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Related ArticlesTreatment Outcomes of Long-Pulsed Nd: YAG Laser for Two Different Subtypes of Rosacea. J Clin Aesthet Dermatol. 2015 Sep;8(9):16-20 Authors: Say EM, Gokhan O, Gökdemir G Abstract BACKGROUND: A variety of lasers have been used for the treatment of rosacea. However, treatment of this condition with long-pulsed neodymium-doped yttrium aluminium garnet laser has not been reported yet. OBJECTIVE: To assess the efficacy and safety of long-pulsed neodymium-doped yttrium aluminium garnet laser in two different subtypes (erythematotelangiectatic and papulopustular) of rosacea. METHODS: A total of 66 patients were enrolled in the study. All of the patients were treated with long-pulsed neodymium-doped yttrium aluminium garnet laser with 3- to 4-week intervals. Rosacea severity score was assessed by using photographs. Improvement in severity was defined as the percentage reduction in severity scores from baseline to the end of treatment. Patients were also asked about their own opinions of improvement at the end of the treatment. Side effects were also documented. RESULTS: Good to excellent improvement was achieved in up to 50 percent of the patients in the erythematotelangiectatic and papulopustular groups. Percent improvement of global severity was significantly greater in the erythematotelangiectatic patients than in the papulopustular patients. The majority of patients from both groups noted a significant improvement of the lesions. Hypopigmented atrophic scars were seen in two patients. CONCLUSION: The long-pulsed neodymium-doped yttrium aluminium garnet laser is a safe and effective treatment for vascular and inflammatory lesions of rosacea. PMID: 26430486 [PubMed] {url} = URL to article

Related ArticlesDemodicosis in Renal Transplant Recipients. Am J Transplant. 2015 Oct 2; Authors: Chovatiya RJ, Colegio OR Abstract Solid organ transplant recipients have an increased incidence of skin infections resulting from immunosuppression. Common pathogens include herpes simplex virus, varicella zoster virus, Gram-positive bacteria and dermatophytes; however, the contribution of multicellular parasitic organisms to dermatologic disease in this population remains less studied. Demodex folliculorum and brevis are commensal mites that reside on human skin. Proliferation of Demodex mites, or demodicosis, is associated with rosacea and rosacea-like disorders, particularly in immunocompromised populations, although their ability to cause disease is still the subject of debate. We present a case series of four renal transplant recipients with the singular chief complaint of acne rosacea who we diagnosed with demodicosis. Although one of the four patients showed complete resolution following initial antiparasitic therapy, the other three required subsequent antibacterial treatment to fully resolve their lesions. We suggest that demodicosis may be more prevalent than once thought in solid organ transplant recipients and showed that Demodex-associated acne rosacea can be effectively treated in this population. PMID: 26431451 [PubMed - as supplied by publisher] {url} = URL to article

PERIORAL DERMATITIS: STILL A THERAPEUTIC CHALLENGE. Acta Clin Croat. 2015 Jun;54(2):179-85 Authors: Mokos ZB, Kummer A, Mosler EL, Čeović R, Basta-Juzbašić A Abstract Perioral dermatitis is a common and often chronic dermatosis. In its classic form, it primarily affects women aged 15 to 45 years, but there are also variants including lupus-like and granulomatous perioral dermatitis, where granulomatous form is more common in childhood and affects mostly prepubescent boys. The etiopathogenesis of the disease remains unclear, but there is a frequent finding of prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis, preceding the clinical manifestation of perioral dermatitis. Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor. Clinical presentation of papulovesicular eruption in the perioral region with a typical narrow spared zone around the edge of the lips is characteristic. Therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient's age, with special attention to patient's education and continuous psychological support. In mild forms of perioral dermatitis, 'zero therapy' is the treatment of choice. In the initial treatment period, patients with steroid-induced perioral dermatitis should be closely followed up because the rebound phenomenon usually develops after cessation of previous topical treatment. In moderate disease, treatment includes topical metronidazole, erythromycin, and pimecrolimus, whereas in more severe cases the best validated choice is oral tetracycline in a subantimicrobial dose until complete remission is achieved. Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies. PMID: 26415314 [PubMed - in process] {url} = URL to article

