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Related ArticlesOptimal management of papulopustular rosacea: rationale for combination therapy. J Drugs Dermatol. 2012 Jul 1;11(7):838-44 Authors: Bhatia ND, Del Rosso JQ Abstract The pathophysiology of papulopustular rosacea (PPR) is primarily characterized by inflammation associated with several factors such as abnormal innate immune response, neurovascular dysregulation, stratum corneum barrier dysfunction, and depletion of antioxidant reserve, with no definitive evidence supporting an underlying microbial etiology. Several molecular inflammatory pathways have now been identified that enable the development of therapeutic agents that target the signs and symptoms of disease by modifying specific pathophysiological mechanisms. Available evidence demonstrates that topical and oral agents commonly used to treat PPR appear to modify some of these pathophysiological mechanisms and may prove to be complimentary when used in combination potentially leading to better therapeutic outcomes. During the past two decades, six clinical studies have been published on the benefits of combining oral and topical therapies for PPR. Four studies suggest that doxycycline, including anti-inflammatory dose doxycycline (doxycycline 40 mg modified-release capsule once daily) can be combined with topical metronidazole or azelaic acid in patients with PPR to achieve more rapid control of a flare. At present, subantimicrobial dosing of a tetracycline agent that also maintains anti-inflammatory activity has only been established with doxycycline. Although antibiotic doses of tetracycline agents (such as doxycycline, minocycline, and tetracycline) are known to be effective for PPR, the use of subantimicrobial dosing of doxycycline avoids the risk of antibiotic resistance. J Drugs Dermatol. 2012;11(7):838-844. PMID: 22777226 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/22777226?dopt=Abstract = URL to article

Hair dryer use to optimize pulsed dye laser treatment in rosacea patients. J Clin Aesthet Dermatol. 2012 Jun;5(6):41-4 Authors: Kashlan L, Graber EM, Arndt KA Abstract Rosacea is a common chronic inflammatory condition characterized by erythema, telangiectasias, papules, and pustules. While there are many effective treatment options for the papulopustular type, laser therapy remains the most effective modality to treat erythematotelangiectatic rosacea. Erythema and flushing associated with rosacea remains an uncomfortable and socially embarrassing problem for patients. Unfortunately, patients often do not have significant erythema or flushing when they present for laser treatment. With this in mind, we propose a novel technique aimed at enhancing the response of rosacea patients being treated for erythema with pulsed dye laser. Specifically, we present a split-face example of our clinical observation that pre-treatment with forced heated air prior to pulsed-dye laser leads to a greater response in rosacea patients with erythema and flushing. PMID: 22768356 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/22768356?dopt=Abstract = URL to article

Evaluation of Quality of Life after a Medical Corrective Make-Up Lesson in Patients with Various Dermatoses. Dermatology. 2012 Jul 4; Authors: Peuvrel L, Quéreux G, Brocard A, Saint-Jean M, Vallet C, Mère A, Labetoulle G, Le Fol C, Dréno B Abstract Background: Apparent skin lesions can impair quality of life (QoL). Objective: To assess QoL improvement brought by a medical corrective make-up lesson and its daily use in practice using the Dermatology Life Quality Index (DLQI). Methods: Patients with facial disorders participating during 2 years in our lessons conducted by a trained nurse were included in an open prospective study. Results: 86 patients aged 4-79 years were included. They suffered from acne (25), rosacea (10), scars (14) and various dermatoses (19). 63 patients (73%) sent back the questionnaire. One-month DLQI improvement was significant (p < 0.001) in acne (p = 0.006) as well as rosacea (p = 0.036), with a trend for scars (p = 0.057). QoL significantly improved, independently of a low (p < 0.001) or high (p = 0.006) initial DLQI. Since the lesson, 95% of patients re-made up with 97% of good tolerance. Conclusion: This is the first study examining at-home make-up completion and showing the beneficial effect of a medical corrective make-up lesson on the QoL of patients with various facial dermatoses in France. PMID: 22759904 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/22759904?dopt=Abstract = URL to article

