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Self-Reported Treatment Impressions and Satisfaction of Papulopustular Rosacea Patients Treated With Doxycycline, USP, 40 mg Capsules. J Drugs Dermatol. 2011 Dec 1;10(12):1376-81 Authors: Johnson SM, Levine P Abstract Objectives: This survey program was designed to evaluate patients' experiences with doxycycline, USP, 40 mg capsules (30 mg immediate release, 10 mg delayed release beads, ORACEA®; Galderma Laboratories, L.P.) as a treatment for the inflammatory lesions of rosacea and to provide patient-reported feedback to physicians. Methods: This prospective, cross-sectional survey was implemented in January 2010. One thousand, two hundred and ninety-five physicians identified patients eligible for treatment with doxycycline, USP, 40 mg capsules and provided them with information about the program. Patients voluntarily participated by contacting a program coordinator or by enrolling online, providing consent, and responding to a series of questions prior to medication use and approximately four weeks post-treatment initiation. Surveys were completed through an automated interactive voice response system or a dedicated, secure website and included questions regarding patients' perceptions of when the treatment first started working, patients' symptom severity, interference of symptoms with work and social activities, and confidence in appearance. Patients were also asked about prior medication use, adjunct medication use, and treatment satisfaction. Reports of patient progress and responses to these survey questions were sent directly to each patient's treating physician within a few days of survey completion. Paired t-tests were used to evaluate the statistical significance of differences in symptom severity, interference and confidence ratings before and after treatment. Results: Two thousand, eight hundred ninety-eight patients enrolled in the survey program and completed the baseline survey. Of these, a total of 1,346 patients completed the baseline and four-week survey (mean age 50 years; 75% female). Most (58%) reported use of a prior prescription medication to treat rosacea. Over half the patients (52%) responded that the product began to work within two weeks of use. After four weeks of using doxycycline, USP, 40 mg capsules, patients felt that the severities of redness as well as bumps/blemishes were significantly reduced (P<.05). Patients also reported having more confidence with their skin's appearance (P<.05). In addition, with use of doxycycline, USP, 40 mg capsules, patients reported significant reductions in the interference of symptoms with work and social activities (P<.05). Satisfaction with doxycycline, USP, 40 mg capsules averaged 6.8 on a scale of 1 (not at all satisfied) to 9 (very satisfied) for patients using only doxycycline, USP, 40 mg capsules; mean satisfaction was 6.7 for those using it with adjunct medication. Seven patients reported 11 adverse events during the program, including lack of efficacy, joint injury with fatigue, dizziness, back pain, bloating and constipation, increased facial redness and pimples, yeast infection, sore throat, increased bruising and worsening of rosacea. Conclusion: Satisfaction with doxycycline, USP, 40 mg capsules for the treatment of papulopustular rosacea was apparent from patient-rated measures of treatment impact. Patients with papulopustular rosacea reported improvement in symptoms, reductions in the interference of symptoms with life's activities and satisfaction with treatment with doxycycline, USP, 40 mg capsules. J Drugs Dermatol. 2011;10(12):1376-1381. PMID: 22134561 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22134561&dopt=Abstract = URL to article

Periorificial Dermatitis Due to Systemic Corticosteroids in Children: Report of Two Cases. Pediatr Dermatol. 2011 Nov 28; Authors: Clementson B, Smidt AC Abstract   Periorificial dermatitis is a common acneiform eruption that is thought to represent a variant of rosacea. These patients typically present with uniform erythematous papules most commonly located periorally but also occurring around the nose and eyelids. This eruption has been linked to topical corticosteroid use, with only a few reports in the literature associated with systemic steroid use in adults. Here, we report two cases of periorificial dermatitis occurring after systemic corticosteroid use in children. PMID: 22122785 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22122785&dopt=Abstract = URL to article