Brimonidine gel 0.33% rapidly improves patient-reported outcomes by controlling facial erythema of rosacea: a randomized, double-blind, vehicle-controlled study. J Eur Acad Dermatol Venereol. 2015 Sep 28; Authors: Layton AM, Schaller M, Homey B, Hofmann MA, Bewley AP, Lehmann P, Nohlgård C, Sarwer DB, Kerrouche N, Ma YM Abstract BACKGROUND: Facial redness contributes to impaired psychosocial functioning in rosacea patients and the only approved treatment for erythema is topical brimonidine gel 0.33%. OBJECTIVES: To evaluate patient-reported outcomes, as well as efficacy and safety, in subjects with self-perceived severe erythema treated with brimonidine gel 0.33% compared to vehicle. METHODS: An 8-day multicenter, randomized study comparing once-daily brimonidine gel 0.33% with vehicle gel using a facial redness questionnaire, subject satisfaction questionnaire and a patient diary of facial redness control to assess patient-reported outcomes. RESULTS: Of the 92 included subjects with self-perceived severe erythema, very few were satisfied with their appearance at baseline (4.2% brimonidine group, 0 vehicle group). On Day 8, significantly more brimonidine group subjects were satisfied with their facial appearance compared to vehicle group (36.9% vs. 21.5%; P < 0.05), with the overall treatment effect (69.6% vs. 40.4%; P < 0.01), and with the improvement in their facial redness (67.4% vs. 33.3%; P < 0.001). More brimonidine group subjects were able to control their facial redness daily (e.g. 83.0% vs. 38.9% on Day 1). On Day 8, significantly more brimonidine group subjects than vehicle group had at least a one-grade improvement from baseline in the Clinician Erythema Assessment score (71.7% vs. 35.7%; P = 0.0011) and Patient Self-Assessment score (76.1% vs. 47.6%; P = 0.004). More subjects in the brimonidine group (29.2%) reported treatment-related adverse events than in the vehicle group (15.9%) but most were mild and transient. CONCLUSIONS: Once-daily brimonidine gel 0.33% allowed patients to rapidly control their facial redness and significantly improved patient-reported outcomes in the treatment of persistent facial erythema of rosacea. PMID: 26416154 [PubMed - as supplied by publisher] {url} = URL to article

Chlamydial plasmid-encoded virulence factor Pgp3 neutralizes the antichlamydial activity of human cathelicidin LL-37. Infect Immun. 2015 Sep 28; Authors: Hou S, Dong X, Yang Z, Li Z, Liu Q, Zhong G Abstract Chlamydia trachomatis infection in the lower genital tract can ascend to and cause pathologies in the upper genital tract, potentially leading to severe complications such as tubal infertility. However, chlamydial organisms depleted of plasmid or deficient in the plasmid-encoded Pgp3 are attenuated in ascending infection and no longer able to induce the upper genital tract pathologies, indicating a significant role of Pgp3 in chlamydial pathogenesis. We now report that C. trachomatis Pgp3 can neutralize the antichlamydial activity of human cathelicidin LL-37, a host antimicrobial peptide secreted by both genital tract epithelial cells and infiltrating neutrophils. Pgp3 bound to and formed stable complexes with LL-37. We further showed that the middle region of Pgp3 (Pgp3m) was responsible for both the binding to and neutralization of LL-37, suggesting that Pgp3m may be targeted for attenuating chlamydial pathogenicity or developed for blocking LL-37-involved non-genital tract pathologies such as rosacea and psoriasis. Thus, the current study has provided significant information for both understanding the mechanisms of chlamydial pathogenesis and developing novel therapeutic agents. PMID: 26416907 [PubMed - as supplied by publisher] {url} = URL to article