Rosacea. J Midwifery Womens Health. 2012 Jun 21; Authors: Fuller D, Martin S Abstract Rosacea is a chronic skin condition that is diagnosed frequently in women. It can occur at any age but is most commonly diagnosed in women aged between 30 and 50 years. The National Rosacea Society organizes rosacea into 4 primary subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. There are no diagnostic tests to confirm the diagnosis of rosacea, and skin biopsy is warranted solely to rule out alternative diagnoses. While there is no known cure for rosacea, a number of pharmacologic and nonpharmacologic management strategies are available. Management is tailored to disease subtype, severity, and emotional impact as well as to clinical response and patient preferences. PMID: 22727268 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/22727268?dopt=Abstract = URL to article

Non-invasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy. Br J Dermatol. 2012 Jun 20; Authors: Sattler EC, Maier T, Hoffmann VS, Hegyi J, Ruzicka T, Berking C Abstract Background:  In many Demodex-associated skin diseases Demodex mites are present in abundance and seem to be at least partially pathogenic. So far all diagnostic approaches such as scraping or standardized superficial skin biopsy are (semi-) invasive and may cause discomfort to the patient. Aim of this study was to see whether confocal laser scanning microscopy (CLSM) - a non-invasive method for the visualization of superficial skin layers - was able to detect and quantify Demodex folliculorum in facial skin of patients with rosacea. Material and Methods:  25 patients (34-79 years of age) with facial rosacea and 25 age- and gender-matched normal controls were examined by CLSM. Mosaics of 8x8 mm and 5x5 mm were created by scanning horizontal layers of lesional skin and quantification of the mites per follicle and per area as well as of the follicles per area was performed. Results:  In all patients Demodex folliculorum could be detected by CLSM and presented as roundish or lengthy cone-shaped structures. CLSM allowed the quantification of Demodex mites and showed significant differences (p-value < 0.0001): The mean number of mites was 165.4 per 8x8 mm area and 94.2 per 5x5 mm area in the patients compared to 34.7 and 22.4, respectively, in the controls. The corresponding mean number of mites per follicle was 0.7 and 0.8, respectively, in the patients and 0.1 and 0.2, respectively, in the controls. Conclusion:  With the help of CLSM it is possible to non-invasively detect, image and quantify Demodex mites in facial skin of patients with rosacea. PMID: 22716072 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/22716072?dopt=Abstract = URL to article

Positive correlation between serum immuno-reactivity to Demodex-associated Bacillus proteins and Erythematotelangiectic Rosacea. Br J Dermatol. 2012 Jun 18; Authors: O'Reilly N, Menezes N, Kavanagh K Abstract Background:  Rosacea is a chronic inflammatory condition that affects the skin of the face and the eyes. Erythematotelangiectic rosacea is characterized by flushing, edema and telangiectasia. Rosacea patients demonstrate elevated densities of Demodex mites in their skin compared to controls. A bacterium (Bacillus oleronius) isolated from a Demodex mites from a patient with papulopustular rosacea has been demonstrated to produce antigenic proteins that may play a role in papulopustular and ocular rosacea. Objectives:  The aim of the work presented here was to establish whether there was a correlation between the reactivity of sera from patients with erythematotelangiectic rosacea to Bacillus antigens and to characterise the proteins to which these patients showed reactivity. Methods:  Serum from patients with erythematotelangiectic rosacea and controls was examined for reactivity to Bacillus proteins by Western blot analysis. Proteins to which the sera reacted were excised from gels, trypsin digested and putative identities were assigned following LC/MS analysis. Results:  Eighty per cent (80%, 21/26) of patients with erythematotelangiectic rosacea showed sera reactivity to the 62 and 83kDa proteins of B.oleronius compared to 40% (9/22) of controls (p = 0.004). The 62kDa protein was characterized by LC mass spectrometry to show homology to groEL chaperonin which provokes a strong immune response in mammals. The 83kDa protein showed homology to aconitate hydratase which is increased in expression in bacteria under oxidative stress and is highly immunogenic. Conclusions:  The majority of patients with erythematotelangiectic rosacea show sera reactivity to two proteins from B.oleronius so suggesting that this bacterium may play a role in the induction of this condition. The two proteins to which patient sera reacted were found to be similar to a heat shock protein and an enzyme involved in regulating the stress response of the bacterium. PMID: 22709541 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/22709541?dopt=Abstract = URL to article

Rosacea. JAMA. 2012 Jun 6;307(21):2333 Authors: Torpy JM, Schwartz LA, Golub RM PMID: 22706840 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22706840&dopt=Abstract = URL to article

