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Acta Med Port. 2023 Jun 28. doi: 10.20344/amp.19904. Online ahead of print. NO ABSTRACT PMID:37381776 | DOI:10.20344/amp.19904 {url} = URL to article

Eye Contact Lens. 2023 Jun 26. doi: 10.1097/ICL.0000000000001008. Online ahead of print. ABSTRACT PURPOSE: Investigation of the relationship between blepharitis-related symptom scores, tear film functions, and conjunctival microbiota in patients with ocular rosacea (OR) compared with healthy controls was aimed. METHODS: Consecutive 33 eyes of 33 patients with OR who were admitted from the dermatology clinic and age-matched and gender-matched 30 healthy controls were included in the study. Tear breakup time (TBUT), Schirmer score, and blepharitis symptom score (BLISS) were recorded for each patient. For the bacteriological examination, bacterial culture was obtained by inoculating the samples on chocolate agar, blood agar, and fluid thioglycollate medium. The growth of different colonies of bacteria was identified using matrix-assisted laser desorption or ionization time-of-flight mass spectrometry. RESULTS: Bacterial culture positivity was observed in 13 eyes (39.4%) in the patients with OR and 10 eyes (33.3%) in the controls (P=0.618). Patients with OR showed worse TBUT and Schirmer scores, and higher BLISSs (P=0.005, P=0.007, and P=0.001, respectively). Patients with OR with conjunctival culture-positive results showed higher BLISSs (8.0±4.7) compared with those with negative results (4.7±2.3; P<0.001). The most frequent bacteria was Micrococcus luteus (18.2%) in patients with OR and Staphylococcus epidermidis (20.0%) in the controls. CONCLUSION: This pilot study showed that patients with OR had similar conjunctival culture positivity compared with healthy controls. However, the observation of different dominant bacterial species in conjunctival microbiota and the observation of worse BLISSs in patients with OR with positive culture might suggest a potential role of conjunctival microbiota in the pathogenesis of OR. PMID:37363964 | DOI:10.1097/ICL.0000000000001008 {url} = URL to article

J Am Acad Dermatol. 2023 Jun 23:S0190-9622(23)01181-7. doi: 10.1016/j.jaad.2023.06.027. Online ahead of print. ABSTRACT BACKGROUND: 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) showed potential to treat rosacea according to recent studies, but a lack of clinical evidence and unclear adverse effects limit its use. OBJECTIVE: To compare the effect of ALA-PDT versus minocycline for rosacea. METHODS: In this single-center, randomized, evaluator-blind, controlled study, patients with moderate to severe rosacea were allocated to receive 3 to 5 sessions of ALA-PDT or 8 weeks of 100 mg daily minocycline treatment, followed by a 24-week follow-up. RESULTS: Of all the 44 randomized patients, 41 received complete treatment (ALA-PDT 20, Minocycline 21). At the end of treatment, ALA-PDT showed non-inferior improvement of papulopustular lesions and Rosacea-related Quality of Life (RosaQoL) compared to minocycline (median reduction of lesion count: 19 vs. 22, median change of RosaQoL score: 0.48 vs. 0.53). The Clinician's Erythema Assessment (CEA) success of ALA-PDT was lower than minocycline's (35% vs. 67%). Demodex density and relapse rate were comparable in both groups. Erythema, mild pain and exudation were the most common adverse reactions of ALA-PDT. LIMITATIONS: Limited sample size restricted us from drawing further conclusions. CONCLUSION: As minocycline does, ALA-PDT can improve rosacea mainly in papulopustular lesions and patients' quality of life, indicating a new option for rosacea. PMID:37356626 | DOI:10.1016/j.jaad.2023.06.027 {url} = URL to article

Acta Derm Venereol. 2023 Jun 22;103:adv6485. doi: 10.2340/actadv.v103.6485. ABSTRACT Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions. PMID:37345973 | PMC:PMC10296546 | DOI:10.2340/actadv.v103.6485 {url} = URL to article

