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Quality of Health Care of Rosacea in Germany from the Patient's Perspective: Results of the National Health Care Study RosaReal 2009. Dermatology. 2011 Sep 5; Authors: Langenbruch AK, Beket E, Augustin M Abstract Objectives: To obtain reliable data on quality of care of rosacea and to compare care indicators with those found in atopic dermatitis and psoriasis. Patients and Methods: In this cross-sectional study, clinical history, health-related quality of life (HrQoL), medication and treatment benefit of patients with rosacea were assessed by standardized questionnaires. Data were compared to patients with atopic dermatitis and psoriasis. Results: Almost all 475 participants (96.4%) had received topical therapy. 24% had used cortisone ointments. The mean Dermatology Life Quality Index (DLQI) was 4.3 ± 4.6 (atopic dermatitis: 8.5 ± 6.0, psoriasis: 6.7 ± 6.2). The Patient Benefit Index (patient-defined therapeutic benefit) was 1.9 ± 1.2 (psoriasis: 2.3 ± 1.1, atopic dermatitis: 2.1 ± 1.1). Conclusions: Only a small proportion of the rosacea patients had substantial impairments in HrQoL. Overall, their burden appears to be lower than in patients with atopic dermatitis or psoriasis. However, the lower therapeutic benefit and the high proportion of topical steroid use indicate a need for optimized therapy. PMID: 21893958 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21893958&dopt=Abstract = URL to article

Epidemiological Study of Periocular Dermatitis in a Specialised Hospital Department. Iran J Allergy Asthma Immunol. 2011 Sep;10(3):195-205 Authors: Rojo-España R, Tomas-Mallebrera L, Gimeno-Clemente N, Marquina-Vila A, Morales-Suárez-Varela M Abstract Contact dermatitis is frequent skin pathology and eyelids are one of the more frequent locations of this pathology. The objective of the present work was to study the population distribution of periocular dermatitis, determine the allergens which most frequently indicate positive in patch tests and in provocative use tests, and analyse the clinical relevance of the positive tests.Patients with periocular dermatitis (N=93) underwent a thorough physical examination and a patch test with standard series. According to clinical suspicions, 76 patients underwent a patch test with specific series. Finally a provocative use test was done for 36 patients with suspected products that the patients brought. The tests were classified according their relevance.The most frequently observed allergen in the patch tests (with standard and specific series) was nickel followed by mercury, and anti-glaucoma drops in the provocative use tests with patients products.Patients' sex, age, occupation, clinical status, presence of associated periocular symptoms, and presence of atopic or seborrheic dermatitis and/or rosacea did not relate with relevance.We conclude that a clinical diagnosis may not always be made with patch tests with standard and specific series due to lack of relevance. It is important to do provocative use tests with the products suspected as allergens in those cases where patch tests with standard and specific series indicated positive for more than one allergen. PMID: 21891826 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21891826&dopt=Abstract = URL to article