Preparation and evaluation of topical microemulsion system containing metronidazole for remission in rosacea. Chem Pharm Bull (Tokyo). 2012;60(5):583-92 Authors: Tirnaksiz F, KayiÅŸ A, Celebi N, AdiÅŸen E, Erel A Abstract The aim of this study was to prepare a topical water-in-oil type microemulsion containing metronidazole and to compare its effectiveness with a commercial gel product in the treatment of rosacea. A pseudo-ternary phase diagram (K<inf>m</inf>=2 : 1) was constructed using lecithin/butanol/isopropyl myristate/water. The microemulsion was chosen from the microemulsion region in the phase diagram. The formulation was a water-in-oil type microemulsion (droplet size: 11.6 nm, viscosity: 457.3 mPa·s, conductivity: 1.5 µs/cm, turbidity: 6.89 NTU) and the addition of the metronidazole did not alter the properties of the system. The release experiment showed that the release rate of metronidazole from the commercial gel product was higher than that of the microemulsion. Stability experiments showed that the metronidazole microemulsion remained stable for at least 6 months; none of the characteristic properties of the microemulsion had changed, the system retained its clarity and there was no sign that crystallization of metronidazole has occurred. Microemulsion was compared to a gel product in a randomized, double-blind, baseline-controlled, split-face clinical trial for the treatment of patients. After the 6-week treatment period there was a statistically significant difference in reduction of the main symptoms of rosacea. Of the patients treated with the microemulsion, 17% experienced complete relief from inflammatory lesions, and 50% from erythema. The microemulsion resulted in complete relief in 38% of the patients with telangiectasia while the commercial product did not provide any relief of telangiectasia symptoms. In conclusion, the microemulsion containing metronidazole was found to be more effective in reducing the symptoms of rosacea compared to the commercial gel product. PMID: 22689395 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22689395&dopt=Abstract = URL to article

Macrolides in chronic inflammatory skin disorders. Mediators Inflamm. 2012;2012:159354 Authors: Alzolibani AA, Zedan K Abstract Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents. PMID: 22685371 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22685371&dopt=Abstract = URL to article

Allergic contact dermatitis induced by topical hydrocortisone-17-butyrate mimicking papular rosacea. Dermatitis. 2012 Mar;23(2):95-6 Authors: D'Erme AM, Gola M PMID: 22653130 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22653130&dopt=Abstract = URL to article

Diagnosis and treatment of rosacea: state of the art. J Drugs Dermatol. 2012 Jun 1;11(6):725-30 Authors: Baldwin HE Abstract Rosacea is a common disorder that is both under recognized and undertreated. Prevalence figures indicate that it may be present in 1 of every 10 adults in a primary care waiting room. Untreated, patients with rosacea can suffer significant emotional, workplace, and social impairments. While rosacea has been recognized since ancient times, only recently have investigators begun to identify the pathophysiologic elements responsible for the characteristic erythema, flushing, dysesthesias, and papulopustular manifestations of the disease. Although the etiology of rosacea is unclear, inflammation appears to be a central element. Experimental evidence suggests that abnormalities of the skin's innate and adaptive immune responses may play pivotal roles. Once recognized, effective topical and systemic therapies can be prescribed to lessen the impact of the disease on the patient's life. Although initially administered in an empiric fashion, it now seems clear that the role of antibiotics in patients with rosacea depends upon their anti-inflammatory rather than their antimicrobial properties. Consequently, practitioners have the opportunity to practice good antibiotic stewardship when treating the disease, particularly with systemic therapies. Therapy with subantimicrobial dosing and with topical treatments can modulate the inflammation of rosacea without exerting antibiotic pressure responsible for the emergence of antibiotic resistance. J Drugs Dermatol. 2012;11(6):725-730. PMID: 22648219 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22648219&dopt=Abstract = URL to article