Effect of ionization and vehicle on skin absorption and penetration of azelaic acid. Drug Dev Ind Pharm. 2011 Nov 23; Authors: Li N, Wu X, Jia W, Zhang MC, Tan F, Zhang J Abstract Objective: The aim of this study is to investigate the effect of ionization and vehicle of topical formulations on skin absorption and penetration of azelaic acid (AZA). Materials and methods: In vitro transport of AZA was determined for two topical formulations containing AZA with pH values of 3.9 and 4.9, respectively. FINACEA(®) (15% AZA gel), a US Food and Drug Administration approved drug for treatment of acne and rosacea, was also used for comparison. Release profile and flux of AZA were determined in an in vitro hairless mouse skin model using Franz Diffusion Cell. Results: The data have shown that a higher concentration of AZA is retained in the epidermis/dermis layer and the whole skin for the formulation with pH = 4.9 as compared to that with pH = 3.9 at an active loading level of 2.82 mg/cm(2). In addition, the flux of ionized species of AZA in the pH 4.9 formulation (128.4 ±â€‰35.9 μg/cm(2)/h) is approximately five-fold greater than that in the pH 3.9 formulation (27.7 ±â€‰4.0 μg/cm(2)/h). The results suggest that the ionized AZA penetrates through the skin and accounts for majority of the total flux. Discussion and conclusion: This study has demonstrated that the penetration and absorption of AZA show a strong pH- and vehicle-dependency. Solubilization is the rate-limiting step in percutaneous absorption of AZA. PMID: 22111946 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22111946&dopt=Abstract = URL to article

Demodex-associated bacterial proteins induce neutrophil activation. Br J Dermatol. 2011 Nov 19; Authors: O'Reilly N, Bergin D, Reeves EP, McElvaney NG, Kavanagh K Abstract Background:  Patients with rosacea demonstrate a higher density of Demodex mites in their skin than controls. A bacterium isolated from a Demodex mite from a patient with papulopustular rosacea (PPR) was previously shown to provoke an immune response in patients with PPR or ocular rosacea thus suggesting a possible role for bacterial proteins in the etiology of this condition. Objectives:  To examine the response of neutrophils to proteins derived from a bacterium isolated from a Demodex mite. Methods:  Bacterial cells were lysed and proteins were partially purified by AKTA-FPLC. Isolated neutrophils were exposed to bacterial proteins and monitored for alterations in migration, degranulation and cytokine production. Results:  Neutrophils exposed to proteins from Bacillus cells demonstrated increased levels of migration and elevated release of MMP-9, an enzyme known to degrade collagen and cathelicidin, an antimicrobial peptide. In addition neutrophils exposed to the bacterial proteins demonstrated elevated rates of Il-8 and TNF-alpha production. Conclusions:  Proteins produced by a bacterium isolated from a Demodex mite have the ability to increase the migration, degranulation and cytokine production abilities of neutrophils. These results suggest that bacteria may play a role in the inflammatory erythema associated with rosacea. PMID: 22098186 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22098186&dopt=Abstract = URL to article

Why are Dermatologists Still Talking About Acne? Because So Many People Have It... and We Are Always Seeking Better Ways to Manage It. J Drugs Dermatol. 2011 Jun;10(6):575-7 Authors: PMID: 21637896 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21637896&dopt=Abstract = URL to article

Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011 Dec;15(1):53-62 Authors: Schwab VD, Sulk M, Seeliger S, Nowak P, Aubert J, Mess C, Rivier M, Carlavan I, Rossio P, Metze D, Buddenkotte J, Cevikbas F, Voegel JJ, Steinhoff M Abstract Rosacea is a common skin disease with a high impact on quality of life. Characterized by erythema, edema, burning pain, immune infiltration, and facial skin fibrosis, rosacea has all the characteristics of neurogenic inflammation, a condition induced by sensory nerves via antidromically released neuromediators. To investigate the hypothesis of a central role of neural interactions in the pathophysiology, we analyzed molecular and morphological characteristics in the different subtypes of rosacea by immunohistochemistry, double immunofluorescence, morphometry, real-time PCR, and gene array analysis, and compared the findings with those for lupus erythematosus or healthy skin. Our results showed significantly dilated blood and lymphatic vessels. Signs of angiogenesis were only evident in phymatous rosacea. The number of mast cells and fibroblasts was increased in rosacea, already in subtypes in which fibrosis is not clinically apparent, indicating early activation. Sensory nerves were closely associated with blood vessels and mast cells, and were increased in erythematous rosacea. Gene array studies and qRT-PCR confirmed upregulation of genes involved in vasoregulation and neurogenic inflammation. Thus, dysregulation of mediators and receptors implicated in neurovascular and neuroimmune communication may be crucial at early stages of rosacea. Drugs that function on neurovascular and/or neuroimmune communication may be beneficial for the treatment of rosacea. PMID: 22076328 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076328&dopt=Abstract = URL to article