[Metronidazole: Alternative treatment for ocular and cutaneous rosacea in the pediatric population.] J Fr Ophtalmol. 2011 Aug 30; Authors: Léoni S, Mesplié N, Aitali F, Chamaillard M, Boralevi F, Marques da Costa C, Taïeb A, Léauté-Labrèze C, Colin J, Mortemousque B Abstract OBJECTIVE: To assess the effectiveness and tolerance of systemic metronidazole in the treatment of childhood ocular and cutaneous rosacea. METHOD: Single-center multidisciplinary retrospective study. PATIENTS: Children aged between 1 and 15, with ocular and/or cutaneous rosacea, treated in the pediatric ophthalmology and dermatology department of Bordeaux, France, from January 1996 to September 2009. RESULTS: Eleven patients out of 20 had ocular and cutaneous rosacea, three had ocular symptoms only, and six had cutaneous symptoms only. In 11 patients (55%), the ocular symptoms preceded the skin disease. Meibomian cyst and phlyctenular conjunctivitis were the main symptoms. Keratitis was seen in four patients and lower corneal ulcer in two cases. The papulopustular form was the most frequent dermatologic form. All patients with ocular involvement received first-line treatment of eyelid hygiene. No topical ophthalmic treatment such as corticosteroid or cyclosporine 0.5% or 2% was used. Thirteen patients who showed no improvement despite eyelid treatment, the association of ocular and cutaneous rosacea, severe ocular involvement with keratitis, and severe recurrent cutaneous rosacea were treated orally. Two patients, aged between 12 and 14 years, received treatment with an anti-inflammatory dose of doxycycline for 2 to 3 months and achieved complete remission. One 22-month-old patient received oral treatment with erythromycin at a dose of 250mg three times daily for 4 months. Ten patients, aged 12 to 64 months, were treated with systemic Metronidazole. Treatment lasting at least 3 months at a dose between 20 and 30mg/kg per day was necessary to obtain complete and lasting remission. An early cessation of treatment, before 3 months, seems associated with partial remission of the disease and early recurrence. In cases complicated by ocular keratitis and corneal ulcer, prolonged treatment lasting 6 months led to clinical remission. The short courses (3-6 months) were preferred to long-term administration to prevent neurological toxicity. Maintenance therapy was based on eyelid hygiene. No recurrences and no toxic effects were observed at a median of 48±6 months. CONCLUSION: Childhood ocular rosacea is not rare, but is often misdiagnosed. It often precedes skin symptoms but it can remain isolated. Metronidazole could be alternative treatment for ocular and cutaneous rosacea in the pediatric population. PMID: 21885154 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21885154&dopt=Abstract = URL to article

Wound management in a patient with rhinophyma and basal cell carcinoma. J Am Acad Dermatol. 2011 Jul;65(1):e11-2 Authors: Kwah R, Lawrence C PMID: 21679795 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21679795&dopt=Abstract = URL to article

Malignancies Within Rhinophyma: Report of Three New Cases and Review of the Literature. Aesthetic Plast Surg. 2011 Aug 20; Authors: Lazzeri D, Colizzi L, Licata G, Pagnini D, Proietti A, Alì G, Massei P, Fontanini G, Pantaloni M, Agostini T Abstract BACKGROUND: Rhinophyma, which represents the end stage of rosacea, is characterized by sebaceous hyperplasia, fibrosis follicular plugging, and telangiectasia. Although it is commonly labeled as an aesthetic problem, it may also determine airway obstruction and because of its nature to hide the growth of tumors. Due to the increasing number of reports of nonmelanoma skin types of cancer within rhinophyma, further concern about a higher incidence of malignancies in rhinophyma than in the skin of normal noses is reasonable. METHODS: We describe three male patients who developed malignancies (2 basal and 1 squamous cell carcinoma) associated with rhinophyma disease. The tumors developed over a mean of 23.3 years after primary diagnosis of rhinophyma. One case had a previous history of facial skin tumor. Surgical excision with clear margins allowed resolution in all three patients with a mean follow-up of 34.8 months. CONCLUSIONS: These three new cases and the review of 43 cases reported in the literature call attention to the clinical features of carcinomas arising in the context of rhinophyma, raising further concerns about the possible association between these two entities. The need for histologic examination of all surgically removed tissue in patients with rhinophyma is highlighted. Several macroscopic changes, including ulceration, drainage, and a rapid growth pattern, should alarm the physician and should be considered as suspicious of a malignant degeneration. Unexpected clinical modifications of a preexisting long-lasting silent rhinophyma could indicate the possibility of hidden malignancy rather than a rhinophyma itself. Although evidence of an association between the two entities remains inconclusive, half of the malignancies reported in our review were incidental findings associated with rhinophyma. Thus, since rhinophyma should not be considered solely a cosmetic problem, we recommend that all specimens be reviewed by a pathologist and if malignancy is diagnosed, re-excision with clear margins should be achieved when necessary with periodic follow-up. PMID: 21858597 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21858597&dopt=Abstract = URL to article

