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  1. Association between rosacea severity and relative muscle mass: A cross-sectional study. J Dermatol. 2018 Oct 31;: Authors: Nam JH, Yang J, Park J, Seo JH, Chang Y, Ryu S, Kim WS Abstract Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross-sectional study was conducted on subjects who attended a skin check-up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86-38.40%, 38.41-43.44% and 43.45-80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (Ptrend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22-26.20) and 4.43 (1.12-17.55), respectively (Ptrend = 0.03). This association was present in women with marginal significance (Ptrend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation. PMID: 30379346 [PubMed - as supplied by publisher] {url} = URL to article
  2. Related Articles A Decade Retrospective Study of Light/Laser Devices in Treating Nasal Rosacea. J Dermatolog Treat. 2019 Feb 07;:1-24 Authors: Zhang Y, Jiang S, Lu Y, Wu Y, Yan H, Xu Y, Xu T, Li Y, Geng L, Gao XH, Chen HD Abstract BACKGROUND: Large-scale retrospective studies of light/laser in treating nasal rosacea were lacking. OBJECTIVE: The study was aimed to perform a decade retrospection of the patients with nasal rosacea who were treated with light/laser devices. METHODS: Methods: A study between 2008 and 2017 was performed retrospectively. Categorization of rosacea type (erythema/telangiectasia, ET; papules/pustules, PP; rhinophyma, RP) was made according to the photographs. Device settings, treatment regimens and treatment sessions of light/laser facilities were summarized. Efficacy was evaluated using a grading scale. RESULTS: In all, 807 patients received light/laser treatments. The subtypes of nasal rosacea were ET (n = 196), PP (n = 95), RP (n = 42), ET + PP (n = 334), ET + RP (n = 15), PP + RP (n = 88), and ET + PP + RP (n = 37). The lesions of ET or PP were mainly treated with non-invasive devices (Intense pulsed light, IPL; Dye pulse light, DPL; Dual wavelength laser system, DW) and those of RP were treated with the Fractional carbon dioxide (FCO2) laser. For the mixed subtypes, the general disposal orders of lesions were ET, PP and later RP. And the fundamental orders of devices application were IPL, DPL, DW and FCO2 laser. For all types of rosacea except for RP (2-4 sessions), most of the patients received 4-6 sessions of treatments. Of all subtypes of ET, PP, RP, ET + PP, ET + RP, PP + RP, ET + PP + RP, the patients who achieved more than 50% improvement accounted for 74.5%, 58.3%, 83.3%, 69.2%, 73.3%, 61.4%, 51.4%, respectively. CONCLUSION: The multiple, sequential light/laser devices can be safely used in nasal rosacea with various degrees efficacies based on different types. PMID: 30732485 [PubMed - as supplied by publisher] {url} = URL to article
  3. Related Articles Metronidazole loaded nanostructured lipid carriers to improve skin deposition and retention in the treatment of rosacea. Drug Dev Ind Pharm. 2019 Feb 06;:1-30 Authors: Shinde UA, Parmar SJ, Easwaran S Abstract The objective of the present investigation was to improve the skin deposition and retention of metronidazole (MTZ) in rosacea therapy, by incorporating it into nanostructured lipid carriers (NLCs). The main challenge in this endeavour was the partial hydrophilicity of MTZ, which mandated careful selection of excipients, including solid and liquid lipids, surfactants, and their ratios in combination. NLCs were produced by the phase inversion temperature method and finally converted into a gel for topical application. The prepared nanoparticles were evaluated for their particle size, zeta potential, entrapment efficiency, solid state characteristics, surface morphology, in vitro drug release, and permeation through excised skin. The gel was additionally characterized for its pH, drug content, viscosity and spreadability. The prepared nanoparticles were spherical and of size below 300nm. Incorporation of judiciously chosen excipients made possible a relatively high entrapment efficiency of almost 40%. The drug release was found to be biphasic, with an initial burst release followed by sustained release up to 8 hours. In comparison to the plain drug gel, which had a tissue deposition of 11.23%, the NLC gel showed a much superior and desirable deposition of 26.41%. The lipophilic nature of the carrier, its size and property of occlusion enabled greater amounts of drug to enter and be retained in the skin, simultaneously minimizing permeation through the skin, i.e., systemic exposure. The results of the study suggest that NLCs of anti-rosacea drugs have the potential to be of use in the therapy of rosacea. PMID: 30727789 [PubMed - as supplied by publisher] {url} = URL to article