Effectiveness and Safety of Modified-Release Doxycycline Capsules Once Daily for Papulopustular RosaceaMonotherapy Results from a Large Community-Based Trial in Subgroups Based on Gender. J Drugs Dermatol. 2012 Jun 1;11(6):703-7 Authors: Del Rosso JQ, Preston NJ, Caveney SW, Gottschalk RW Abstract This article is a prospective planned analysis of data evaluating the effectiveness and safety of modified-release doxycycline capsules (30 mg immediate-release and 10 mg delayed-release beads) used once daily for up to 12 weeks in subgroups of males and females with papulopustular (subtype 2) rosacea from a large, open-label, multicenter, community-based study. A total of 1421 patients participated in the study. The per-protocol population comprised 826 patients on monotherapy, with 28.5% male participants (n=235) and 71.5% female participants (n=591). Rosacea was assessed on a 5-point investigator's global assessment (IGA) scale (0=clear, 1=near clear, 2=mild, 3=moderate, 4=severe). Erythema was also assessed on a 5-point clinician's erythema assessment (CEA) scale (0=none, 1=mild, 2=moderate, 3=significant, 4=severe). At baseline, males had a higher percentage of IGA scores of 3 (116 per 235; 49.4% versus 273 per 591; 46.2% in females) and 4 (32 per 235; 13.6% versus 35 per 591; 5.9% in females). Significant improvements in severity rating and erythema were observed in males and females as demonstrated by shifts in the distribution of IGA and CEA scores between baseline and week 12 (P<.001). Treatment success (IGA score of 0 or 1) at week 12 was achieved in 172 per 235 (73.2%) of males and in 444 per 591 (75.2%) of females. Adverse events (primarily mild or moderate gastrointestinal events) were reported in 9.9% of males and 12.8% of females. Anti-inflammatory dose doxycycline, which is administered as a 40 mg modified-release capsule once daily was effective and safe as monotherapy for papulopustular rosacea in both the female (n=591) and male (n=235) study groups. This specific 40 mg capsule delivers 30 mg immediate-release and 10 mg as delayed release using specially designed beads, and is subantimicrobial with both single and repeated dosing. J Drugs Dermatol. 2012;11(6):703-707. PMID: 22648216 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22648216&dopt=Abstract = URL to article

Why is rosacea considered to be an inflammatory disorder? The primary role, clinical relevance, and therapeutic correlations of abnormal innate immune response in rosacea-prone skin. J Drugs Dermatol. 2012 Jun 1;11(6):694-700 Authors: Del Rosso JQ, Gallo RL, Kircik L, Thiboutot D, Baldwin HE, Cohen D Abstract The pathophysiology of rosacea has undergone renewed interest over the past decade, with a large body of evidence supporting the role of an abnormal innate immune response in rosacea. Many mechanisms interact with the cutaneous innate immune system that may be operative. A variety of potential triggers stimulate this immune detection system which is upregulated and hyper-responsive in facial skin of patients with rosacea as compared to normal skin. Based on the most current data, two conclusions have been reached. First, the major presentations of rosacea appear to be inflammatory dermatoses. Second, the presence of a microbial organism is not a primary or mandatory component of the pathogenesis of rosacea. Available therapies for rosacea exhibit reported modes of action that appear to correlate with the inhibition of inflammatory processes involved in the pathophysiology of at least some presentations of rosacea. J Drugs Dermatol. 2012;11(6):694-700. PMID: 22648215 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22648215&dopt=Abstract = URL to article

Tacrolimus-Induced Rosacea-Like Dermatitis: A Clinical Analysis of 16 Cases Associated with Tacrolimus Ointment Application. Dermatology. 2012 May 22; Authors: Teraki Y, Hitomi K, Sato Y, Izaki S Abstract Background: Recently, reports have indicated that the continuous use of topical calcineurin inhibitors such as tacrolimus may induce rosacea-like dermatitis (RD). Objective and Methods: To assess clinical features of RD associated with tacrolimus, 44 cases of patients diagnosed with RD between 2005 and 2010 at our hospital were retrospectively reviewed. Results: In total, 22 cases were caused by topical steroid use, 8 by topical tacrolimus use, and 8 by consecutive treatment with topical steroids and tacrolimus. Clinical presentation was basically similar among the 3 groups, although the nose was less frequently affected and pustules were rarely observed in the latter 2 sets of cases. Demodex mites were often found in smears of skin lesions from patients with RD caused by steroids and tacrolimus. Treatment with topical metronidazole was effective in most RD patients. Conclusion: Topical tacrolimus is becoming an important cause of RD along with topical steroids. PMID: 22626964 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22626964&dopt=Abstract = URL to article

