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Inflammation in rosacea and acne: Implications for patient care. J Drugs Dermatol. 2011 Jun;10(6):614-20 Authors: Fleischer AB Abstract Rosacea and acne are chronic inflammatory skin conditions that share an inflammatory pathogenesis, but clinically remain quite distinct. Although many have long assumed that these conditions are primarily infectious, emerging evidence suggests that inflammation plays a critical role in the pathogenesis of these disorders. Part of the innate immune system, the antimicrobial and proinflammatory cathelicidins, may be downregulated by both azelaic acid and sub antimicrobial doxycycline. In acne, the creation of papules, pustules and nodules is clearly mediated through immune mechanisms, and the antiinflammatory effects of retinoids play a key role in management. Recent observations help us understand in greater detail the role that inflammation plays in these two diseases, and the mechanisms by which commonly used medications exert their effect by modulating inflammatory processes. This review will present and synthesize recently acquired information as it relates to inflammatory acne and rosacea pathogenesis and clinical management. PMID: 21961194 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21961194&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: Del Rosso JQ PMID: 21637895 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21637895&dopt=Abstract = URL to article

Pimecrolimus 1% cream for the treatment of rosacea. J Dermatol. 2011 Sep 28; Authors: Kim MB, Kim GW, Park HJ, Kim HS, Chin HW, Kim SH, Kim BS, Ko HC Abstract Rosacea is a common inflammatory skin disorder; the pathogenesis is unclear. Various treatment options for rosacea are available, but most have limited effectiveness. The aim of this study was to investigate the efficacy and safety of 1% pimecrolimus cream for the treatment of rosacea. Thirty patients with rosacea were enrolled in this 4-week, single-center, open-label study of 1% pimecrolimus cream. Patients were instructed to apply the cream to their faces twice daily and were not permitted to use any other agents. Clinical efficacy was evaluated by a rosacea grading system using photographic documentation and a mexameter. The 26 patients who completed the study experienced significantly reduced rosacea clinical scores from 9.65 ±â€ƒ1.79 at baseline to 7.27 ±â€ƒ2.11 at the end of treatment (P < 0.05). The mexameter-measured erythema index decreased significantly from 418.54 ±â€ƒ89.56 at baseline to 382.23 ±â€ƒ80.04 at week 4 (P < 0.05). The side-effects were mostly transient local irritations. The results of this study suggest that 1% pimecrolimus cream is an effective and well-tolerated treatment for patients with mild to moderate inflammatory rosacea. PMID: 21954922 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21954922&dopt=Abstract = URL to article

Rosacea Treatment with Intermediate-dose Isotretinoin: Follow-up with Erythema and Sebum Measurements. Acta Derm Venereol. 2011 Sep 28; Authors: Uslu M, Savk E, Karaman G, Sendur N Abstract Isotretinoin is one of the therapeutic options for rosacea. However, the response of erythema to treatment with isotretinoin is usually slow and incomplete with common (0.5-1 mg/kg/day) or low (10 mg/day) doses. This study investigated the efficacy of, and relapse on, 20 mg/day isotretinoin treatment in rosacea, with the aid of instrumental measurement of facial erythema and sebum levels. A 20 mg/day dose of isotretinoin was given for 4 months, and then the dose was tapered off within the following 6 months. A total of 25 patients were included in the study. Papule and pustule counts, erythema index, sebum level, dermatologist's and patient's erythema scores, and dermatologist's sebum scores were significantly lower in the first month of therapy compared with pre-treatment values (p < 0.05). Within a median follow-up of 11 months (95% confidence interval: 8.4-13.5 months) 45% of patients had a relapse. In conclusion, 20 mg/day isotretinoin was rapidly efficient for reducing both inflammatory lesions and erythema in rosacea. PMID: 21952746 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21952746&dopt=Abstract = URL to article