  4. Related Articles Assessment of Skin Physiology Change and Safety After Intradermal Injections With Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Pilot Study in Rosacea Patients With Facial Erythema. Dermatol Surg. 2019 Feb 01;: Authors: Kim MJ, Kim JH, Cheon HI, Hur MS, Han SH, Lee YW, Choe YB, Ahn KJ Abstract BACKGROUND: Botulinum toxin (BTX) has been used cosmetically with good clinical efficacy and tolerable safety. OBJECTIVE: This randomized, double-blind, split-face clinical study aimed to investigate the efficacy and safety of intradermal BTX in patients with rosacea. MATERIALS AND METHODS: Twenty-four participants were enrolled and randomly given intradermal injections of BTX and normal saline in both cheeks. Clinician Erythema Assessment (CEA) score, Global Aesthetic Improvement Scale (GAIS) score, skin hydration, transepidermal water loss (TEWL), melanin content, erythema index, elasticity, and sebum secretions were evaluated at baseline and 2, 4, 8, and 12 weeks. RESULTS: On the BTX-treated side, the CEA score significantly decreased and the GAIS score significantly increased. The erythema index decreased at Weeks 4 and 8. Skin elasticity was improved at Weeks 2 and 4 and skin hydration, at Weeks 2, 4, and 8. However, TEWL and sebum secretion did not show significant differences. CONCLUSION: Intradermal BTX injections significantly reduced the erythema on both cheeks and improved skin elasticity and hydration, but not TEWL and sebum secretion. Intradermal BTX injections reduced erythema and rejuvenated the skin effectively and safely in patients with rosacea. PMID: 30730346 [PubMed - as supplied by publisher] {url} = URL to article
  5. Related Articles Noninvasive assessment of subclinical atherosclerosis in patients with rosacea. G Ital Dermatol Venereol. 2019 Feb 04;: Authors: Gürel G, Turan Y Abstract BACKGROUND: Rosacea is a chronic, inflammatory cutaneous disorder that is characterized by remissions and relapses that commonly occur in patients over the age of 30 years. There have been many studies in literature evaluating the relationship between cardiovascular disease and psoriasis, which is a chronic inflammatory disease, however, there have been very few studies to date evaluating the relationship between rosacea and cardiovascular disease risk. METHODS: The study included 52 consecutive rosacea patients and 52 healthy controls matched for age, gender and body mass index. Demographic data, anthropometric measurements, lipid parameters, C-reactive protein (CRP), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) were recorded. RESULTS: The main finding of the present study is the significantly higher EFT (p˂0.001) and CIMT (p˂0.001) values identified in patients with rosacea than in the control group and CRP (p=0.004), total cholesterol (p=0.003) and low-density lipoprotein (p=0.004) levels were also significantly higher in the rosacea group. EFT was significantly correlated with CIMT in the rosacea group (p=0.041). Total cholesterol (OR = 1.032, p=0.017), CIMT (OR = 7.391, p˂0.001) and EFT (OR = 3.959, p=0.036) were independently associated with rosacea. CONCLUSIONS: Clinicians should be aware of the risk of cardiovascular disease when presenting with conditions involving persistent subclinical inflammation, as in the case of rosacea. EFT and CIMT measurements, which are noninvasive, easily accessible and cheap, can be useful to determine cardiovascular risk in rosacea patients. PMID: 30717569 [PubMed - as supplied by publisher] {url} = URL to article