Intense Pulsed Light for the Treatment of Rosacea and Telangiectasias. J Cosmet Laser Ther. 2011 Aug 17; Authors: Kassir R, Kolluru A Abstract Abstract Background: Rosacea is a chronic disease that affects the aesthetic appearance of skin. Topical and oral medications have been used to treat the erythema and acneiform papules associated with the disease. However, improvement is only partial, and in severe cases a significant amount of flushing remains. The use of intense pulsed light (IPL) has shown significant clearing in erythema, telangiectasia, and papules in rosacea. We seek parameters for IPL that will achieve optimal reduction in the appearance of rosacea with minimal adverse effects. Objective: To investigate the use of IPL on 102 patients at various parameters (fluence and pulse duration) in the treatment of rosacea. Reduction of redness was assessed by the investigator and photodocumentation. Reductions in flushing and acneiform breakouts were assessed by the patient. Methods: 102 patients with mild to severe rosacea were treated with intense pulsed light (IPL) treatment using the NaturaLight IPL system (Focus Medical, Bethel, CT). Patients received treatments at 1-3 week intervals, with an average of 7.2 treatments. The Reveal Imager (Canfield Scientific, Fairfield, NJ) was used for photodocumentation and analyses. Results: Treatments were given at 2.5/5 milliseconds double, triple, or quadruple pulsed with 20-30 milliseconds delay time. A 530 nm filter was used with fluences varying from 10-30 J/cm2, or 10-20 J/cm2 with a 420 nm filter for those patients with acneiform breakouts in addition to telangiectasias. 80% of patients had reduction in redness, 78% of patients reported reduced flushing and improved skin texture, and 72% noted fewer acneiform breakouts. There were no complications or adverse effects. Conclusion: The use of intense pulsed light at specified parameters provides optimal therapy for the treatment of rosacea. PMID: 21848421 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21848421&dopt=Abstract = URL to article

Nare obstruction due to massive rhinophyma treated using the Shaw scalpel. Dermatol Surg. 2011 Jun;37(6):876-9 Authors: Seiverling EV, Neuhaus IM PMID: 21605256 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21605256&dopt=Abstract = URL to article

Metophyma: case report and review of a rare phyma variant. Dermatol Surg. 2011 Jun;37(6):867-9 Authors: Chan JL, Soliman S, Miner AG, Hughes SM, Cockerell CJ, Perone JB PMID: 21605253 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21605253&dopt=Abstract = URL to article

Prevalence analysis of smoking in rosacea. J Eur Acad Dermatol Venereol. 2011 Sep;25(9):1112-3 Authors: Breton AL, Truchetet F, Véran Y, Doumat-Batch F, Baumann C, Barbaud A, Schmutz JL, Bursztejn AC PMID: 21812830 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21812830&dopt=Abstract = URL to article

Vasoactive properties of calcitonin gene-related peptide in human skin. Int Angiol. 2011 Oct;30(5):424-8 Authors: Dias M, Newton D, McLeod G, Belch JJ, Khan F Calcitonin gene-related peptide (CGRP) is a potential mediator of neurogenic inflammation in eczema, psoriasis and rosacea, and also contributes to vasodilatation and oedema in complex regional pain disorder. We investigated the feasibility of administering CGRP and its antagonist CGRP8-37 by iontophoresis in human skin to characterise their vasoactive profiles. PMID: 21804480 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21804480&dopt=Abstract = URL to article

Radiosurgical excision of rhinophyma. Dermatol Surg. 2011 May;37(5):684-7 Authors: Somogyvári K, Battyáni Z, Móricz P, Gerlinger I PMID: 21457393 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21457393&dopt=Abstract = URL to article