Rosacea: the cytokine and chemokine network. J Investig Dermatol Symp Proc. 2011 Dec;15(1):40-7 Authors: Gerber PA, Buhren BA, Steinhoff M, Homey B Abstract Rosacea is one of the most common dermatoses of adults. Recent studies have improved our understanding of the pathophysiology of rosacea. Current concepts suggest that known clinical trigger factors of rosacea such as UV radiation, heat, cold, stress, spicy food, and microbes modulate Toll-like receptor signaling, induce reactive oxygen species, as well as enhance antimicrobial peptide and neuropeptide production. Downstream of these events cytokines and chemokines orchestrate an inflammatory response that leads to the recruitment and activation of distinct leukocyte subsets and induces the characteristic histopathological features of rosacea. Here we summarize the current knowledge of the cytokine and chemokine network in rosacea and propose pathways that may be of therapeutic interest. PMID: 22076326 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076326&dopt=Abstract = URL to article

Neurovascular aspects of skin neurogenic inflammation. J Investig Dermatol Symp Proc. 2011 Dec;15(1):33-9 Authors: Aubdool AA, Brain SD Abstract Neurogenic inflammation is involved in skin inflammation. It is hypothesized that it is involved in the pathogenesis of the common chronic cutaneous vascular disorder rosacea, but the exact mechanism of action is currently unknown. Transient receptor potential vanilloid 1 (TRPV1) and ankyrin 1 (TRPA1) are widely expressed on primary sensory neuron endings and non-neuronal cells such as keratinocytes. Here we describe the potential for TRPV1 and TRPA1 receptors to be involved in the pathophysiology of rosacea due to their polymodal activation, including cold and hot temperature, pungent products from vegetable and spices, reactive oxygen species, and mechanical stimuli. We discuss the role of both receptors and the sensory neuropeptides that they release in inflammation and pain sensation and evidence suggesting that both TRPV1 and TRPA1 receptors may be promising therapeutic targets for the treatment of the inflammatory symptoms of rosacea. PMID: 22076325 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076325&dopt=Abstract = URL to article

Epidermal proteases in the pathogenesis of rosacea. J Investig Dermatol Symp Proc. 2011 Dec;15(1):16-23 Authors: Meyer-Hoffert U, Schröder JM Abstract A number of different proteases and their inhibitors have a role in skin physiology and in the pathophysiology of inflammatory skin diseases. Proteases are important in the desquamation process and orderly regulation of the skin's barrier function. On the basis of the catalytic domain, proteases are classified into aspartate-, cysteine-, glutamate-, metallo-, serine-, and threonine proteases. Particularly, serine proteases (SPs) contribute to epidermal permeability barrier homeostasis, as acute barrier disruption increases SP activity in skin and inhibition by topical SP inhibitors accelerated recovery of barrier function after acute abrogation. In rosacea, increased levels of the vasoactive and inflammatory host-defense peptide cathelicidin LL-37 and its proteolytic peptide fragments were found, which were explained by an abnormal production of tryptic activity originating from kallikrein-related peptidase (KLK) 5. It is therefore possible that also other proteases, even from microbial or parasite origin, have a role in rosacea by forming alternate angiogenic and proinflammatory cathelicidin peptides. Further, the regulation of protease activity, in particular KLK-5 activity, might have a role in rosacea. This review briefly summarizes our current knowledge about keratinocyte-derived proteases and protease inhibitors, which might have a role in the pathophysiology of rosacea. PMID: 22076323 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076323&dopt=Abstract = URL to article