Dermatol Ther (Heidelb). 2023 Jun 20. doi: 10.1007/s13555-023-00964-6. Online ahead of print. ABSTRACT INTRODUCTION: Rosacea and inflammatory bowel disease (IBD) are chronic inflammatory disorders of the skin and the gut, which are interfaces between the environment and the human body. Although growing evidence has implicated a possible link between rosacea and IBD, it remains unclear whether IBD increases the risk of rosacea and vice versa. Therefore, we investigated the association between rosacea and IBD in this study. METHODS: We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RESULTS: Eight eligible studies were included in this meta-analysis. Overall, the prevalence of rosacea was higher in the IBD group than in the control group, with a pooled odds ratio (OR) of 1.86 (95% confidence interval [CI](1), 1.52-2.26). Both the Crohn's disease and the ulcerative colitis groups had higher prevalences of rosacea than the control group, with ORs of 1.74 (95% CI 1.34-2.28) and 2.00 (95% CI 1.63-2.45), respectively. Compared with those in the control group, the risks of IBD, Crohn's disease, and ulcerative colitis were significantly higher in the rosacea group, with incidence rate ratios of 1.37 (95% CI 1.22-1.53), 1.60 (95% CI 1.33-1.92), and 1.26 (95% CI 1.09-1.45), respectively. CONCLUSION: Our meta-analysis suggests that IBD is bidirectionally associated with rosacea. Future interdisciplinary studies are needed to better understand the mechanism of interaction between rosacea and IBD . PMID:37338720 | DOI:10.1007/s13555-023-00964-6 {url} = URL to article

Proc (Bayl Univ Med Cent). 2023 May 15;36(4):458-460. doi: 10.1080/08998280.2023.2210964. eCollection 2023. ABSTRACT Idiopathic facial aseptic granuloma (IFG) is a benign condition that typically presents as asymptomatic nodules on the cheeks of pediatric patients. The underlying etiology of IFG remains unknown; however, increasing evidence supports the theory that IFG may lie on a spectrum with childhood rosacea. Typically, biopsy and excision are deferred due to the benign nature, high spontaneous resolution rates, and cosmetically sensitive location. As biopsy is infrequently used to diagnose IFG, a limited library of histopathologic findings exists to characterize the lesions. We present a single-center retrospective review of five cases of IFG diagnosed by histology after surgical excision. PMID:37334085 | PMC:PMC10269409 | DOI:10.1080/08998280.2023.2210964 {url} = URL to article

Front Immunol. 2023 Jun 2;14:1160779. doi: 10.3389/fimmu.2023.1160779. eCollection 2023. ABSTRACT INTRODUCTION: Localized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers. METHODS: We hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology. RESULTS: During follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors. CONCLUSION: LBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases. PMID:37334352 | PMC:PMC10272756 | DOI:10.3389/fimmu.2023.1160779 {url} = URL to article

Photodiagnosis Photodyn Ther. 2023 Jun 17:103657. doi: 10.1016/j.pdpdt.2023.103657. Online ahead of print. ABSTRACT BACKGROUND: To investigate retinal and optic disc (OD) microvascular morphological changes in erythemato-telangiectatic rosacea (ETR) patients using optical coherence tomography angiography (OCTA), and compare the findings to age- and gender-matched healthy individuals METHODS: This study included newly diagnosed 31 ETR patients (31 right eyes, group 1) who were clinically diagnosed by two experienced dermatologists. A control group had 32 healthy individuals (32 right eyes, group 2). Demographic data, including age and gender were collected, followed by a thorough ophthalmologic exam. A 6 × 6 mm macular OCTA analysis of superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), as well as foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), foveal VDs 300 µm area around FAZ (FD-300), and flow areas in the outer retinal and choriocapillaris, was then performed. RESULTS: Mean age in groups 1 and 2 was 43.70±13.02 and 43.62±12.30 years, respectively (p=0.979). Male-to-female ratio in group 1 was 4:27 and 4:28 in group 2. Capillary flow analysis revealed slightly higher values in group 1 than in group 2, with the former having a significantly higher select area in the outer retinal layer (p=0.001) and flow area in the choriocapillaris (p=0.002). Despite slightly higher values in group 1, there were no significant differences in SCP and DCP VDs (p>0.05), FAZ area (p=0.471), PERIM (p=0.778), or FD-300 (p=0.527) CONCLUSIONS: ETR appears to be associated with posterior segment changes, especially retinal microvascular morphology, even in asymptomatic ocular conditions. Given the disease's high rate of misdiagnosis, understanding rosacea-induced ocular manifestations is critical for ophthalmologists. PMID:37336467 | DOI:10.1016/j.pdpdt.2023.103657 {url} = URL to article