  6. Related Articles Claudin reduction may relate to an impaired skin barrier in rosacea. J Dermatol. 2019 Feb 04;: Authors: Deng Z, Chen M, Xie H, Jian D, Xu S, Peng Q, Sha K, Liu Y, Zhang Y, Shi W, Li J Abstract Rosacea is a chronic inflammatory skin disorder whose pathophysiological mechanism remains largely unknown. Although recent studies have revealed the hypersensitivity of the skin towards chemical, thermal and biological stimuli, there is no direct molecular evidence suggesting the skin barrier is impaired in rosacea. In this study, we demonstrated that the mRNA levels of most claudins (CLDN), the main components of tight junctions determining the major barrier of the paracellular pathway between epithelial cells, were lowered in lesional skin of rosacea patients, especially with erythematotelangiectatic (ETR) and papulopustular (PPR) subtypes. Immunohistochemical analysis showed a significant decrease in the expression of CLDN1, CLDN3, CLDN4 and CLDN5 in the epidermis of ETR and PPR patients. However, the expression of other skin barrier genes, such as filaggrin, loricrin and keratin 10, was not altered. In vitro, various rosacea trigger factors reduced the protein levels of CLDN1, CLDN3 and CLDN5 in keratinocytes. Taken together, our results demonstrate a significant decrease in the expression of CLDN rather than other skin barrier genes, which may be associated with an impaired skin barrier responsible for the development of rosacea. PMID: 30714633 [PubMed - as supplied by publisher] {url} = URL to article
  7. Severe Rhinophyma. Tips and Tricks in Carbon Dioxide Laser Decortication. J Am Acad Dermatol. 2019 Jan 30;: Authors: Iglesias-Puzas Á, Olmos-Nieva C, Rodríguez-Prieto MÁ PMID: 30710601 [PubMed - as supplied by publisher] {url} = URL to article
  8. Related Articles The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample. Clin Exp Dermatol. 2019 Jan 31;: Authors: Singam V, Rastogi S, Patel KR, Lee HH, Silverberg JI Abstract BACKGROUND: Little is known about the mental health (MH) hospitalization among patients with acne and rosacea. AIMS: To determine the MH disorders and cost burden associated with acne and rosacea. METHODS: Data were examined from the 2002-2012 US National Inpatient Sample, comprising a sample of ~20% of all US paediatric and adult hospitalizations (n = 87 053 155 admissions). RESULTS: A diagnosis of ≥ 1 MH disorder was much more common among all inpatients with vs. those without a diagnosis of acne (43.7% vs. 20.0%, respectively) and rosacea (35.1% vs. 20.0%, respectively). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, acne (adjusted OR = 13.02; 95% CI 11.75-14.42) and rosacea (adjusted OR = 1.70; 95% CI 1.56-1.95) were associated with significantly higher odds of a primary admission for an MH disorder (13 and 8, respectively, of 15 MH disorders examined). Both acne and rosacea were associated with higher risk of mood, anxiety, impulse control and personality disorders, and with > $2 million of excess mean annual costs of hospitalization for MH disorders in the USA. CONCLUSION: In this study, inpatients with acne or rosacea had increased odds of comorbid MH disorders. In particular, there was an increased number of hospital admissions secondary to a primary MH disorder with coexistent acne/rosacea. MH comorbidities were associated with considerable excess costs among inpatients with acne or rosacea. PMID: 30706514 [PubMed - as supplied by publisher] {url} = URL to article
  9. Nuclear Factor Kappa-B is Enriched in Eyelid Specimens of Rosacea: Implications for Pathogenesis and Therapy. Am J Ophthalmol. 2019 Jan 28;: Authors: Wladis EJ, Lau KW, Adam AP Abstract PURPOSE: To assess the role of nuclear factor kappa-B (NFKB) in cutaneous specimens of rosacea and unaffected tissue METHODS: Immunohistochemical staining was performed for the activated, phosphorylated variant of NFKB (pNFKB) in eyelid specimens of rosacea (n = 12) and normal, healthy tissue (n = 12). The numbers of positively-staining cells/40x microscopic field were counted across five consecutive fields. Additionally, quantitative western blotting was carried out for pNFKB and NFKB in specimens of rosacea (n = 15) and normal controls (n = 14). Statistical comparisons were performed via