Rosacea as a disease of cathelicidins and skin innate immunity. J Investig Dermatol Symp Proc. 2011 Dec;15(1):12-5 Authors: Yamasaki K, Gallo RL Abstract Rosacea is a common and chronic inflammatory skin disease most frequently seen in groups of genetically related individuals. Although the symptoms of rosacea are heterogeneous, they are all related by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. Until recently, the pathophysiology of this disease was limited to descriptions of a wide variety of factors that exacerbate or improve disease. Recent molecular studies show a common link between the triggers of rosacea and the cellular response, and these observations suggest that an altered innate immune response is involved in disease pathogenesis. Understanding rosacea as a disorder of innate immunity explains the benefits of current treatments and suggests new therapeutic strategies for alleviating this disease. PMID: 22076322 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076322&dopt=Abstract = URL to article

Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011 Dec;15(1):2-11 Authors: Steinhoff M, Buddenkotte J, Aubert J, Sulk M, Novak P, Schwab VD, Mess C, Cevikbas F, Rivier M, Carlavan I, Déret S, Rosignoli C, Metze D, Luger TA, Voegel JJ Abstract Rosacea is a chronic inflammatory skin disease of unknown etiology. Although described centuries ago, the pathophysiology of this disease is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been identified yet. Four subtypes and several variants of rosacea have been described. It is still unclear whether these subtypes represent a "developmental march" of different stages or are merely part of a syndrome that develops independently but overlaps clinically. Clinical and histopathological characteristics of rosacea make it a fascinating "human disease model" for learning about the connection between the cutaneous vascular, nervous, and immune systems. Innate immune mechanisms and dysregulation of the neurovascular system are involved in rosacea initiation and perpetuation, although the complex network of primary induction and secondary reaction of neuroimmune communication is still unclear. Later, rosacea may result in fibrotic facial changes, suggesting a strong connection between chronic inflammatory processes and skin fibrosis development. This review highlights recent molecular (gene array) and cellular findings and aims to integrate the different body defense mechanisms into a modern concept of rosacea pathophysiology. PMID: 22076321 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076321&dopt=Abstract = URL to article

Pathophysiology of rosacea: introduction. J Investig Dermatol Symp Proc. 2011 Dec;15(1):1 Authors: Steinhoff M, Bergstresser PR PMID: 22076320 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22076320&dopt=Abstract = URL to article

Estimating Gene Flow between Refuges and Crops: A Case Study of the Biological Control of Eriosoma lanigerum by Aphelinus mali in Apple Orchards. PLoS One. 2011;6(11):e26694 Authors: Lavandero B, Figueroa CC, Franck P, Mendez A Abstract Parasitoid disturbance populations in agroecosystems can be maintained through the provision of habitat refuges with host resources. However, specialized herbivores that feed on different host plants have been shown to form host-specialized races. Parasitoids may subsequently specialize on these herbivore host races and therefore prefer parasitizing insects from the refuge, avoiding foraging on the crop. Evidence is therefore required that parasitoids are able to move between the refuge and the crop and that the refuge is a source of parasitoids, without being an important source of herbivore pests. A North-South transect trough the Chilean Central Valley was sampled, including apple orchards and surrounding Pyracantha coccinea (M. Roem) (Rosales: Rosacea) hedges that were host of Eriosoma lanigerum (Hemiptera: Aphididae), a globally important aphid pest of cultivated apples. At each orchard, aphid colonies were collected and taken back to the laboratory to sample the emerging hymenopteran parasitoid Aphelinus mali (Hymenoptera: Aphelinidae). Aphid and parasitoid individuals were genotyped using species-specific microsatellite loci and genetic variability was assessed. By studying genetic variation, natural geographic barriers of the aphid pest became evident and some evidence for incipient host-plant specialization was found. However, this had no effect on the population-genetic features of its most important parasitoid. In conclusion, the lack of genetic differentiation among the parasitoids suggests the existence of a single large and panmictic population, which could parasite aphids on apple orchards and on P. coccinea hedges. The latter could thus comprise a suitable and putative refuge for parasitoids, which could be used to increase the effectiveness of biological control. Moreover, the strong geographical differentiation of the aphid suggests local reinfestations occur mainly from other apple orchards with only low reinfestation from P. cocinnea hedges. Finally, we propose that the putative refuge could act as a source of parasitoids without being a major source of aphids. PMID: 22073185 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22073185&dopt=Abstract = URL to article