Indian J Dermatol Venereol Leprol. 2023 Apr 1:1-3. doi: 10.25259/IJDVL_215_2022. Online ahead of print. NO ABSTRACT PMID:37317773 | DOI:10.25259/IJDVL_215_2022 {url} = URL to article

J Cosmet Dermatol. 2023 Jun;22 Suppl 2:8-15. doi: 10.1111/jocd.15772. ABSTRACT OBJECTIVE: Different devices are currently used for treating facial vascular lesions (FVL). This paper presents the aesthetic outcomes using different light-based and laser devices, including narrow band spectrum intense pulsed-light dye (NB-Dye-VL), Pulsed dye laser (PDL)-neodymium-doped yttrium-aluminum-garnet (Nd:YAG) dual-therapy, and either PDL or LP Nd:YAG for treating FVL in a clinical setting. METHODS: A retrospective and single-center study conducted on subjects ≥18 years with FVL. Patients underwent treatment with either PDL + LP Nd:YAG dual-therapy, NB-Dye-VL, PDL, or LP Nd:YAG, according to the patient and lesion characteristics. The primary outcome was the weighted degree of satisfaction. RESULTS: The cohort consisted of fourteen patients, nine women (64.3%) and five men (35.7%). The most prevalent FVL types treated were rosacea (28.6%; 4/14) and spider hemangioma (21.4%; 3/14). Seven patients underwent PDL + Nd:YAG (50.0%), three were treated with NB-Dye-VL (21.4%), and PDL or LP Nd:YAG was performed in two patients each (14.3%). Eleven patients rated their treatment outcome as excellent (78.6%), and three as very good (21.4%). Practitioners 1 and 2 classified treatment results as excellent in eight cases (57.1%) each. No serious or permanent adverse events were reported. Two (14.3%) patients, one treated with PDL and the other with PDL + LP Nd:YAG dual-therapy, had post-treatment purpura, which was successfully resolved with topical treatment after 5 and 7 days, respectively. CONCLUSIONS: NB-Dye-VL and the PDL + LP Nd:YAG dual-therapy devices achieve excellent aesthetic outcomes for treating a wide range of FVL. PMID:37318787 | DOI:10.1111/jocd.15772 {url} = URL to article

Clin Cosmet Investig Dermatol. 2023 Jun 5;16:1419-1430. doi: 10.2147/CCID.S412800. eCollection 2023. ABSTRACT Rosacea is a chronic inflammatory facial skin disease usually occurring in middle-aged patients. It manifests itself as an inflammatory condition with perivascular infiltrate, dilated blood vessels, lymphoedema, hyperplasia of sebaceous glands, and disorders of connective tissue structures brought on by fibrosis. Rosacea is characterized by multifactorial inflammatory mechanisms, and therefore it requires an interdisciplinary approach including adequate skin care, topical and/or systemic therapy, and physical modalities to successfully treat the various symptoms and disease subtypes. However, data regarding the possible role of cosmetologists in rosacea remains scanty and equivocal. The objectives of cosmetology therapy include restoration and regeneration, anti-inflammatory effects, the strengthening of blood vessels and regulation of their permeability, and the regulation of keratinization. Vascular abnormalities can be targeted with specific light and laser devices. Therefore, the present paper aims to review the latest advances and summarize different aspects concerning skin care in rosacea. Particular attention has been paid to the co-operation of cosmetologists with other specialists in order to bring about the interdisciplinary management of rosacea. It is also important to keep in mind that it is usually necessary to combine various methods of treatment, as this approach is more effective than monotherapy for attaining satisfactory cosmetic results in rosacea patients. PMID:37303984 | PMC:PMC10252991 | DOI:10.2147/CCID.S412800 {url} = URL to article