a dedicated software package. RESULTS: The mean number of cells/40x microscopic field which stained positively for pNFKB was 18.4 for control patients (standard deviation = 15.3 cells) and 39.3 (standard deviation = 16.9) for rosacea patients, and the difference between the two groups was statistically significant (p = 0.0024). On western blotting, the mean ratios of pNFKB:NFKB for control and rosacea patients measured 0.58 (standard deviation = 0.81) and 3.11 (standard deviation = 3.53), respectively. The two groups were statistically significantly different (p = 0.0002). CONCLUSIONS: The activated form of NFKB is enriched in rosacea, indicating a role for this pathway in the pathogenesis of this disease. Interference with NFKB signaling may represent a novel therapy for rosacea as clinical agents become available. PMID: 30703356 [PubMed - as supplied by publisher] {url} = URL to article
  10. Related Articles A Novel Night Moisturizer Enhances Cutaneous Barrier Function in Dry Skin and Improves Dermatological Outcomes in Rosacea-prone Skin. J Clin Aesthet Dermatol. 2018 Dec;11(12):11-17 Authors: Santoro F, Teissedre S Abstract Objective: We assessed whether Cetaphil Redness Control Night Cream (CRCNC; Galderma Laboratories, Fort Worth, Texas) improves electrical capacitance (EC) and transepidermal water loss (TEWL) in healthy subjects with dry skin and determined efficacy and tolerability in subjects with rosacea. Study design: The present study included two independent, open-label investigations: in the first, EC and TEWL were measured at baseline and at two, four, eight, and 24 hours after one application of CRCNC to dry skin; in the second, an evaluation of once-daily CRCNC application for 22 days using a chromameter, image analysis, and trained rater was performed, with patient evaluations at baseline and Days 1, 8, and 22 collected. The first study enrolled 20 subjects (13 women; mean age: 45 years). The second study enrolled 33 women (mean age: 54 years), with 30 having sensitive skin. Results: EC increased significantly at two (by 67.0%), four (60.2%), eight (52.1%), and 24 (17.9%) hours after CRCNC application. TEWL was reduced significantly at two (18.0%), four (14.3%), and eight (18.2%) hours after application. Additionally, improvements in redness were seen at Days 8 (24.2%; p=0.008) and 22 (27.3%; p=0.004). Versus baseline, 21.2% (p=0.07), 39.4% (p<0.001), and 48.5% (p<0.001) of subjects reported improvements at 30 minutes after application and on Days 8 and 22, respectively. Conclusions: CRCNC is an effective and well-tolerated moisturizer that improves cutaneous barrier function in subjects with dry skin and in those subjects with sensitive skin and type 1 rosacea. PMID: 30666273 [PubMed] {url} = URL to article
  11. Clinical and erythema-Directed imaging evaluation of Papulo-Pustular rosacea with topical ivermectin: A 32 weeks duration study. J Dermatolog Treat. 2019 Jan 20;:1-15 Authors: Dall'Oglio F, Lacarrubba F, Luca M, Boscaglia S, Micali G Abstract BACKGROUND: Ivermectin (IVM) 1% cream represents an emerging therapy for papulo-pustular rosacea (PPR) and erythema-directed photography is a useful tool for evaluation of patient's erythema. OBJECTIVE: The aim of our study was to assess the efficacy of IVM in PPR in achieving clear status at 8 weeks and, if unresponsive up to 20 weeks followed by respectively 24 and 12 weeks follow-up, using clinical/instrumental evaluation. METHODS: Twenty patients with PPR were instructed to apply IVM for 8 weeks. At week 8, in case of complete response the therapy was stopped and a follow-up period up to 24 weeks was carried out, whereas in case of improvement the treatment was extended for additional 12 weeks followed by a 12 weeks follow-up. Instrumental evaluation was performed by erythema-directed digital photography (VISIA-CRTM- RBXTM). RESULTS: At week 8, complete response was observed in 31.6% of cases along with a significant decrease of erythema degree. During treatment extension, additional improvement in terms of complete response, respectively at 12 (42%), 16 (47%) and 20 (58%) weeks, and reduction of erythema degree was observed. CONCLUSIONS: IVM is a valuable therapeutic option in mild/moderate PPR. Erythema-directed digital photography enhances erythema changes visualization compared to clinical observation alone. PMID: 30663445 [PubMed - as supplied by publisher] {url} = URL to article