Rosacea-like Demodicosis Mimicking Cutaneous Lymphoma. Acta Derm Venereol. 2011 Sep 28; Authors: Kito Y, Hashizume H, Tokura Y PMID: 21952646 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21952646&dopt=Abstract = URL to article

Interventions for 'rosacea'. Br J Dermatol. 2011 Oct;165(4):707-8 Authors: Powell FC, Ni Raghallaigh S PMID: 21950499 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21950499&dopt=Abstract = URL to article

Periocular rash. JAMA. 2011 Sep 21;306(11):1263-4 Authors: Chang HJ PMID: 21934064 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21934064&dopt=Abstract = URL to article

Use of Oral Isotretinoin in the Management of Rosacea. J Clin Aesthet Dermatol. 2011 Sep;4(9):54-61 Authors: Park H, Del Rosso JQ Abstract Rosacea is a chronic inflammatory disease affecting roughly 16 million Americans. Topical and oral antibiotic/anti-inflammatory agents are currently the mainstay of therapy and are often used in combination. In this article, the authors discuss the use of oral isotretinoin in the management of rosacea, exploring dosage, comparable efficacy, safety, and cost. PMID: 21938271 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21938271&dopt=Abstract = URL to article

Generalized Pustular Psoriasis-Like Dermatophytosis due to Trichophyton rubrum. Acta Dermatovenerol Croat. 2011 Sep;19(3):206-11 Authors: Feily A, Reza Namazi M, Seifmanesh H Abstract Trichophyton rubrum (T. rubrum) accounts for approximately 90% of chronic superficial dermatophyte infections in human host (1). In particular, it is frequently implicated in tinea corporis caused by anthropophilic fungi, in which it can produce large annular lesions with a poorly defined border and erythema or scaling (2). In 1968, Ive and Marks (3) used the term "tinea incognito" for cases of epidermomycosis, erroneously treated with topical steroids, having clinical manifestations that mimicked other skin conditions such as seborrheic dermatitis, lichen planus, folliculitis, and rosacea (1). We reported on a patient with generalized tinea incognito caused by T. rubrum, who presented two weeks after being cured by fluconazole, with pustular psoriasis-like generalized tinea corporis. A 56-year-old previously healthy woman presented to dermatology clinic (Faghihi Hospital, Shiraz, Iran) with a 2-year history of pruritic erythematous lesions involving the left leg, back, shoulders, right arm and forearm. The lesions were treated erroneously as eczema in three other medical centers, and she received to¬pi¬cal corticosteroids, emollients and antihistamines. Her past medical history did not reveal any significant di¬sease. In terms of drug history, she did not use any drug on regular basis except for the above-mentioned drugs. On physical examination, erythematous, sharply demarcated lesions were observed on the above-mentioned areas of her body (Fig. 1). Other physical examinations showed nothing abnormal. Routine laboratory tests were within the normal limits. Microscopic examination of skin scrapings from the lesions with potassium hydroxide (KOH) revealed dermatophyte hyphae. T. rubrum was detected in the culture of skin scrapings. A course of 4-week fluconazole (150 mg daily) was started. The patient did not present to our clinic for follow up. Two weeks after ending the treatment course, the patient presented again to one of the above-mentioned dermatologic centers. They suspected pustular psoriasis and decided to start therapy with methotrexate. Before starting the new treatment, the patient presented to our dermatologic clinic. On physical examination, previous lesions were found to have changed to well-demarcated and round plaques with scaling and pustules on the back, face, arms, and right leg (Fig. 2). KOH smear and fungal culture indicated the diagnosis of T. rubrum dermatophytosis again, thus the previous 4-week course of fluconazole was reintroduced. After four weeks, complete resolution of all lesions was observed. Six-month follow up was normal. Tinea corporis may be caused by either zoophilic fungi or anthropophilic organisms, less frequently by geophilic fungi (2). As a result of misdiagnosis or presence of pre-existing pathologies treated with local steroids, the clinical appearance of the lesions may mimic other skin conditions (1). Crawford et al. (4) report on not only corticosteroids but also new class topical non-steroidal medications including pimecrolimus and tacrolimus to have induced tinea incognito. Generalized dermatophyte infections of the skin are typically observed in immunocompromised patients (e.g., patients receiving long-term immunosuppressive therapy, patients with HIV infection or with underlying lymphoproliferative disorders) (5). There are a few descriptions in the literature of widespread tinea corporis in immunocompetent patients (6), but there are some reports of widespread and chronic dermatophyte infections in atopics (2) and in patients with Cushing's syndrome (7). The novel case described herein presented with pustular psoriasis-like generalized tinea corporis lesions. Serarslan (8) reports on a patient with tinea incognito characterized by pustular inflammatory skin lesions after receiving steroid and emollient therapy, as in our patient. T. rubrum is a fungus that most frequently induces both widespread dermatophytosis and atypical features and may cause pustular reaction (2). IIkit et al. (9) report on plaques with erythema and papules in the neck and breast area due to T. rubrum in a 20-year-old female. She was treated with corticosteroids for a long time. They conclude that tinea incognito could present in various clinical features, usually due to wrong treatment modalities. They suggest investigation of fungi in atypical erythematous plaques. Kastelan et al. (10) report on a 72-year-old woman treated unsuccessfully with topical steroid cream for 3 months. Multiple nummular scaly papules and plaques were found on her arms and trunk. They describe circular and erythematous lesions with sharp demarcated and raised scaly edges. Finally, T. rubrum was cultured on Sabouraud's agar. They suggest that in patients previously treated with steroids, disseminated scaly infiltrate lesions should be investigated for fungal infection. Although we treated our patient with fluconazole, terbinafine remains a good first-line treatment because T. rubrum is still highly sensitive to terbinafine (11). In conclusion, concerning clinical features of the case presented, dermatophyte infection may be considered on differential diagnosis of generalized pustular dermatoses. PMID: 21933649 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21933649&dopt=Abstract = URL to article