J Clin Med. 2023 May 30;12(11):3759. doi: 10.3390/jcm12113759. ABSTRACT Rosacea is a chronic inflammatory skin disorder associated with various ocular manifestations. However, little is known about the association between rosacea and glaucoma. This study aimed to determine the risk of glaucoma in patients with rosacea. This nationwide population-based retrospective cohort study enrolled 1056 individuals with rosacea and 10,440 age- and sex-matched controls without rosacea from the Korean National Health Insurance System (NHIS) database from 2002 to 2015. The incidence rate of glaucoma was 1215.4 per 100,000 person-years (PYs) in patients with rosacea and 741.3 per 100,000 PYs in patients without rosacea. A significantly higher cumulative incidence probability of glaucoma was observed in patients with rosacea than in non-rosacea controls (p = 0.0004). Rosacea was associated with an increased risk of developing glaucoma (adjusted hazard ratio [aHR], 1.659; 95% confidence interval [CI], 1.245-2.211) compared to those without rosacea. In subgroup analysis, increased risk of glaucoma was observed in patients with rosacea younger than 50 years (aHR, 1.943; 95% CI, 1.305-2.893), females (aHR, 1.871; 95% CI, 1.324-2.644), and patients with hypertension (aHR, 1.561; 95% CI, 1.037-2.351) compared to those without rosacea. Rosacea is associated with an increased risk of developing glaucoma. Proper screening for glaucoma should be conducted in rosacea patients younger than 50 years, females, and patients with hypertension to better control the disease and prevent vision loss from glaucoma. PMID:37297954 | PMC:PMC10253517 | DOI:10.3390/jcm12113759 {url} = URL to article

Cureus. 2023 May 6;15(5):e38640. doi: 10.7759/cureus.38640. eCollection 2023 May. ABSTRACT Minocycline is an antibiotic used for several dermatologic conditions, including rosacea. The development of skin, scleral, and nail hyperpigmentation may occur with long-term use of minocycline, and this is associated with no adverse effect on function. We present a case of a 66-year-old male who developed blue-gray hyperpigmentation of his nail beds after treating rosacea with systemic minocycline for over 20 years. The remainder of the physical exam was unremarkable for hyperpigmentation elsewhere. The patient was informed that this was likely an adverse effect of his chronic minocycline use. He insisted upon the continuation of minocycline, so he was counseled on the adverse effects of the medication and scheduled for follow-up. PMID:37288172 | PMC:PMC10243409 | DOI:10.7759/cureus.38640 {url} = URL to article

J Clin Aesthet Dermatol. 2023 May;16(5):26-34. ABSTRACT OBJECTIVE: Topical therapies remain the mainstay in treating patients with acne and rosacea. However, emerging real-world evidence demonstrates that desired treatment outcomes might not be achieved if patient satisfaction and adherence are low. Poor tolerability of active drug(s) and vehicle components and/or the drug delivery system could negatively influence adherence. Additionally, adherence might be lower with complex treatment regimens involving the application of multiple topical formulations. Optimizing vehicle tolerability and simplifying regimens that use fixed-dose combinations may improve treatment outcomes, better patient satisfaction, and reduce overall treatment costs. This qualitative review discusses several innovative drug delivery technologies and formulations aimed at improving patient satisfaction and adherence. METHODS: The authors conducted a search of current and emerging topical drug delivery technologies used in clinical studies, reviewed primary literature on the chemical characteristics of topical dosage forms, and compared the impacts on treatment outcomes for acne and rosacea. RESULTS: This article provides insight into innovative vehicles and drug delivery systems that have emerged allowing for fixed-dose combinations of incompatible active drugs and improving the tolerability of historically irritative active ingredients. LIMITATIONS: Further research is needed to fully highlight the impact of patient satisfaction and modern topical formulations on adherence and treatment outcomes. CONCLUSION: Drug microencapsulation is a delivery technology that has enabled development of a topical fixed-dose combination of benzoyl peroxide and tretinoin preventing the oxidation of tretinoin by benzoyl peroxide and improving the tolerability of the active ingredients. PMID:37288283 | PMC:PMC10243731 {url} = URL to article