  12. Related Articles Relationship between rosacea and dietary factors: A multicenter retrospective case-control survey. J Dermatol. 2019 Jan 18;: Authors: Yuan X, Huang X, Wang B, Huang YX, Zhang YY, Tang Y, Yang JY, Chen Q, Jian D, Xie HF, Shi W, Li J Abstract Although patients with rosacea often consult dermatologists for dietary factors that might be related to their skin disorders, few studies have been conducted to research the relationship between rosacea and dietary factors. The purpose of this study was to evaluate the potential relationship between rosacea and diet among the large Chinese population with rosacea, which would provide dietary guidelines for patients with rosacea. A multicenter case-control study was conducted. The feeding frequency 2 years before the occurrence of rosacea was collected by standardized questionnaires. Multiple logistic regression analysis was used to calculate risks related to the diet. One thousand three hundred and forty-seven patients with rosacea and 1290 controls were enrolled in our study. We found that high-frequency intake of fatty food and tea presented a positive correlation with rosacea, while high-frequency dairy product intake showed significant negative correlation with rosacea. Sweet food, coffee and spicy food appeared to be independent of any subset of rosacea in our study. However, high-frequency dairy product intake showed a borderline beneficial effect on rosacea severity. We further analyzed the correlation between diet and the subtype of rosacea. We found that high-frequency fatty intake was associated with erythematotelangiectatic rosacea (ETR) and phymatous rosacea, while high-frequency tea intake was only associated with ETR. In addition, high-frequency dairy product intake showed negative correlations with ETR and papulopustular rosacea. Rosacea is associated with some dietary factors, and our study is valuable in establishing dietary guidelines to prevent and improve rosacea. PMID: 30656725 [PubMed - as supplied by publisher] {url} = URL to article
  13. Related Articles Botulinum toxin blocks mast cells and prevents rosacea like inflammation. J Dermatol Sci. 2018 Dec 28;: Authors: Choi JE, Werbel T, Wang Z, Wu CC, Yaksh TL, Di Nardo A Abstract BACKGROUND: Rosacea is a chronic inflammatory skin condition whose etiology has been linked to mast cells and the antimicrobial peptide cathelicidin LL-37. Individuals with refractory disease have demonstrated clinical benefit with periodic injections of onabotulinum toxin, but the mechanism of action is unknown. OBJECTIVES: To investigate the molecular mechanism by which botulinum toxin improves rosacea lesions. METHODS: Primary human and murine mast cells were pretreated with onabotulinum toxin A or B or control. Mast cell degranulation was evaluated by β-hexosaminidase activity. Expression of botulinum toxin receptor Sv2 was measured by qPCR. The presence of SNAP-25 and VAMP2 was established by immunofluorescence. In vivo rosacea model was established by intradermally injecting LL-37 with or without onabotulinum toxin A pretreatment. Mast cell degranulation was assessed in vivo by histologic counts. Rosacea biomarkers were analyzed by qPCR of mouse skin sections. RESULTS: Onabotulinum toxin A and B inhibited compound 48/80-induced degranulation of both human and murine mast cells. Expression of Sv2 was established in mouse mast cells. Onabotulinum toxin A and B increased cleaved SNAP-25 and decreased VAMP2 staining in mast cells respectively. In mice, injection of onabotulinum toxin A significantly reduced LL-37-induced skin erythema, mast cell degranulation, and mRNA expression of rosacea biomarkers. CONCLUSIONS: These findings suggest that onabotulinum toxin reduces rosacea-associated skin inflammation by directly inhibiting mast cell degranulation. Periodic applications of onabotulinum toxin may be an effective therapy for refractory rosacea and deserves further study. PMID: 30658871 [PubMed - as supplied by publisher] {url} = URL to article