Importance of vehicles in acne therapy. J Drugs Dermatol. 2011 Jun 1;10(6):s17-23 Authors: Kircik LH Topiucal drug therapy is an intuitively sound approach to the management of skin diseases. Depositing medication at the site of disease involvement is potentially effective and reduces systemic exposure. Topical drugs are absorbed usually by passive diffusion. In clinical practice, the choice of an optimized formulation that will be effective and well tolerated is essential. Data confirm that patient adherence with therapy leads to better outcomes and lower long-term treatment costs, while poor adherence is directly linked to poor treatment outcomes and and patient dissatisfaction. Local cutaneous irritation, which may be linked to components of the formulation and/or to the active drug itself, is a common cause of non-adherence. Well-designed drugs are important in the management of acne vulgaris and acne rosacea. Formulators have sought to improve treatment efficacy and tolerability by several different techniques, such as delayed release of the active drug, fixed combinations of two different molecules, or incorporating ingredients into the formulation vehicle that improve epidermal barrier function and offset the irritating effects of the active drugs. PMID: 21780342 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21780342&dopt=Abstract = URL to article

Rhinophyma: big problem, simple solution. Acta Derm Venereol. 2011 Mar;91(2):188-9 Authors: Rørdam OM, Guldbakke K PMID: 21103850 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21103850&dopt=Abstract = URL to article

Carvedilol for the Treatment of Refractory Facial Flushing and Persistent Erythema of Rosacea. Arch Dermatol. 2011 Jul 18; Authors: Hsu CC, Lee JY PMID: 21768447 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21768447&dopt=Abstract = URL to article

Treatment of recalcitrant granulomatous rosacea with ALA-PDT: Report of a case. Indian J Dermatol Venereol Leprol. 2011 Jul-Aug;77(4):536 Authors: Baglieri F, Scuderi G PMID: 21727720 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21727720&dopt=Abstract = URL to article

Evaluation of mechanical and rheological properties of metronidazole gel as local delivery system. Arch Pharm Res. 2011 Jun;34(6):931-40 Authors: Jelvehgari M, Montazam H Rosacea is a chronic multifactorial vascular skin disorder that affects about 10 percent of the general population. Metronidazole is an effective antibiotic in the treatment of moderate-tosevere rosacea. Metronidazole is a suitable drug in cases of resistance to tetracycline or erythromycin, but it has also been shown that oral metronidazole may increase the side effects (e.g., peripheral neuropathy). Oral metronidazole should not be used for more than three months, and hence topical metronidazole gel is the best therapeutic choice in rosacea (especially during pregnancy). This study examined the mechanical (adhesiveness, cohesiveness, extrudability, spreadability, homogeneity) and rheological (viscosity), skin irritant and drug release properties of different metronidazole gel formulations that contain anionic emulsifying wax, glycerin and lactic acid in different proportions. The release studies were conducted using Franz diffusion cells and Silastic membrane as a barrier. The results indicated that gel compressibility, hardness, and adhesiveness, are the factors that influence the ease of gel removal from the container, ease of gel application onto the mucosal membrane, and gel bioadhesion. The findings showed that there exists a strong negative correlation between the spreadability of a formulation and its cohesiveness, the spreadability of a formulation is inversely proportional to its cohesiveness. However, sorbitol solution (70%) concentration was not significantly correlated with drug release. In addition, drug release was significantly reduced as the concentration of anionic emulsifying wax increased and the concentration of lactic acid decreased. The maximum metronidazole release was achieved at a pH of 4-6. Data obtained from in vitro release studies were fitted to various kinetic models and high correlation was obtained in the Higuchi and first order models. The results showed that all the gel formulations showed good extrudability, viscosity, cohesiveness, homogeneity and spreadability. PMID: 21725814 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21725814&dopt=Abstract = URL to article