Patient Prefer Adherence. 2023 Jun 1;17:1335-1345. doi: 10.2147/PPA.S378724. eCollection 2023. ABSTRACT INTRODUCTION: Evaluation of patient-reported outcomes including health-related quality of life (HRQoL) and perceived benefits from treatment has become a fundamental component of medical decision-making. Standardized evaluation of treatment benefits in rosacea based on patient preferences is still lacking. OBJECTIVE: Development and validation of an instrument for recording patient-defined benefits in rosacea therapy based on the Patient Benefit Index (PBI) methodology. PATIENTS AND METHODS: In an open survey of n = 50 patients, potential benefits of therapy from the patient's perspective were examined. The generated item pool was combined with pre-existing PBI items for other skin conditions and reviewed by an expert panel of dermatologists, psychologists and patients. Items were condensed to n = 25 and converted into a Likert-scaled questionnaire. The validity and feasibility of the resulting Patient Benefit Index for rosacea (PBI-RO) were tested on individuals with rosacea recruited from a German rosacea patient organization. RESULTS: N = 446 patients with rosacea completed the PBI-RO. The internal consistencies measured by Cronbach's alpha were high (Patient Needs Questionnaire [PNQ] 0.94). Mean PBI-RO was 1.9 ± 1.2 (scale from 0 = no benefit to 4 = maximum benefit), 23.5% of the patients experienced a PBI-RO < 1 (no clinically relevant benefit). The PBI-RO correlated with HRQoL, health state, current extent of rosacea lesions and treatment satisfaction. The highest correlation was found between PBI-RO and satisfaction with previous treatment (r = -0.59, p < 0.001); correlation with the extent of rosacea lesions was low (r = 0.16, p < 0.001). CONCLUSION: The PBI-RO shows satisfying internal consistency and construct validity. It offers the option of a patient-weighted evaluation of the therapeutic benefit of rosacea therapy and may add to more stringent goal orientation in therapy. PMID:37284248 | PMC:PMC10241185 | DOI:10.2147/PPA.S378724 {url} = URL to article

Eye Contact Lens. 2023 Jun 2. doi: 10.1097/ICL.0000000000001003. Online ahead of print. ABSTRACT Demodex blepharitis is a common disease of the eyelid, affecting approximately 25 million Americans. This article reviews what is known about the mechanisms and impact of Demodex blepharitis, risk factors, signs and symptoms, diagnostic techniques, current management options, and emerging treatments. Demodex mites contribute to blepharitis in several ways: direct mechanical damage, as a vector for bacteria, and by inducing hypersensitivity and inflammation. Risk factors for Demodex blepharitis include increasing age, rosacea, and diabetes. The costs, symptom burden, and psychosocial effects of Demodex blepharitis are considerable. The presence of collarettes is pathognomonic for Demodex blepharitis. Redness, dryness, discomfort, foreign body sensation, lash anomalies, and itching are also hallmarks of the disease. Although a number of oral, topical, eyelid hygiene and device-based options have been used clinically and evaluated in studies for the management of Demodex blepharitis, none have been FDA approved to treat the disease. Recent randomized controlled clinical trials suggest that lotilaner ophthalmic solution, 0.25%, is a topical treatment with the potential to eradicate Demodex mites and eliminate collarettes and eyelid redness for an extended period. PMID:37272680 | DOI:10.1097/ICL.0000000000001003 {url} = URL to article

ACS Omega. 2023 May 19;8(21):18714-18725. doi: 10.1021/acsomega.3c00638. eCollection 2023 May 30. ABSTRACT The barrier functionalities of the skin offer a major but not insuperable hindrance for fabrication of skin delivery effective systems. This work aimed to develop an optimized lipid polymer hybrid nanoparticle and assess the skin delivery effectiveness of hydrocortisone (9.872 ± 0.361 × 10-3 cm2/h) of a drug through the skin from an optimized formulation when compared with a drug solution. Meanwhile, histological examination after topical application of the optimized formulation showed a safe increase in epidermal thickness. In vivo, the optimized formulation showed promising anti-inflammatory activity in a croton oil-induced ear rosacea model. As an excellent anti-inflammatory agent, these findings propose that the use of lipomers could be a promising strategy to improve the topical effectiveness of hydrocortisone acetate (HCA) against inflammatory diseases. Collectively, these results support our view that lipid polymer hybrid nanoparticles can proficiently deliver hydrocortisone to the skin in treating skin inflammatory conditions. PMID:37273643 | PMC:PMC10233847 | DOI:10.1021/acsomega.3c00638 {url} = URL to article