  14. Related Articles Sarecycline: First Global Approval. Drugs. 2019 Jan 18;: Authors: Deeks ED Abstract Sarecycline (Seysara™) is an oral, once-daily, tetracycline-class drug for which a tablet formulation is approved in the USA for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris in patients aged ≥ 9 years. The drug was developed by Paratek and Allergen and later acquired by Almirall S.A. (a Barcelona-based pharmaceutical company focused on medical dermatology). Sarceycline tablets were approved in early October 2018 and are planned to be available for patients in January 2019. Sarecycline capsules have also been studied in the USA, but no recent reports of development have been identified for this formulation. There are currently no clinical trials underway assessing sarecycline in rosacea. This article summarizes the milestones in the development of sarecycline leading to this first approval for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris. PMID: 30659422 [PubMed - as supplied by publisher] {url} = URL to article
  15. Therapeutic uses of metronidazole and its side effects: an update. Eur Rev Med Pharmacol Sci. 2019 Jan;23(1):397-401 Authors: Hernández Ceruelos A, Romero-Quezada LC, Ruvalcaba Ledezma JC, López Contreras L Abstract OBJECTIVE: Metronidazole is an antibiotic widely used in different medical conditions such as trichomoniasis, amoebiasis, and giardiasis among others. Its use has been associated with toxicity; however, it is not well characterized. In this review, we discuss the different therapeutic uses of metronidazole and its side effects in order to aid future investigation in this field. MATERIALS AND METHODS: Relevant information, original research articles, clinical trials, and reviews were collected from PubMed to know the state of the art of the different therapeutic uses of metronidazole and the reported side effects. RESULTS: Metronidazole was used by the first time in 1959, to treat an infection caused by Trichomonas vaginalis; subsequently, new therapeutic properties were discovered. Nowadays, Metronidazole is used to treat infections caused by Bacteroides, Fusobacteria and Clostridia, rosacea, oral and dental infections, bone and joint infections, gynecologic infections, endocarditis, septicemia, and respiratory tract infections. It also can be used to treat Crohn´s disease or even like prophylaxis, before surgical procedures. Metronidazole is well tolerated with mild to moderate side effects such as nausea, abdominal pain, and diarrhea. Nevertheless, serious neurotoxicity, optic neuropathy, peripheral neuropathy, and encephalopathy have been reported in rare cases. Their genotoxic effects observed in animal models are controversial in humans. CONCLUSIONS: The therapeutic use of metronidazole had increased worldwide. Even though it is widely used, metronidazole has been associated with neurotoxicity and genotoxicity; however, its side effects are not well established. Conversely, its veterinary use is restricted in some countries because of its tumor association. Subsequently, further studies are needed to discover the secure use of metronidazole and describe new usages for this drug. PMID: 30657582 [PubMed - in process] {url} = URL to article
  16. [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
  17. 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
  18. 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
  19. 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
  20. Related Articles [Advancement in phodynamic therapy for non-neoplastic skin diseases]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Dec 28;43(12):1380-1383 Authors: Zhan Y, Xiao R, Zhang Z Abstract Photodynamic therapy is mainly used in dermatology to treat skin tumors, precancerous lesions, and condyloma acuminatum. Due to its excellent tissue selectivity, easy operation and good cosmetic effect, it has been gradually applied to the treatment of various non-neoplastic skin diseases, such as verruca acuminata, acne, rosacea, chronic skin ulcer, fungal diseases, keloid, and so on. Here is the review on the advancement in photodynamic therapy for non-neoplastic skin diseases. PMID: 30643057 [PubMed - in process] {url} = URL to article