Risk factors and prevalence of Demodex mites in young adults. Acta Microbiol Immunol Hung. 2011 Jun;58(2):145-55 Authors: Horváth A, Neubrandt DM, Ghidán A, Nagy K Demodex mites are ectoparasites often found in follicles of facial skin. Their role in human diseases is under investigation, and a growing number of studies indicated that they contribute to chronic inflammatory conditions of the skin, such as rosacea, blepharitis, otitis externa, alopecia and folliculitis. In our study we tested 96 healthy adults for the presence of Demodex mites. Risk factors influencing presence of mites and skin types of the tested individuals were evaluated. We found Demodex folliculorum or Demodex brevis in 17.7% of the samples, more frequently in males (21.9%) and in older adults (20%). Use of make-up seems to reduce the likelihood of Demodex carriage, while pet ownership, use of shared items and living in close contact with older adults had no significant influence of presence of mites. Demodex positive individuals described their skin to be drier, more prone to erythema, but less for folliculitis compared to Demodex negative subjects. PMID: 21715284 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21715284&dopt=Abstract = URL to article

Rosacea fulminans in pregnancy: successful treatment with azithromycin. Clin Exp Dermatol. 2011 Jun 30; Authors: Fuentelsaz V, Ara M, Corredera C, Lezcano V, Juberias P, Carapeto FJ PMID: 21714808 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21714808&dopt=Abstract = URL to article

The appearance of facial foundation cosmetics applied after metronidazole gel 1%. Cutis. 2011 May;87(5):251-9 Authors: Draelos ZD, Colón LE, Preston N, Johnson LA, Gottschalk RW The purpose of this study was to assess the cosmetic appearance of commonly marketed facial cosmetics when used after the application of metronidazole gel 1%. An observational. open-label, single-site study was conducted with women (N=30) aged 20 to 75 years and diagnosed with moderate papulopustular rosacea (investigator global severity score of 3). After cleansing the face with a gentle skin cleanser, participants applied metronidazole gel 1% once daily before applying their usual facial foundation. Two surveys were conducted: (1) investigator assessment of cosmetic appearance; and (2) participant assessment of cosmetic appearance. The investigator also evaluated erythema, disease severity, and tolerability at baseline and week 2. Adverse events were collected. The 28 per-protocol (PP) participants had a mean age (standard deviation [sD]) of 54.0 (10.3) years and a mean duration (SD) of rosacea of 15.4 (13.2) years. The median response score for both the investigator and participant assessments of cosmetic appearance was 10 (best) for each survey question. Signs and symptoms of rosacea did not increase with use of metronidazole gel 1% and the participants' selected cosmetic regimen. At baseline all 28 participants were classified as having moderate erythema. At week 2, 18 (64%) participants were classified as having moderate erythema and 10 (36%) mild. At baseline all 28 (100%) participants were classified as having moderate rosacea according to the investigator global severity score. At week 2, 10 (36%) participants were classified as mild and 18 (64%) moderate. In addition, few participants reported cutaneous irritation during the study. At week 2, 10 participants had dryness, 2 had itching, 8 had scaling, and 2 had stinging/burning. According to surveys completed by the investigator and the participants themselves, most participants had a good cosmetic appearance with their facial foundation cosmetics that were applied after metronidazole gel 1%. The use of various cosmetic regimens after application of metronidazole gel 1% did not cause rosacea symptoms to worsen and treatment was well-tolerated. PMID: 21699130 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21699130&dopt=Abstract = URL to article

