins are epithelial antimicrobial peptides expressed in higher-order mammals. In humans, mature LL-37 is cleaved from its precursor in response to microbial infection, UV light, and injury. In their new article in the Journal of Investigative Dermatology, Yoon et al. expand on existing evidence supporting LL-37 proinflammatory activity in lipopolysaccharide (LPS)- and UV-primed models of rosacea. They show in vitro that LL-37 promotes NLRP3-mediated inflammasome activation through lysosomal destabilization in the presence of LPS and that the injection of LL-37 in vivo leads to skin inflammation that is abrogated by direct NLRP3 inhibition and homozygous knockout in a murine model. PMID:34565561 | DOI:10.1016/j.jid.2021.04.024 {url} = URL to article More information on Cathelicidin Peptide LL-37
  13. Clin Epidemiol. 2021 Sep 18;13:845-851. doi: 10.2147/CLEP.S323744. eCollection 2021. ABSTRACT BACKGROUND: Seborrhea is a skin condition characterized by abundant production of sebum associated with typical dermatological conditions such as rosacea and acne. Little is known about the prevalence of seborrhea and the frequency of concurrent skin diseases in the general population. OBJECTIVE: To investigate the epidemiology and comorbidity of seborrhea in the adolescent and adult working population. METHODS: In large-scale examinations by dermatologists in 343 German companies, the seborrheic skin type and the occurrence of skin findings were documented electronically. Odds ratios (OR) and their 95% confidence intervals (95% CI) of further skin diseases were computed. Logistic regression analyses were conducted for each disease using seborrhea as dependent variable. RESULTS: A total of 48,630 employees were examined. About 6.0% showed seborrhea (6.6% in men, 5.4% in women). Seborrhea strongly predicted acne (OR 3.59; CI 3.18-4.05), trichilemmal cysts (OR 1.99; CI 1.25-3.18) and rosacea (OR 1.45; CI 1.17-1.81). Regression analyses controlling for age, gender and phototype confirmed significant associations of seborrhea with acne and rosacea. CONCLUSION: Only a minor proportion of the working population shows meaningful seborrheic skin. However, this condition predicts distinct skin diseases and thus needs attention, in particular, with respect to consulting and secondary prevention. PMID:34566435 | PMC:PMC8459174 | DOI:10.2147/CLEP.S323744 {url} = URL to article
  14. J Cosmet Dermatol. 2021 Sep 26. doi: 10.1111/jocd.14477. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a chronic inflammatory cutaneous disease that can be associated with cardiometabolic disorders. Oxidative stress is included in the pathogenesis of rosacea, and thiol-disulfide homeostasis (TDH) acts as antioxidants. OBJECTIVE: To evaluate the TDH and metabolic parameters in patients with rosacea. MATERIAL AND METHODS: A total of 42 rosacea patients and 50 controls participated in this prospective study. Demographic data, clinical entities, anthropometric measurements, and laboratory findings were recorded. Additionally, TDH was measured by an automated spectrophotometric method. RESULTS: Rosacea patients had greater body mass index values (27.9 ± 5.2 kg/m² vs. 23 ± 1.4 kg/m², p < 0.001), waist-hip ratios (0.87 ± 0.1 vs. 0.77 ± 0.8, p < 0.001), and insulin resistance (3.0 ± 2.0 vs. 1.3 ± 0.5, p < 0.001) compared with controls. Disulfide levels, the disulfide/native thiol ratio (DNTR), and the disulfide/total thiol ratio (DTTR) were increased (p < 0.05) in rosacea patients. Native thiol and total thiol levels and the native/total thiol ratio (NTTR) were decreased in rosacea patients (p < 0.05). Different rosacea subtypes had no effect on oxidative stress markers. The duration of illness and insulin resistance values significantly correlated with DNTR and DTTR in the rosacea group (p < 0.05). CONCLUSION: Rosacea has a metabolic milieu with increased oxidative stress and insulin resistance. Note This adds to the list found at PMID:34564928 | DOI:10.1111/jocd.14477 {url} = URL to article
  15. J Cosmet Dermatol. 2021 Sep 26. doi: 10.1111/jocd.14436. Online ahead of print. ABSTRACT BACKGROUND: While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder. PATIENTS/METHODS: Literature review of last 15 years was made using the terms "diet in dermatology," "nutrition and skin," "nutritional supplements in dermatology," "nutritional agents and acne," "nutritional agents and alopecia," and "nutritional agents and psoriasis." RESULTS: While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet. CONCLUSIONS: Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management. PMID:34564936 | DOI:10.1111/jocd.14436 {url} = URL to article
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