Once-daily topical brimonidine tartrate gel 0.5% is a novel treatment of moderate to severe facial erythema of rosacea: results of two multicenter, randomized and vehicle-controlled studies. Br J Dermatol. 2011 Nov 2; Authors: Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, Liu Y, Leoni M, Abstract Background:  Erythema of rosacea is thought to result from abnormal cutaneous vasomotor activity. Brimonidine tartrate (BT) is a highly selective α(2) -adrenergic receptor agonist with vasoconstrictive activity. Objective:  To determine the optimal concentration and dose regimen of topical BT gel for the treatment of erythema of rosacea and to evaluate its efficacy and safety. Methods:  In Study A, 122 subjects were randomized to receive a single application of BT 0.07%, 0.18%, 0.5% and vehicle. In Study B (4-week treatment and 4-week follow-up), 269 subjects were randomized to receive BT 0.5% once-daily (QD), BT 0.18% QD, vehicle QD, BT 0.18% twice-daily (BID) or vehicle BID. Evaluations included Clinician's Erythema Assessment (CEA), Patient's Self Assessment (PSA), chromameter measurements and adverse events. Results:  Study A - A single application of topical BT gel reduced facial erythema in a dose-dependent fashion. Significant difference between BT 0.5% and vehicle in chromameter redness value was observed from 30 minutes to 12 hours after application. Study B - BT 0.5% QD had a statistically superior success profile (defined as 2-grade improvement on both CEA and PSA over 12 hours) compared to vehicle QD on Days 1, 15 and 29 (all P<.001). No tachyphylaxis, rebound of erythema or aggravation of other disease signs (telangiectasia, inflammatory lesions) was observed. All regimens were safe and well-tolerated with similarly low incidence of adverse events. Conclusions:  Once-daily BT gel 0.5% is well-tolerated and provides significantly greater efficacy than vehicle gel for the treatment of moderate to severe erythema of rosacea. PMID: 22050040 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22050040&dopt=Abstract = URL to article

Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link. J Eur Acad Dermatol Venereol. 2011 Oct 24; Authors: Forton FM Abstract Papulopustular rosacea (PPR) is a common facial skin disease, characterized by erythema, telangiectasia, papules and pustules. Its physiopathology is still being discussed, but recently several molecular features of its inflammatory process have been identified: an overproduction of Toll-Like receptors 2, of a serine protease, and of abnormal forms of cathelicidin. The two factors which stimulate the Toll-like receptors to induce cathelicidin expression are skin infection and cutaneous barrier disruption: these two conditions are, at least theoretically, fulfilled by Demodex, which is present in high density in PPR and creates epithelial breaches by eating cells. So, the major pathogenic mechanisms of Demodex and its role in PPR are reviewed here in the context of these recent discoveries. In this review, the inflammatory process of PPR appears to be a consequence of the proliferation of Demodex, and strongly supports the hypothesis that: (1) in the first stage a specific (innate or acquired) immune defect against Demodex allows the proliferation of the mite; (2) in the second stage, probably when some mites penetrate into the dermis, the immune system is suddenly stimulated and gives rise to an exaggerated immune response against the Demodex, resulting in the papules and the pustules of the rosacea. In this context, it would be very interesting to study the immune molecular features of this first stage, named "pityriasis folliculorum", where the Demodex proliferate profusely with no, or a low immune reaction from the host: this entity appears to be a missing link in the understanding of rosacea. PMID: 22017468 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22017468&dopt=Abstract = URL to article

[Non-pharmacologic management of rosacea.] Hautarzt. 2011 Oct 22; Authors: Borelli C, Korting HC Abstract Rosacea is like no other disease a problem for patients regarding the use of skin care and cleaning products. The subjective assessment of the severity of the illness is an important factor regarding the development of depression in these patients. Inadequate skin care and cleaning products can lead to irritation and stinging of the skin. Dermatologists should address questions regarding skin care, cleaning and sun screens. Because of the higher irritability of the skin of rosacea patients, all possibly irritating cleaning products or procedures should be avoided. The water temperature is also important; it should be lukewarm to avoid the provocation of a vascular reaction. Soaps should be avoided, because they are alkaline and thus lead to a higher pH of the skin. A higher pH of the skin can lead to irritation. Appropriate make-up causes no aggravation of the skin and increases patient's satisfaction with their skin and thus leads to a higher compliance with pharmacological therapy. Laser or intense pulsed light treatment can improve telangiectasia or erythema. Operative treatment of rhinophyma is effective and well-established. PMID: 22015850 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22015850&dopt=Abstract = URL to article