Blushing Propensity and Psychological Distress in People with Rosacea. Clin Psychol Psychother. 2011 Jun 23; Authors: Su D, Drummond PD Rosacea is a chronic skin disorder, characterized by persistent painful facial flushing and often accompanied by papules and pustules. To evaluate the psychological and social impacts of rosacea, 31 individuals with rosacea filled in the Blushing Propensity Scale, the Fear of Negative Evaluation Questionnaire, the Depression Anxiety and Stress Scale, the Social Interaction Anxiety Scale and the Social Phobia Scale. The questionnaires were also completed by 86 controls. Participants with extensive facial papules and pustules had higher blushing propensity, stress and social phobia scores than controls or others without papules or pustules. Childhood blushing was also reported more frequently by participants with rosacea than controls. Cognitive-behavioural therapy appeared to be helpful for managing social anxiety in three individuals with rosacea with a fear of blushing. These findings suggest that people with severe rosacea are anxious about the social consequences of blushing and generally prefer to avoid situations that might involve scrutiny by others. Persistent facial flushing could prime interoceptive cues of blushing or increase anxiety about facial coloration in provocative situations. Treatments that target fear of blushing may help to reduce social anxiety in people with severe rosacea. Copyright © 2011 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Blushing propensity scores are elevated in people with severe rosacea. Fear of blushing may contribute to social anxiety and avoidance in such cases. Cognitive-behavioural therapy for fear of blushing may help to reduce social anxiety in people with severe rosacea. PMID: 21698719 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21698719&dopt=Abstract = URL to article

Microbial Symbiosis with the Innate Immune Defense System of the Skin. J Invest Dermatol. 2011 Jun 23; Authors: Gallo RL, Nakatsuji T Skin protects itself against infection through a variety of mechanisms. Antimicrobial peptides (AMPs) are major contributors to cutaneous innate immunity, and this system, combined with the unique ionic, lipid, and physical barrier of the epidermis, is the first-line defense against invading pathogens. However, recent studies have revealed that our skin's innate immune system is not solely of human origin. Staphylococcus epidermidis, a major constituent of the normal microflora on healthy human skin, acts as a barrier against colonization of potentially pathogenic microbes and against overgrowth of already present opportunistic pathogens. Our resident commensal microbes produce their own AMPs, act to enhance the normal production of AMPs by keratinocytes, and are beneficial to maintaining inflammatory homeostasis by suppressing excess cytokine release after minor epidermal injury. These observations indicate that the normal human skin microflora protects skin by various modes of action, a conclusion supported by many lines of evidence associating diseases such as acne, atopic dermatitis, psoriasis, and rosacea with an imbalance of the microflora even in the absence of classical infection. This review highlights recent observations on the importance of innate immune systems and the relationship with the normal skin microflora to maintain healthy skin.Journal of Investigative Dermatology advance online publication, 23 June 2011; doi:10.1038/jid.2011.182. PMID: 21697881 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21697881&dopt=Abstract = URL to article

Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review. Br J Dermatol. 2011 Jun 21; Authors: van Zuuren EJ, Kramer SF, Carter BR, Graber MA, Fedorowicz Z Background:  Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. Objective:  To assess the evidence for the efficacy and safety of treatments for rosacea. Methods:  Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Results:  Fifty-eight trials, including 27 from the original review, comprising 6,633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40 mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40 mg and 100 mg and with evidence of less adverse effects. One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Conclusions:  Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required. PMID: 21692773 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21692773&dopt=Abstract = URL to article

[Antibiotic therapy in skin diseases]. Pol Merkur Lekarski. 2011 May;30(179):367-72 Authors: Owczarek W, Wydrzyńska A, Paluchowska E Antibiotics are used for systemic and topical skin diseases treatment, taking advantage of their antiseptic, bacteriostatic and also their anti-inflammatory and immunomodulating properties. In case of localized external skin layers infections, a topical treatment is adequate. In case of widespread and deeper infections a systemic treatment is needed. The latter dermatological diseases are mostly treated by beta-lactam antibiotics (penicillins and cefalosporins) macrolides and tetracycline. In topical treatment mostly erythromycin, clindamycin, mupirocyne and fusidic acid are used. Most common bacterial skin diseases, where topical treatment is sufficient are: impetigo contagiosa, folliculitis and erythrasma. Systemic treatment is required in case of: severe staphylococcal and streptococcal infections, sexually transmitted diseases, secondary bacterial infections (i.e. associated to severe AD or lower leg arterial and venous ulceration), acne vulgaris, rosacea and dermatosis with bacterial antigens pathogenesis influence (i.e. psoriasis, guttate parapsoriasis and angitis). Antibiotic resistance is one of the most worrying problems during the treatment; this is why a targeted therapy, with results guarantee, is mostly appropriate. PMID: 21675145 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21675145&dopt=Abstract = URL to article