Clin Cosmet Investig Dermatol. 2023 May 29;16:1363-1371. doi: 10.2147/CCID.S413237. eCollection 2023. ABSTRACT Rosacea is a common chronic inflammatory skin disease with a complex etiology and undefined pathogenesis, and there is still a lack of targeted clinical treatment. Patients with rosacea are at a higher risk of anxiety and depression compared to the healthy population. Compared to skin conditions such as acne and psoriasis, rosacea has been much less studied in relation to multiple-etiology psychiatric disorders such as anxiety and depression. In contrast to the mainstream belief that the causal association between rosacea and psychiatric disorders is that rosacea increases the psychological burden of patients and thus triggers psychiatric disorders simply by altering their facial appearance, this review outlines the possible common mechanisms between rosacea and anxiety and depression disorders, starting from the pathophysiological mechanisms of transient receptor potential family cation channels, HPA axis, and Th1/Th17 cell polarization. It envisages the possibility of the neuroendocrine-immune interplay between rosacea and anxiety and depression, and new ideas on the complex causal relationship between rosacea and psychiatric disorders, offering more orientations to open up new therapeutic approaches for rosacea. PMID:37275216 | PMC:PMC10238710 | DOI:10.2147/CCID.S413237 {url} = URL to article

J Drugs Dermatol. 2023 Jun 1;22(6):605-607. doi: 10.36849/JDD.7237. ABSTRACT Rosacea is a chronic inflammatory skin condition characterized by facial flushing, erythema, telangiectasias, and papulopustular lesions. Treatment for rosacea includes limiting inciting factors and reducing inflammation with topical and oral therapies. Traditional therapies primarily focus on the papulopustular or background erythematotelangiectatic component of rosacea, leaving symptoms of flushing poorly controlled and profoundly impacting the quality of life of patients. Neuromodulators have been speculated to improve the flushing component of rosacea by reducing mast cell degranulation and the release of neuropeptides. However, its use for symptomatic relief in refractory flushing rosacea has been limited by side effects such as facial muscle weakness or paralysis. We present the use of strategic placement of high-dose neuromodulators for treatment-resistant rosacea. This approach has resulted in the gradual stabilization of symptoms, improved quality of life, and superior side effect profile. Silence C, Kourosh AS, Gilbert E. Placement of high-dose neurotoxins for treatment-resistant rosacea. J Drugs Dermatol. 2023;22(6):605-606. doi:10.36849/JDD.7237. PMID:37276156 | DOI:10.36849/JDD.7237 {url} = URL to article

J Drugs Dermatol. 2023 Jun 1;22(6):576-581. doi: 10.36849/JDD.7424. ABSTRACT BACKGROUND: A growing body of evidence suggests that several inflammatory skin diseases (ISDs) are associated with systemic inflammation and cardiovascular disease (CVDs). METHODS: We used the TriNetX analytics platform to conduct a retrospective, cross-sectional, single-center study in the Mount Sinai Health System network. Cases (all patients &ge;18 years of age with a diagnosis of 1 of the 4 ISDs studied) were compared with matched controls (no history of any of these ISDs) to evaluate odds ratios for being diagnosed with CVD. RESULTS: We identified a total of 70,090 patients with ISDs, including 35,160 patients with atopic dermatitis, 19,490 with psoriasis, 12,470 with rosacea, and 2,970 with alopecia areata, and 70,090 propensity score-matched controls without any of these ISDs. Patients with atopic dermatitis and psoriasis had significantly increased odds of all CVD diagnoses analyzed compared to controls (P&lt;0.001 for all comparisons). Patients with rosacea had significantly increased odds of being diagnosed with all diseases of the circulatory system (P&lt;0.001), hypertensive diseases (P&lt;0.001), cerebrovascular diseases (P=0.037), and arterial disease (P&lt;0.001) compared to controls. Patients with alopecia areata had increased odds for all diseases of the circulatory system (P&lt;0.001), hypertensive diseases (P&lt;0.001), and arterial disease (P&lt;0.001). The prevalence of patients with elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels was significantly greater in all ISD groups compared to controls. CONCLUSION: This study identified significant associations between ISDs and several CVD diagnoses. Furthermore, CRP and ESR were elevated in all ISD groups compared to controls. Pagan AD, Jung S, Caldas S, et al. Cross-sectional study of psoriasis, atopic dermatitis, rosacea, and alopecia areata suggests association with cardiovascular diseases. J Drugs Dermatol. 2023;22(6):576-581. doi:10.36849/JDD.7424. PMID:37276159 | DOI:10.36849/JDD.7424 {url} = URL to article