Molecular Biologic Assessment of Cutaneous Specimens of Ocular Rosacea. Ophthal Plast Reconstr Surg. 2012 May 21; Authors: Wladis EJ, Iglesias BV, Adam AP, Gosselin EJ Abstract PURPOSE:: To characterize the molecular biologic environment of pathological skin in ocular rosacea and to differentiate the levels of inflammatory molecules in ocular rosacea from those of normal skin. METHODS:: The concentrations of 48 molecules were assayed in cutaneous biopsies taken from patients with ocular rosacea and from normal controls. RESULTS:: There were very few molecular differences between the 2 groups, and 43 of the 48 molecules that were measured in this study were not significantly different between the 2 groups. The concentrations of 5 molecules (interleukin-1β, interleukin-16, stem cell factor, monocyte chemotactic protein-1, and monokine induced by γ-interferon) were significantly enriched in ocular rosacea. CONCLUSION:: Ocular rosacea is a highly ordered molecular process and involves elevations in the concentrations of specific molecules. The particular pattern of enrichment supports the notion that ocular rosacea represents a disorder of innate immunity. Furthermore, these molecules may represent novel therapeutic targets in the future management of this disorder. PMID: 22617640 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22617640&dopt=Abstract = URL to article

[Meibomian gland dysfunction]. Klin Monbl Augenheilkd. 2012 May;229(5):506-13 Authors: Finis D, Schrader S, Geerling G Abstract Meibomian gland dysfunction (MGD) is a chronic disease, usually caused by obstruction of the secretory Meibomian glands. The subsequent reduction of gland secretion results in a decreased amount of lipids in the tear film. This results in a faster evaporation of the tear film and thus an evaporative dry eye. MGD alone is responsible for about 60 % of all cases in combination with aqueous deficiency for a further 20 % of dry eyes. While in Europe up to 20 % of the population are suffering from MDD, this is true in Asia for over 60 % of the population. MGD is more common in women and it incidence increases with age. It is influenced by the hormonal status as well as chemical and mechanical noxious stimuli. Additional risk factors include various skin diseases such as rosacea, acne or atopy. To diagnose MGD, particular attention should be paid to changes in the lid margin such as plugging or pouting of the ducts, thickening and telangiectasia. However, most important is the diagnostic expression of the glands. At first it should be assessed whether secretion can be caused by pressure to the eyelid against the globe and secondly the quality of the expressed secretions should be evaluated. MGD should be treated according to the severity of the disease. While in mild stages instructions for lid margin hygiene, warming and massage in combination with artificial tears might be sufficient, in more severe stages oral tetracyclin derivatives and anti-inflammatory eye drops such as steroids or CSA are necessary for successful treatment. PMID: 22592341 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22592341&dopt=Abstract = URL to article

Antibiotic overuse and resistance in dermatology. Dermatol Ther. 2012 Jan;25(1):55-69 Authors: Chon SY, Doan HQ, Mays RM, Singh SM, Gordon RA, Tyring SK Abstract Antibiotics have a significant role in dermatology, treating a wide range of diseases, including acne, rosacea, inflammatory skin conditions and skin structure infections, such as cellulitis, folliculitis, carbuncles, and furuncles. Because of their consistent use, utility, and availability, antibiotics are susceptible to overuse within the medical practice, and, specific to this discussion, in the dermatologic setting. The issue of continuously increasing risk of antibiotic resistance remains an important concern to the dermatologist. The scope of this review will be to provide an overview of the common antibiotics used in the dermatologic setting with an emphasis on identifying areas of overuse, reported bacterial resistance, and discussion of clinical management aimed at decreasing antibiotic resistance. PMID: 22591499 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22591499&dopt=Abstract = URL to article

New antibiotic therapies for acne and rosacea. Dermatol Ther. 2012 Jan;25(1):23-37 Authors: Mays RM, Gordon RA, Wilson JM, Silapunt S Abstract Acne and rosacea compromise a substantial portion of the dermatology clinical practice. Over the past century, many treatment modalities have been introduced with antibiotics playing a major role. Today, both oral and topical antibiotics are used in the management of acne and rosacea, with several novel formulations and/or combination regimens recently introduced. The latest studies suggest anti-inflammatory actions to be the most likely mechanism of antibiotics in acne and rosacea, shifting the focus to subantimicrobial-dose oral antibiotics and/or topical antibiotic regimens as the preferred first-line agents. Here we will discuss the most recent oral and topical antibiotic therapies available for treatment of acne and rosacea, with special focus on efficacy data, indication, dosing, and mechanism of action. PMID: 22591497 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22591497&dopt=Abstract = URL to article