Coblation of rhinophyma. J Laryngol Otol. 2011 Jul;125(7):724-8 Authors: Timms M, Roper A, Patrick C Abstract INTRODUCTION: Rhinophyma is a disfiguring hypertrophy of the skin of the tip of the nose. OBJECTIVE: To assess the new technique of coblation of rhinophyma. STUDY DESIGN: Case series of six patients. RESULTS: All patients had a good cosmetic result. Comparison with existing techniques showed advantages due to the lower tissue temperature involved. CONCLUSION: Coblation of rhinophyma is an effective treatment with few side effects. PMID: 21524328 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21524328&dopt=Abstract = URL to article

Contact hypersensitivity in rosacea - a study in 82 patients. J Eur Acad Dermatol Venereol. 2011 Sep 20; Authors: Pónyai G, Kiss D, Németh I, Temesvári E PMID: 21929553 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21929553&dopt=Abstract = URL to article

Botanicals and anti-inflammatories: natural ingredients for rosacea. Semin Cutan Med Surg. 2011 Sep;30(3):148-55 Authors: Emer J, Waldorf H, Berson D Abstract Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here. PMID: 21925368 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21925368&dopt=Abstract = URL to article

Crusted rosacea-like demodicidosis in an HIV-positive female. J Am Acad Dermatol. 2011 Oct;65(4):e131-2 Authors: Brutti CS, Artus G, Luzzatto L, Bonamigo RR, Balconi SN, Vettorato R PMID: 21920237 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21920237&dopt=Abstract = URL to article