  21. Clinical effectiveness of novel rosacea therapies. Curr Opin Pharmacol. 2019 Jan 10;46:14-18 Authors: Feaster B, Cline A, Feldman SR, Taylor S Abstract Rosacea is a common inflammatory skin disease that is difficult to manage because of the unknown etiology and due to its variable manifestations. These facts and the few new available treatment options make it difficult to select a really effective treatment. This review aims to assess the efficacy and safety of novel treatment options for rosacea. The topical alpha adrenergic agonist oxymetazoline reduces rosacea-related erythema. Topical ivermectin improves lesion count, inflammation, and maintenance of remission of rosacea compared to topical metronidazole. Procedural therapies including pulsed dye laser, radiofrequency, and dual frequency ultrasound are promising as both monotherapies or in combination. Although there are several effective treatment modalities for rosacea management, treatments options should be tailored for the specific clinical scenario. PMID: 30639950 [PubMed - as supplied by publisher] {url} = URL to article
  22. Classifying signs and symptoms of dry eye disease according to underlying mechanism via the Delphi method: the DIDACTIC study. Br J Ophthalmol. 2019 Jan 12;: Authors: Labetoulle M, Bourcier T, Doan S, DIDACTIC group Abstract BACKGROUND/AIMS: Dry eye disease (DED) is categorised by pathophysiology as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE) or mixed. Treatment should be tailored to DED pathophysiology, but this is challenging to determine. This Delphi consultation aimed to categorise and weight signs and symptoms to help identify the evaporative or aqueous deficient DED origin. METHODS: A panel of French DED experts created an initial list of 77 DED signs and symptoms. In a Delphi consultation, experts categorised items by DED pathophysiology. Likert scoring was used to indicate whether items were strongly or moderately indicative of ADDE or EDE. Items could also be judged non-applicable to DED, with the opportunity to suggest alternative diagnoses. RESULTS: Experts attributed 19 items (of which 11 were strongly indicative) to a pathophysiology of EDE and 12 items (of which four were strongly indicative) to ADDE. Items scored strongly indicative with agreement >90% for EDE were previous chalazia, rosacea/rhinophyma, telangiectasias of eyelid margin and thick non-expressible meibomian gland secretions, and for ADDE were Sjögren syndrome or associated disease, and Schirmer <5 mm after 5 min (without anaesthesia). Seventeen items indicated neither pathophysiology and 18 items were found to be suggestive of alternative diagnoses. CONCLUSIONS: This Delphi consultation categorised signs and symptoms, using an innovative weighting system to identify DED pathophysiology. An algorithm integrating the weighting of each sign and symptom of an individual patient would be valuable to help general ophthalmologists to classify the DED subtype and tailor treatment to DED underlying mechanism. PMID: 30636211 [PubMed - as supplied by publisher] {url} = URL to article
  23. Related Articles Recent advances in understanding and managing rosacea. F1000Res. 2018;7: Authors: Buddenkotte J, Steinhoff M Abstract Rosacea is a common chronic inflammatory skin disease of the central facial skin and is of unknown origin. Currently, two classifications of rosacea exist that are based on either "preformed" clinical subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) or patient-tailored analysis of the presented rosacea phenotype. Rosacea etiology and pathophysiology are poorly understood. However, recent findings indicate that genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the innate and adaptive immune system. Trigger factors also lead to the release of various mediators such as keratinocytes (for example, cathelicidin, vascular endothelial growth factor, and endothelin-1), endothelial cells (nitric oxide), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (T H1) and T H17 cells. Additionally, trigger factors can directly communicate to the cutaneous nervous system and, by neurovascular and neuro-immune active neuropeptides, lead to the manifestation of rosacea lesions. Here, we aim to summarize the recent advances that preceded the new rosacea classification and address a symptom-based approach in the management of patients with rosacea. PMID: 30631431 [PubMed - in process] {url} = URL to article