Minocycline-induced Black Bone Disease Encountered During Total Knee Arthroplasty. Orthopedics. 2012 May 1;35(5):e737-9 Authors: Reed DN, Gregg FO, Corpe RS Abstract Finding discolored bone intraoperatively can be confusing and concerning to orthopedic surgeons. Multiple causes of pigmented bone exist, including ochronosis, metabolic bone diseases, metal deposits, sequestrum, metastatic disease, and minocycline use. Bone quality is an important consideration in intraoperative decision making with respect to components and fixation options in total joint arthroplasty. Abnormal bone encountered in routine arthroplasty can raise concerns over the integrity and healing potential of the bone when the etiology is uncertain.Minocycline is a drug routinely used for the treatment of acne, rosacea, and rheumatoid arthritis. Pigmentation is a commonly recognized adverse reaction associated with most of the drugs in the tetracycline family, affecting the skin, nails, teeth, oral mucosa, bones in the oral cavity, ocular structures, cartilage, thyroid, and other visceral structures.This article describes a case of pigmented bone secondary to minocycline use in a 55-year-old woman undergoing total knee arthroplasty. This entity has rarely been documented in the orthopedic literature; however, orthopedic surgeons should be aware of this side effect secondary to the widespread use of minocycline. Questions concerning the effect of minocycline on bone metabolism and structural integrity have yet to be fully answered, but an understanding and recognition of the entity will help guide surgeons with intraoperative decision making. PMID: 22588418 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22588418&dopt=Abstract = URL to article

Guidance on the diagnosis and clinical management of acne. Clin Exp Dermatol. 2012 May;37 Suppl 1:1-6 Authors: Archer CB, Cohen SN, Baron SE, Abstract This article discusses the effects of acne (sometimes referred to as acne vulgaris), how to diagnose it confidently and how to distinguish it from rosacea, and the options available for treatment, especially in primary care. We also suggest when referral to dermatology should be considered, and try to anticipate some frequently asked questions. PMID: 22486762 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22486762&dopt=Abstract = URL to article

Willingness to pay and quality of life in patients with rosacea. J Eur Acad Dermatol Venereol. 2012 May 14; Authors: Beikert FC, Langenbruch AK, Radtke MA, Augustin M Abstract Background: Rosacea is a chronic inflammatory dermatosis affecting >2% of the population. Willingness to pay (WTP) is a well established method which reflects the individual burden of disease. Objectives: Evaluation of WTP and quality of life (QoL) in patients with rosacea. Methods: Nationwide postal survey on adult patients with rosacea affiliated with the German rosacea patient advocacy group. WTP was evaluated by three standardized items and compared to historical data on vitiligo (n = 1023). QoL was assessed using the Dermatology Life Quality Index (DLQI). Results: Data from n = 475 rosacea patients (79.9% women, mean age 56.3, range 26-90) were analysed. On average, patients were willing to pay € 2880 (median € 500) for complete healing compared with € 7360 (median € 3000) in vitiligo. Relative WTP was higher in women; the highest sums were registered for the age group 21-30 years. The extent of facial involvement predicted a higher relative WTP, whereas WTP decreased with the duration of symptoms and age. Mean DLQI total score was 4.3 compared to 7.0 in vitiligo. In rosacea, the highest values were observed in patients <30 years. Severe QoL reductions (DLQI>10) were less frequent (11%) than in vitiligo (24.6%). The correlation between WTP and DLQI was significant (e.g. r = 0.249, P = 0.000 for relative WTP). Conclusion: Rosacea patients show a moderate WTP and average QoL reduction is mild. WTP proved to be a valid tool to assess patients' burden of disease. Patient education and the development of effective treatment options might still improve patients' satisfaction. PMID: 22583164 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22583164&dopt=Abstract = URL to article "Vitiligo is a long-term skin condition characterized by patches of the skin losing their pigment." Wikipedia