Azelaic acid gel 15% in the management of papulopustular rosacea: a status report on available efficacy data and clinical application. Cutis. 2011 Aug;88(2):67-72 Authors: Del Rosso JQ, Bhatia N Abstract Azelaic acid (AzA) gel 15% is approved by the US Food and Drug Administration (FDA) for the treatment of papulopustular rosacea (PPR). Its efficacy and safety as monotherapy have been demonstrated. Release of active drug from the gel formulation is superior to the cream. The combination of AzA gel 15% with oral doxycycline appears to expedite and augment response, especially in cases of PPR of greater severity, and AzA gel 15% maintains control of PPR over 6 months as compared to vehicle. Adjunctive skin care is recommended to augment the therapeutic outcome of PPR and reduce the potential for irritation that can occur with topical therapy. PMID: 21916272 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21916272&dopt=Abstract = URL to article

A Guide to the Ingredients and Potential Benefits of Over-the-Counter Cleansers and Moisturizers for Rosacea Patients. J Clin Aesthet Dermatol. 2011 Aug;4(8):31-49 Authors: Levin J, Miller R Abstract It is difficult for rosacea patients to discern which products and ingredients will be beneficial to their skin and which products will lead to an exacerbation of the signs and symptoms of rosacea. In this paper, the authors provide a brief overview of rosacea, its pathogenesis, signs and symptoms, and the management of the two major rosacea subtypes-erythematotelangiectatic rosacea and papular pustular rosacea. Reviewed in greater detail are the common ingredients used in over-the-counter cleansers and moisturizers with discussion of how these ingredients potentially benefit or harm the skin of patients with rosacea. Clinical studies investigating the benefits of using certain over-the-counter cleansers and moisturizers in patients with erythematotelangiectatic rosacea and papular pustular rosacea with or without topical prescription therapy are also reviewed. The specific formulas used in the clinical studies include a sensitive skin synthetic detergent bar, a nonalkaline cleanser and moisturizer, polyhydroxy acid containing cleanser and moisturizer, and a ceramide-based cleanser and moisturizer formulated in a multivesicular emulsion. Based on review of available data, the authors conclude that the use of mild over-the-counter cleansers and moisturizers is beneficial for patients with erythematotelangiectatic rosacea and papular pustular rosacea. The properties of over-the-counter cleansers and moisturizers that contribute to their mildness include an acidic-neutral pH to minimize the flux in skin pH; surfactants or emulsifiers that will not strip the skin of its moisture or strip the lipids and proteins of the stratum corneum; moisturizing ingredients such as emollients, humectants, and occlusives; and formulas without potential irritants and allergens. The most consistent clinical benefits demonstrated in the reviewed studies were a subjectively perceived improvement in subjective symptoms of dryness and irritation as well as an objective improvement in dryness. PMID: 21909456 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21909456&dopt=Abstract = URL to article

Management of Papulopustular Rosacea and Perioral Dermatitis with Emphasis on Iatrogenic Causation or Exacerbation of Inflammatory Facial Dermatoses: Use of Doxycycline-modified Release 40mg Capsule Once Daily in Combination with Properly Selected Skin Care as an Effective Therapeutic Approach. J Clin Aesthet Dermatol. 2011 Aug;4(8):20-30 Authors: Rosso JQ Abstract A variety of inflammatory facial dermatoses, such as papulopustular rosacea and perioral dermatitis, are often idiopathic. However, prolonged continuous and/or repeated intermittent topical corticosteroid use can exacerbate these disorders or, in some cases, induce them. This article discusses corticosteroid-induced rosacea-like dermatitis and primary perioral dermatitis with regard to clinical presentations, including in both adults and children, and management considerations. The rationale for use of an anti-inflammatory dose of doxycycline that is subantimicrobial, doxycycline modified-release 40mg capsule once daily, along with properly selected skin care, is discussed. Case illustrations are also included. PMID: 21909455 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21909455&dopt=Abstract = URL to article