  24. Related Articles The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea. J Cosmet Dermatol. 2018 Aug 11;: Authors: Bageorgou F, Vasalou V, Tzanetakou V, Kontochristopoulos G Abstract BACKGROUND: Erythematotelangiectatic rosasea is a common,chronic, relapsing disease characterized mainly by vascular components, for which many therapies may exist but with limited efficacy. OBJECTIVES: We decided to test the efficacy of tranexamic acid when applied topically on the affected areas.,Tranexamic acid is an antifibrinolytic,thus we considered it could be effective at this type of rosacea. METHODS: This is an unblinded study. We included 20 patients, having erythematotelangiectatic rosacea. All patients were women between 27 and 65 years-old. We divided the patients in two groups,the first group was treated only with tranexamic acid solution (Transamin inj/sol 500 mg/5 mL) infused wet dressing for 20 minutes, and the second group was treated with microneedling simultaneously with tranexamic acid solution topical application followed by tranexamic acid solution infused dressing therapy,every 15 days for four sessions. RESULTS: The improvement assecion was outlined according to the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS) and the use of clinical photos and dermoscopy. All patients were improved in the end of the therapy. There was statistically significant improvement, 2 units IGA-RSS in the first group, whereas 3 units IGA-RSS in the second group. The improvement lasted more than four months. The tolerability of the use of tranexamic acid was also asessed. CONCLUSIONS: According to our results a new really promising simple, safe and cheap treatment option targeting mainly to the vascular net and the erythema of rosacea is proposed. PMID: 30099833 [PubMed - as supplied by publisher] {url} = URL to article Another article: Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis RRDi Post on TXA
  25. Related Articles Nickel Sensitivity In Rosacea Patients: A Prospective Case Control Study. Endocr Metab Immune Disord Drug Targets. 2019 Jan 01;: Authors: Çifci N Abstract BACKGROUND: Rosacea is a frequently seen chronic disease that allergens, some foods and beverages are known to trigger symptoms of rosacea. OBJECTIVE: We aimed to assess if nickel sensivity is more common in rosacea patients than normal population. METHOD: Fourty patients with rosacea and 40 healthy age and sex matched volunteers were included in the study. From European standard patch test series, test units with nickel were applied on the skin of the upper back. According to the scheme of the International Contact Dermatitis Research Group (ICDRG), test results were evaluated at 48th, 72th and 96th hours. Seven days later, reevaluation was done for late reactions. Statistical analyses were done by using Statistics package for Social Sciences (SPSS) 17 package program and p<0.05 was accepted as statistically significant. RESULTS: Female/male ratio was 34/6 in patient group and 32/8 in control group. Mean age of patient group and the control group were 39.97±12.65 (18-65 years), 40.82±11.79 (19-68 years), respectively. Age and sex distributions were found to be statistically similar. Nickel allergy in the patient and control group was found to be 52.5%, 22.5% respectively and the difference between groups was statistically significant (p=0. 006). CONCLUSION: Our results showed that there may be an association between nickel sensitivity and rosacea. Nickel sensitivity may be one of the underlying pathology or a triggering factor of the rosacea. Nickel restricted diet and avoiding use of nickel containing jewellery and piercings, may extend the remission periods. PMID: 30621570 [PubMed - as supplied by publisher] {url} = URL to article
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