J Drugs Dermatol. 2023 Jun 1;22(6):566-575. doi: 10.36849/JDD.7181. ABSTRACT Rosacea is a chronic skin disorder involving central facial erythema secondary to vascular instability and cutaneous inflammation. Rosacea is divided into different subtypes based on the morphology of the rash &mdash; erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea. A less-known subtype called neurogenic rosacea has been proposed to categorize patients suffering from rosacea with erythematous flushing and burning sensation that is refractory to traditional treatment. There is minimal data on this subgroup of rosacea patients and its potential treatment options. This review aims to explore current medical literature to define characteristics of neurogenic rosacea and its management. We performed a systematic search of PubMed database and identified 6 articles meeting inclusion criteria with a total of 37 patients with suspected neurogenic rosacea. Combination treatments with topicals (eg, metronidazole, brimonidine), as well as oral medications including vascular (eg, beta blockers), psychiatric (eg, diazepam, duloxetine), neurologic (eg, pregabalin, sumatriptan), and antibiotic agents (eg, rifaximin), were often cited to have better outcomes, but this finding was highly variable between patients. There were isolated reports of effective management with onabotulinumtoxinA intradermal injections and endoscopic thoracic sympathectomy treatment. Current literature supports selecting agents aimed at treating the major symptom pattern (eg, erythema, telangiectasias, burning sensation). Neurogenic rosacea treatment: a literature review. Ivanic MG, Oulee A, Norden A, et al. J Drugs Dermatol. 2023;22(6):566-571. doi:10.36849/JDD.7181 &nbsp. PMID:37276164 | DOI:10.36849/JDD.7181 {url} = URL to article

J Drugs Dermatol. 2023 Jun 1;22(6):546-553. doi: 10.36849/JDD.7494. ABSTRACT Rosacea changes are a result of an immune mediated response and the angiogenic properties of the LL-37 peptide. This peptide induces an inflammatory signal that activates the NLRP3-mediated inflammasome, triggering rosacea pathogenesis. Research findings show that LL-37 peptide is inhibited by binding to a cell surface glycosaminoglycan, heparan sulfate. Heparan Sulfate Analog (HSA) is a proprietary low molecular weight analog of heparan sulfate that has been formulated into a Dermal Repair Cream (DRC), specifically to aid in such immune mediated responses. Herein, in vitro studies using human epidermal keratinocytes showed an increase in HSA decreased LL-37 toxicity and IL-8 cytokine release. A single-center, randomized double-blind trial included 16 subjects (Fitzpatrick skin types I-IV) with a clinical diagnosis of type 1 rosacea and moderate to severe facial erythema, who were undergoing Pulsed Dye Laser (PDL) treatment. The clinical improvements of their facial erythema were assessed at baseline, 2 weeks, 4 weeks, and 8 weeks. Results revealed that low molecular weight HSA significantly improves the clinical signs of rosacea during the 8 weeks of use likely resulting from inhibition of LL-37 induced IL-8 cytokine release. These findings support the use of DRC in rosacea topical treatment regimens as it demonstrates visible skin benefits and improves tolerability of PDL therapy in a shorter duration of time as compared with PDL alone.George R, Gallo RL, Cohen JL, et al. Reduction of erythema in moderate-severe rosacea by a low molecular weight Heparan Sulfate Analog (HSA). J Drugs Dermatol. 2023;22(6):546-553. doi:10.36849/JDD.7494. PMID:37276169 | DOI:10.36849/JDD.7494 {url} = URL to article