[Laser and intense pulsed light management of couperose and rosacea.] Ann Dermatol Venereol. 2011 Sep;138S2:S167-S170 Authors: Dahan S Abstract Management of couperosis and rosacea has been totally renewed by laser and vascular laser techniques, with efficacy targeted on the telangiectases and to a lesser extent on the erythrosis. Laser management of hypertrophic rosacea or rhinophyma depends on surgical treatment with decortication, continuous CO(2) ablative laser or Erbium, fractionated at high power, then vascular laser treatment for the telangiectases: lasers with pulsed dye, KTP, or pulsed lights for red laser telangiectases and long pulse Nd-Yag laser for blue telangiectases. For papulopustular rosacea, vascular laser treatment (pulsed dye and KTP) and intense pulsed light will be begun once the inflammation has been treated. The major indication for vascular lasers and intense pulsed light is found in erythematotelangiectatic rosacea, with high efficacy for the telangiectases. Diffuse erythrosis is difficult to treat, requiring a high number of laser and/or intense pulsed light sessions. PMID: 21907878 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907878&dopt=Abstract = URL to article

[Dermocosmetic management of the red face and rosacea.] Ann Dermatol Venereol. 2011 Sep;138S2:S163-S166 Authors: Guerrero D Abstract Erythematotelangiectatic rosacea is a frequent condition and affected patients benefit from medical treatments and dermatological procedures but also a complementary dermocosmetic assistance that aims at obtaining optimal skin comfort and preventing irritation of these particularly overreactive skins. Choice of dermocosmetics is crucial - especially in respect to their texture and the simplicity in ingredients - in order to optimize the application of the products and their tolerance. The addition of soothing and decongestant active ingredients is particularly important. Finally, photoprotection and a specific medical make-up are useful to attenuate the unattractive appearance of « red faces ». PMID: 21907877 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907877&dopt=Abstract = URL to article

[Treatment of rosacea.] Ann Dermatol Venereol. 2011 Sep;138S2:S158-S162 Authors: Parodi A, Drago F, Paolino S, Cozzani E, Gallo R Abstract A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole. PMID: 21907876 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907876&dopt=Abstract = URL to article

[sensitive skin and rosacea : nosologic framework.] Ann Dermatol Venereol. 2011 Sep;138S2:S154-S157 Authors: Misery L Abstract Flushing due to rosacea may be confused with sensitive skin because it is characterized by slightly acute reactions to varied factors with the perception of abnormal sensations and often common triggering factors. Nevertheless, these are clearly two different phenomena. On the one hand, rosacea is a vascular disease, with progressive worsening and eruptions set off by systemic factors, with a facial and/or ocular topography that respond to specific treatments. On the other hand, sensitive skin corresponds to an epidermal, cosmetic problem, with variable progression, whose eruptions are instead set off by contact factors and have a ubiquitous topography. Eruptions are improved by specific cosmetics and usually worsened by rosacea treatments. PMID: 21907875 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907875&dopt=Abstract = URL to article

[Clinical presentations and classification of rosacea.] Ann Dermatol Venereol. 2011 Sep;138S2:S138-S147 Authors: Jansen T Abstract Rosacea is a chronic skin disease affecting up to 10% of the population. It includes various combinations of characteristic signs and symptoms in a centrofacial distribution. There is a lack of consensus in the understanding of the different expressions of rosacea and the classification of the disease. It has been previously classified into four stages (pre-rosacea, stages I-III) and a variety of variants (persistent erythema and edema in rosacea, rosacea conglobata, rosacea fulminans, etc.). The National Rosacea Society (NRS) has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, ocular) and one variant (lupoid or granulomatous) avoiding assumptions on pathogenesis and progression. This classification system uses diagnostic criteria which assess both primary and secondary features of the disease. Suggestions for rosacea severity assessment have been included. Classification of rosacea into stages or subtypes, with or without progression, remains controversial until there is a better understanding of the pathogenesis of the disease. PMID: 21907873 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907873&dopt=Abstract = URL to article