Related ArticlesTopical PDT in the Treatment of Benign Skin Diseases: Principles and New Applications. Int J Mol Sci. 2015;16(10):23259-78 Authors: Kim M, Jung HY, Park HJ Abstract Photodynamic therapy (PDT) uses a photosensitizer, light energy, and molecular oxygen to cause cell damage. Cells exposed to the photosensitizer are susceptible to destruction upon light absorption because excitation of the photosensitizing agents leads to the production of reactive oxygen species and, subsequently, direct cytotoxicity. Using the intrinsic cellular heme biosynthetic pathway, topical PDT selectively targets abnormal cells, while preserving normal surrounding tissues. This selective cytotoxic effect is the basis for the use of PDT in antitumor treatment. Clinically, PDT is a widely used therapeutic regimen for oncologic skin conditions such as actinic keratosis, squamous cell carcinoma in situ, and basal cell carcinoma. PDT has been shown, under certain circumstances, to stimulate the immune system and produce antibacterial, and/or regenerative effects while protecting cell viability. Thus, it may be useful for treating benign skin conditions. An increasing number of studies support the idea that PDT may be effective for treating acne vulgaris and several other inflammatory/infective skin diseases, including psoriasis, rosacea, viral warts, and aging-related changes. This review provides an overview of the clinical investigations of PDT and discusses each of the essential aspects of the sequence: its mechanism of action, common photosensitizers, light sources, and clinical applications in dermatology. Of the numerous clinical trials of PDT in dermatology, this review focuses on those studies that have reported remarkable therapeutic benefits following topical PDT for benign skin conditions such as acne vulgaris, viral warts, and photorejuvenation without causing severe side effects. PMID: 26404243 [PubMed - in process] {url} = URL to article

Related ArticlesUnderstanding rosacea. Br J Dermatol. 2015 Sep;173(3):635-7 Authors: Powell FC PMID: 26404572 [PubMed - in process] {url} = URL to article

Related ArticlesDeciphering the enigma of rosacea continues…. Br J Dermatol. 2015 Sep;173(3):637-8 Authors: Tan JK PMID: 26404573 [PubMed - in process] {url} = URL to article

Related ArticlesRosacea, Use of Tetracycline, and Risk of Incident Inflammatory Bowel Disease in Women. Clin Gastroenterol Hepatol. 2015 Sep 21; Authors: Li WQ, Cho E, Khalili H, Wu S, Chan AT, Qureshi AA Abstract BACKGROUND & AIMS: Rosacea is an inflammatory skin disease. Case reports have shown rosacea as a comorbidity of inflammatory bowel disease (IBD) but no epidemiologic studies have examined rosacea and risk of subsequent IBD. The association between tetracycline use and risk of IBD was assessed but produced limited findings. We examined the association between rosacea, use of tetracycline, and risk of incident Crohn's disease (CD) and ulcerative colitis (UC). METHODS: We analyzed data from 96,314 participants in the Nurses' Health Study II (1991-2011). Information on IBD was confirmed by medical review. Participants were asked in 2005 about their lifetime histories of clinician-diagnosed rosacea and year of diagnosis. Information on ever use of tetracycline was collected in 1993. RESULTS: During 1,856,587 person-years (1991-2011), we identified 149 cases of CD and 215 cases of UC. Rosacea was not associated with risk of UC. In contrast, rosacea was significantly associated with an increased risk of subsequent CD (hazard ratio [HR]=2.20; 95% confidence interval [CI], 1.15-4.18), which appeared particularly stronger for a longer duration after a diagnosis of rosacea (Ptrend=.01). Tetracycline use was associated with an increased risk of CD (HR=1.56; 95% CI, 1.09-2.24) and UC (HR=1.34; 95% CI, 1.00-1.80); there was a trend toward increased risk with increased duration of use (both Ptrend<.05) (1993-2011). CONCLUSIONS: Based on an analysis of data from the Nurses' Health Study II, ever use of tetracycline at baseline is associated with an increased risk of CD and UC. Personal history of rosacea is associated with an increased risk of only CD. PMID: 26404866 [PubMed - as supplied by publisher] {url} = URL to article