Treatment of ocular rosacea with 40 mg doxycycline in a slow release form. J Dtsch Dermatol Ges. 2011 Jun 15; Authors: Pfeffer I, Borelli C, Zierhut M, Schaller M Background: About 30-50 % of rosacea patients have ocular involvement. The symptoms range from a foreign-body sensation to conjunctivitis or blepharitis and may even include severe corneal ulcerations. Systemic treatment is generally with tetracycline. Side effects can occur with the usual antimicrobial dose. Patients and Methods: In a retrospective study, seven patients were evaluated who had been treated for ocular rosacea with a sub-antimicrobial dose of doxycycline 40 mg in a slow-release form (Oraycea(®) ). The responses were evaluated on the basis of clinical findings. Results: Seven patients with an average age of 63 took slow release doxycycline 40 mg every day for at least two months. In five patients, other systemic drugs had already failed. All patients experienced a clear improvement in their ocular rosacea after an average of 2.29 months of treatment. One patient had complete clearance and another had almost complete clearance. None of the patients experienced side effects. Conclusions: A sub-antimicrobial dose of slow release doxycycline 40 mg daily is an effective long-term therapy for ocular rosacea. It is not associated with the side effects of long-term antibiotic therapy or the risk of resistance. PMID: 21672164 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21672164&dopt=Abstract = URL to article

Bilateral comparison study of pimecrolimus cream 1% and a ceramide-hyaluronic Acid emollient foam in the treatment of patients with atopic dermatitis. J Drugs Dermatol. 2011 Jun 1;10(6):666-72 Authors: Frankel A, Sohn A, Patel RV, Lebwohl M Topical corticosteroids have been the mainstay of treatment for atopic dermatitis (AD) over the last decade, especially in the setting of acute flares. However, heavy and prolonged use of topical corticosteroid is undesirable as it is associated with side effects such as, skin atrophy, telangiectasia, striae, steroid-induced dermatoses, rosacea, acne exacerbation, and in some severe and rare cases, systemic effects such as hypothalamic-pituitary-adrenal axis suppression, growth retardation and ocular problems. Non-steroidal ant-inflammatory agents specific for the treatment of AD (topical calcineurin inhibitors, or TCIs) are now available and they are a viable alternative to topical corticosteroids in treating dermatitis of the face, neck, eyelids, and intertriginous areas where there is a greater risk of the steroid-induced side effects. More recently, medical device emollients have entered the marketplace. These medical devices provide, but are not limited to, anti-oxidant, anti-protease, anti-inflammatory activity, and aid in restoring the natural balance of lipids, which is one of the causes of the epidermal abnormalities seen with AD. The present study evaluated the short-term effectiveness and appeal of a non-steroidal medicated device foam as compared to pimecrolimus cream 1% in the treatment of AD within a wide age group of subjects with active disease at baseline. In this study, both pimecrolimus and the medical device foam exhibited efficacy in mild-to-moderate AD. Primary efficacy was measured by IGA. After four weeks of treatment with the medical device foam, 82% of target lesions were scored "clear" (0) or "almost clear" (1) compared to 71% of target lesions under the pimecrolimus arm. This study confirmed that pimecrolimus cream 1% and the medical device foam work well in the treatment of AD in both adults and children with no associated adverse effects. J Drugs Dermatol. 2011;10(6):666-672. PMID: 21637908 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=21637908&dopt=Abstract = URL to article