Sci Rep. 2023 Jun 5;13(1):9068. doi: 10.1038/s41598-023-36247-5. ABSTRACT Rosacea is a chronic inflammatory skin disease that is characterized by recurrent episodes of erythema, telangiectasia and papulopustular lesions. Although the pathogenesis is not well established, growing knowledge suggests that multiple etiological factors play a role resulting in inflammation. The aim of the present study is to investigate inflammatory status of patients with rosacea by evaluating CBC parameters and systemic immune inflammation (SII) index and compare these parameters with control group. Thus, it is aimed to understand the role of systemic inflammation in the pathogenesis of the disease. This retrospective, case-control study included 100 patients with rosacea and 58 sex- and age-matched controls. Laboratory examinations including CBC, ESR, CRP, HDL, LDL, and triglyceride levels were recorded and neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR), monocyte-to-high-density lipoprotein ratio (MHR) and SII index were calculated. Monocyte and platelet count, SII index, ESR and CRP were significantly higher in patients with rosacea than in the control group. No statistically significant difference was found in other parameters. There was no significant correlation between disease severity and ESR, CRP, and SII index. The findings of this study suggest that apart from the inflammatory pathways at the level of skin, there is an inflammatory state in the blood of patients. Rosacea is a skin disease, but it may have systemic implications and/or associations that need to be clarified completely. PMID:37277425 | PMC:PMC10241869 | DOI:10.1038/s41598-023-36247-5 {url} = URL to article

Curr Rev Clin Exp Pharmacol. 2023 Jun 1. doi: 10.2174/2772432819666230601155545. Online ahead of print. ABSTRACT BACKGROUND: A substantial number of research studies on metronidazole-related cutaneous symptoms have recently been published. Our objective was to identify and evaluate descriptive studies that described metronidazole-related skin manifestations, therapeutic interventions, and consequences. METHODOLOGY: A comprehensive literature search was carried out in the PubMed, Scopus, and grey literature databases from inception to April 2022 without any constraints, as well as a snowball search in Google and a search in Google Scholar. Descriptive articles describing metronidazole-related cutaneous manifestations were considered for the review. Two distinct reviewers carried out the research selection, data extraction, and quality assessment; any discrepancies were resolved by consensus with the third reviewer. RESULTS: About 24 out of 4648 descriptive studies, including 26 patients (20 Female patients and 6 male patients), were included in this review. The included studies comprised a range of ages from 16 to 78 years old. Metronidazole was indicated for the treatment of bacterial vaginosis, trichomoniasis, sepsis, anti-infection therapy, perforated appendicitis, rosacea, vaginal discharge, dysentery, acne rosacea, trichomonal vaginitis, lichen planus, liver abscess, facial rosacea, intestinal amoebiasis, and gingivitis. Fixed drug eruption was the most common skin manifestation which was reported in 7 cases included in this review. Cutaneous manifestations were ameliorated by cessation of the offending drug and by apportioning antihistamines, topical steroids, parenteral corticosteroids, emollients, and topical moisturizers. CONCLUSION: Clinicians and healthcare professionals should be cognizant of the potential cutaneous adverse drug reactions (CADRs) induced by metronidazole to mitigate fatal circumstances. The management of the CADRs appears to respond effectively with immediate drug discontinuation and supportive therapy. PMID:37264661 | DOI:10.2174/2772432819666230601155545 {url} = URL to article

Dermatologie (Heidelb). 2023 Jul;74(7):527-534. doi: 10.1007/s00105-023-05154-1. Epub 2023 Jun 2. ABSTRACT Guidelines are systematically developed decision-making aids to ensure appropriate clinical care for specific medical conditions. In Germany, dermatological guidelines are developed under the aegis of the German Dermatological Society (DDG) and the Professional Association of German Dermatologists (BVDD), while European and international guidelines are published by organisations such as the European Centre for Guidelines Development (EuroGuiDerm), founded by the European Dermatology Forum (EDF) in cooperation with the Division of Evidence-Based Medicine at Charité-Universitätsmedizin Berlin. In 2021 and 2022, the German guidelines were revised or developed on topics such as the management of anticoagulation during dermatological procedures, chronic pruritus, contact dermatitis, laser therapy of the skin, psoriasis vulgaris, rosacea, extracorporeal photopheresis, onychomycosis, mucous membrane pemphigoid and prevention of skin cancer. A selection of the most important recommendations and innovations in the guidelines is summarized here. PMID:37266595 | DOI:10.1007/s00105-023-05154-1 {url} = URL to article