[Physiopathology of rosacea. Redness, telangiectasia, and rosacea.] Ann Dermatol Venereol. 2011 Sep;138S2:S129-S137 Authors: Cribier B Abstract The physiopathology of rosacea involves a large number of factors that are at times difficult to correlate. There is not a single physiopathological model. Nevertheless, today it seems to have been established that two essential factors are involved: vascular and inflammatory. The disease occurs in individuals with a predisposition, mainly a light phototype subjected to substantial variations in climate. On a background of primary vascular anomaly, external factors (climate, exposure to ultraviolet rays, cutaneous flora, etc.) contribute to the development of abnormal superficial blood vessels, with a low permeability. The edema that results undoubtedly favors the colonization and multiplication of Demodex folliculorum. This parasite creates inflammation, directly and indirectly, which is seen in the papules and pustules as well as granulomas. Inflammation from rosacea is also characterized by innate immune system anomalies, with an increase in the expression of epidermal proteases and production of pro-inflammatory cathelicidin peptides. In addition, facial hypersensitivity exists, even though the cutaneous barrier is not altered. Finally, rhinophyma remains poorly explained; the vascular abnormalities induce local production of transforming growth factor β 1 (TGF-β1) capable of creating fibrosis and therefore cutaneous thickening. PMID: 21907872 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907872&dopt=Abstract = URL to article

[Epidemiology of rosacea: updated data.] Ann Dermatol Venereol. 2011 Sep;138S2:S124-S128 Authors: Chosidow O, Cribier B Abstract The epidemiological data on rosacea remain fragmentary and the methodological quality debatable. Rosacea affects mainly adults around the age of 30 years and classically predominates in females. Recent Estonian and Irish studies suggest that the female predominance may not be as high as previously believed. However, prevalence does increase with age. The prevalence statistics published in Europe and the United States are highly variable, ranging from less than 1% to more than 20% of the adult population; actually, the methods used and the populations studied vary greatly from one study to another; consequently, they cannot be compared. A family history of the disease is a risk factor, as is the very light skin phototype (Celtic skin type). Alcohol and coffee, classically blamed, are not risk factors; however, tobacco may have a protective effect. New studies are undoubtedly necessary: they should use the diagnostic and severity criteria established in 2002 and 2004. Rosacea has a strong impact on quality of life and can be associated with depressive symptoms. A specific quality-of-life scale, the RosaQol, has been established and validated in the United States, by the same group that elaborated the Skindex scale. Translations of this scale into French, Italian, German, and Spanish have been validated, which may allow future intercultural comparisons. PMID: 21907871 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907871&dopt=Abstract = URL to article

[The red face: art, history and medical representations.] Ann Dermatol Venereol. 2011 Sep;138S2:S116-S123 Authors: Cribier B Abstract For millennia, a red face has been a handicap in social relations, mainly because of the associated bias against alcoholics. The color red is also the color of emotion, betrayal of the person who blushes. Since the color red is one of the main characteristics of rosacea, it contributes to the bad reputation this disorder has, which is therefore the subject of a pressing therapeutic demand, principally in women. Nineteenth-century French novelists such as Balzac and later Proust, admirably described blotchy, red, or sanguine faces, which always announced a difficult, violent temperament, or was simply the mark of the laboring class. The color red remains ambivalent today, on the one hand denoting blood and life and on the other suffering, shame, and death. The history of dermatology shows that the semiology of rosacea was very well described in the earliest reports, notably those written in the Middle Ages. The term "acne rosacea" appeared in Bateman's writings, who made it a clinical form of acne. This confusion lasted throughout the nineteenth century. It was not until Hebra in Austria and Darier in France that the differential diagnosis was clearly made between acne and rosacea. A "couperosis" previously referred to the entire range of the disease, particularly the papules and pustules, and it was not until the twentieth century that the current meaning of rosacea progressively gained ground: this term today designates facial telangiectasia, whether or not it is associated with a characteristic redness. PMID: 21907870 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907870&dopt=Abstract = URL to article

[From blotchy complexion to rosacea…] Ann Dermatol Venereol. 2011 Sep;138S2:S115 Authors: Cribier B PMID: 21907869 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21907869&dopt=Abstract = URL to article