[Rosacea : Systemic therapy with retinoids.] Hautarzt. 2011 Oct 22; Authors: Thielitz A, Gollnick H Abstract Systemic isotretinoin has been known for decades as an effective and safe therapeutic option in the treatment of severe and refractory forms of rosacea. It can also be used in special treatment-resistant forms of rosacea, e. g. granulomatous rosacea, as efficacious second-line therapy. Previously, the effect of isotretinoin in rosacea has been mainly studied in small cohorts or anecdotal reports. Recently, a big randomized double-blind dose-response and comparative study revealed that an optimized dosage of 0,3 mg/kg was superior to other dosages and non-inferior to doxycycline as gold standard of systemic rosacea treatment and proved effective and safe in papulopustular and phymatous subtypes. However, the substance is still not licensed for this indication The efficacy of isotretinoin in rosacea is probably mainly related to anti-inflammatory mechanisms as well as anti-oxidative, anti-angiogenic and antifibrotic properties. The classical antiseborrheic effect of isotretinoin might play a role in special subtypes like the phymatous type or rosacea fulminans. PMID: 22015849 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22015849&dopt=Abstract = URL to article

[Rhinophyma in rosacea : What does surgery achieve?] Hautarzt. 2011 Oct 19; Authors: Sadick H, Riedel F, Bran G Abstract Rhinophyma is a benign dermatological disease of the nose which affects primarily Caucasian men in their fifth decade of life. Its main characteristic is a slowly progressive hyperplasia of the sebaceous glands and the adjacent tissue with irregular thickening of the nasal skin and nodular deformation. It is defined as the end stage of acne rosacea. The main reasons for patients to seek medical help are cosmetic problems and functional impairments such as nasal airway obstruction or even difficulty in eating. Surgery is indisputably the treatment of choice for rhinophyma. This article gives an overview on the clinical and histopathologic findings of rhinophyma as well as the different treatment options with their pros and cons as described in literature. PMID: 22006169 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22006169&dopt=Abstract = URL to article

[Antimicrobial peptides, Vitamin D(3) and more : How rosacea may develop.] Hautarzt. 2011 Oct 16; Authors: Schauber J Abstract The pathogenesis of rosacea - a common, chronic inflammatory skin disease mainly affecting the central portions of the face - is only partly understood. In affected skin the expression of cathelicidin - an antimicrobial peptide and effector of innate immunity - is strongly increased. In addition, the activity of cutaneous proteases is greatly increased leading to the generation of cathelicidin peptide fragments with pro-inflammatory activity. UV irradiation and microbial factors contribute to this inflammatory cascade by increasing vitamin D(3) metabolism and the activation of toll-like receptors (TLR). Retinoids, azelaic acid and doxycycline inhibit both skin proteases and TLR expression and could mediate their anti-inflammatory effects in rosacea through these mechanisms. These data increase our understanding of the pathogenesis and therapy of rosacea. Also, these insights might uncover novel targets for innovative therapies of this common, stigmatizing skin disease. PMID: 22002717 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=22002717&dopt=Abstract = URL to article

Associated Morbidity of Chalazia. Cornea. 2011 Oct 11; Authors: Nemet AY, Vinker S, Kaiserman I Abstract PURPOSE:: Chalazion may be associated with some local and systemic conditions. We studied the prevalence of various conditions among patients with chalazion. METHODS:: A retrospective observational case-control study of all the members who were diagnosed with chalazion in the Central District of Clalit Health Services in Israel (years 2000-2008; n = 9119) and 9119 age- and gender-matched controls randomly selected from the district members. We calculated the prevalence of various ocular, systemic, and demographic conditions as risk factors for chalazion. RESULTS:: Demographically, a significant (P < 0.0001) tendency to develop chalazion was found in the population of lower socioeconomic class, in the population living in urban areas, in young females (10-29 years), in older men (older than 60 years), and in non-Ashkenazi Jews. The following risk factors of chalazion were statistically significant: blepharitis [odds ratio (OR), 6.2], rosacea (OR, 2.9), gastritis (OR, 1.4), anxiety (OR, 1.5), irritable bowel syndrome (OR, 1.7), and smoking (OR, 1.2). Diabetes (OR, 0.8) and hypothyroidism (OR, 0.8) were significantly less prevalent among chalazion patients. CONCLUSIONS:: Some systemic conditions are significantly more prevalent and some are significantly less prevalent among patients with chalazion. Better understanding of the pathophysiological association between those diseases and chalazion may help in its treatment and prevention. PMID: 21993469 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21993469&dopt=Abstract = URL to article