Cathelicidin LL-37: an antimicrobial peptide with a role in inflammatory skin disease. Ann Dermatol. 2012 May;24(2):126-35 Authors: Reinholz M, Ruzicka T, Schauber J Abstract Chronic inflammatory skin diseases such as atopic dermatitis, psoriasis or rosacea are very common. Although their exact pathogenesis is not completely understood all three diseases are characterized by dysregulation of cutaneous innate immunity. Cathelicidin LL-37 is an important effector molecule of innate immunity in the skin and atopic dermatitis, psoriasis or rosacea show defects in cathelicidin expression, function or processing. In atopic dermatitis, cathelicidin induction might be disturbed resulting in defective antimicrobial barrier function. In contrast, psoriasis is characterized by overexpression of cathelicidin. However to date it is unclear whether pro- or anti-inflammatory functions of cathelicidin predominate in lesional skin in psoriasis. In rosacea, cathelicidin processing is disturbed resulting in peptide fragments causing inflammation, erythema and telangiectasias. In this review, the current evidence on the role of cathelicidin LL-37 in the pathogenesis of inflammatory skin diseases will be outlined. As cathelicidin LL-37 might also serve as a future treatment target potential novel treatment strategies for those diseases will be discussed. PMID: 22577261 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22577261&dopt=Abstract = URL to article

A Study on the Epidemiology of Rosacea in the UK. Br J Dermatol. 2012 May 5; Authors: Spoendlin J, Voegel JJ, Jick SS, Meier CR Abstract Background:  Rosacea is a chronic facial skin disease of unclear origin. Epidemiological data are scarce and controversial with reported prevalences ranging from 0.09% to 22%. To our knowledge, incidence rates have not been quantified before. Objectives:  In this observational study we quantified incidence rates of diagnosed rosacea in the UK and described demographic characteristics and the prevalence of ocular symptoms in rosacea patients. We compared life-style factors such as smoking and alcohol consumption between rosacea patients and controls. Methods:  Using the UK-based General Practice Research Database, we identified patients with an incident diagnosis of rosacea between 1995 and 2009 and matched them (1:1) to rosacea-free control patients. We assessed person-time of all patients at risk and assessed incidence rates of rosacea, stratified by age, sex, year of the diagnosis, and region. Results:  We identified 60,042 rosacea cases and 60,042 controls (61.5% women). The overall incidence rate for diagnosed rosacea in the UK was 1.65 / 1,000 person-years. Rosacea was diagnosed in some 80% of cases after the age of 30 years. Ocular symptoms were recorded in 20.8% of cases at the index date. We observed a significantly reduced relative risk of developing rosacea among current smokers (odds ratio 0.64, 95% CI 0.62-0.67). Alcohol consumption was associated with a marginal risk increase. Conclusions:  We quantified incidence rates and characteristics of rosacea patients diagnosed in clinical practice in a large epidemiological study using primary care data from the UK. Smoking was associated with a substantially reduced risk of developing rosacea. PMID: 22564022 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22564022&dopt=Abstract = URL to article

Nuances in the management of rhinophyma. Facial Plast Surg. 2012 Apr;28(2):231-7 Authors: Little SC, Stucker FJ, Compton A, Park SS Abstract Rhinophyma is a cosmetically disfiguring disease of the external nose that most frequently affects elderly Caucasian males. Frequently, there is associated derangement of nasal airway patency. Although the true incidence of rhinophyma and its exact etiology remain unknown, it is widely believed to represent the final stage in a continuum of acne rosacea. Medical therapy has not been effective in reversing the disease process, and surgery remains the most accepted method of treating rhinophyma. A wide variety of surgical techniques have been developed and modified over the years in an effort to treat this disorder safely and without significant sequelae. Despite many advances in fundamental understanding, surgical techniques, and related technologies, no single method has been universally embraced and employed as the "gold standard." This review describes the most commonly employed modern surgical techniques and methods used throughout the world to treat rhinophyma. There is special emphasis on the authors' preferred method of excision and postoperative management (tumescent anesthesia, Weck blade excision, and argon beam coagulation), which has been demonstrated to be effective and expeditious. PMID: 22562574 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22562574&dopt=Abstract = URL to article

Treatment of metophyma with the carbon dioxide laser. Dermatol Surg. 2012 Mar;38(3):513-5 Authors: Rai S, Madan V PMID: 22385227 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22385227&dopt=Abstract = URL to article