Rosacea fulminans in der Schwangerschaft mit okulärer Perforation. J Dtsch Dermatol Ges. 2011 Jul;9(7):542-3 Authors: Silva FA, Bonassi M, Steiner D, Cunha TV PMID: 21992667 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21992667&dopt=Abstract = URL to article

Effective treatment of leukemia cutis with combination of rituximab, cladribine, and cyclophosphamide in patient with B-cell chronic lymphocytic leukemia. Ann Hematol. 2011 Aug;90(8):979-80 Authors: Batycka-Baran A, Baran W, Dzietczenia J, Mazur G PMID: 20978760 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=20978760&dopt=Abstract = URL to article

Efficacy of a novel rosacea treatment system: an investigator-blind, randomized, parallel-group study. J Drugs Dermatol. 2011 Oct 1;10(10):1179-85 Authors: Leyden JJ Abstract Introduction: A rosacea treatment system (cleanser, metronidazole 0.75% gel, hydrating complexion corrector, and sunscreen SPF30) has been developed to treat rosacea. Methods: Thirty women with mild or moderate erythema of rosacea on their facial cheeks were randomly assigned to use one of the following for 28 days: the rosacea treatment system (RTS); RTS minus metronidazole (RTS-M); or metronidazole 0.75% gel plus standard skin care (standard cleanser and standard moisturizer/sunscreen) (M+SSC). Results: At day 28, global improvement was evident in 90 percent of patients using RTS, 60 percent using RTS-M, and 67 percent using M+SSC. Erythema was significantly lower with RTS from day 14 onward, and unchanged with M+SSC. The proportion of patients reporting their skin was easily irritated at least sometimes was 40 percent with RTS, 70 percent with RTS-M, and 89 percent with M+SSC. Conclusion: The rosacea treatment system may offer superior efficacy and tolerability to metronidazole plus the standard skin care used in this study. J Drugs Dermatol. 2011;10(10):1179-1185. PMID: 21968669 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21968669&dopt=Abstract = URL to article

Endothelial and axon reflex vasodilatation to acetylcholine in rosacea-affected skin. Arch Dermatol Res. 2011 Oct 4; Authors: Drummond PD, Su D Abstract Rosacea is a chronic skin disorder, characterized by persistent painful facial flushing and often accompanied by papules and pustules. To investigate the mechanism of facial flushing in rosacea, acetylcholine was administered by iontophoresis to a 10-mm diameter site in the forehead of 31 patients with rosacea and in 29 controls of similar age and sex distribution. During the iontophoresis, current strengths doubled in eight steps from 2.5 to 320 μA. For each step, skin blood flow was monitored during 60 s of iontophoresis and for 2 min afterwards with laser Doppler flow probes at the site of iontophoresis and 5-8 mm away in the region of axon reflex vasodilatation. Vascular responses to acetylcholine were similar in patients and controls, but stinging sensations were greater in patients than in controls at the most intense current strength. In addition, axon reflex vasodilatation was greater in patients with severe than mild rosacea. These findings suggest that activation of nociceptive nerve fibres contributes to skin sensitivity in patients with rosacea, and that axon reflexes augment flushing in patients with the most severe symptoms. PMID: 21968600 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21968600&dopt=Abstract = URL to article

The fatty acid profile of the skin surface lipid layer in papulopustular rosacea. Br J Dermatol. 2011 Oct 3; Authors: Ni Raghallaigh S, Bender K, Lacey N, Brennan L, Powell F PMID: 21967555 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21967555&dopt=Abstract = URL to article