Related ArticlesAcneiform eruptions caused by various second-generation tyrosine kinase inhibitors in patients with chronic myeloid leukaemia. Br J Dermatol. 2015 Sep 24; Authors: Jung YS, Kim M, Lee JH, Cho BK, Kim DW, Park HJ Abstract Tyrosine kinase inhibitors (TKIs) are a novel, well-tolerated and promising class of anticancer drugs, commonly used to treat chronic myeloid leukaemia (CML). Imatinib was the first commercially available TKI, approved for the treatment of CML and gastrointestinal stromal tumours. The development of polyclonal resistances to imatinib, due to point mutations in the bcr-abl kinase domain, yielded second generation TKIs including dasatinib, radotinib, and nilotinib. (1) These second generation TKIs have shown higher rates of early optimal responses and fewer side effects when compared to imatinib. (1) These new agents are indeed less toxic, but the range of activity of these drugs is still not only directed at tumour cells. As a result, their use is associated with various systemic adverse events that go beyond the scope of the present review, but cutaneous side effects are the most commonly reported. (1,2) Nevertheless, there have only been few reports of cutaneous adverse events caused by TKIs in CML patients. To the best of our knowledge, this is the first report directly focused on acneiform eruptions due to second generation TKIs in CML patients. Herein, we report 10 cases of acneiform eruptions with or without rosacea-like eruptions caused by various second generation TKIs in CML patients. This article is protected by copyright. All rights reserved. PMID: 26399382 [PubMed - as supplied by publisher] {url} = URL to article

New and Emerging Treatments for Rosacea. Am J Clin Dermatol. 2015 Sep 22; Authors: Gold LM, Draelos ZD Abstract Rosacea is a common chronic inflammatory disorder that affects approximately 16 million Americans. The multifactorial pathophysiology of rosacea is not fully understood. Several new treatment options were recently US Food and Drug Administration approved or are in clinical trials. This paper reviews new treatment options including ivermectin, brimonidine, the new foam formulation of azelaic acid, and oxymetazoline. The potential role in therapy, patient selection, and adverse effects of these agents are discussed. PMID: 26396117 [PubMed - as supplied by publisher] {url} = URL to article

Related ArticlesDermatologic therapy in pregnancy. Clin Obstet Gynecol. 2015 Mar;58(1):112-8 Authors: Tyler KH Abstract Patients present during pregnancy with a variety of dermatologic conditions, most of which can be treated conservatively with topical medication by a primary obstetrician if he or she is familiar with common treatment options. Patients with moderate to severe forms of dermatologic disease or those requiring systemic therapy should be treated in consultation with a dermatologist. Dermatologic surgery can be performed safely in the second trimester using local anesthesia if needed. PMID: 25517754 [PubMed - indexed for MEDLINE] {url} = URL to article

Related ArticlesDermatologic therapy in pregnancy. Clin Obstet Gynecol. 2015 Mar;58(1):112-8 Authors: Tyler KH Abstract Patients present during pregnancy with a variety of dermatologic conditions, most of which can be treated conservatively with topical medication by a primary obstetrician if he or she is familiar with common treatment options. Patients with moderate to severe forms of dermatologic disease or those requiring systemic therapy should be treated in consultation with a dermatologist. Dermatologic surgery can be performed safely in the second trimester using local anesthesia if needed. PMID: 25517754 [PubMed - indexed for MEDLINE] {url} = URL to article

Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol. 2015 Sep 17; Authors: Shi VY, Leo M, Hassoun L, Chahal DS, Maibach HI, Sivamani RK Abstract Skin is an important interface between the host and its environment. Inflammatory dermatoses often have disrupted skin barrier function, rendering patients more susceptible to allergenic triggers leading to an exaggerated immune response. The skin surface lipid film, an important component of the skin barrier, comprises a mixture of keratinocyte and sebaceous gland-derived lipids. Recent evidence demonstrated that defective keratinocyte lipid synthesis predisposes for the development of atopic dermatitis. However, the important role of sebaceous gland-derived lipids in skin inflammatory diseases may be underrecognized. This overview focuses on the importance of the contribution of sebaceous glands to barrier function. Sebaceous gland alteration may play a role in the pathogenesis of common skin diseases including acne vulgaris, atopic dermatitis, psoriasis, rosacea, and seborrheic dermatitis. PMID: 26386632 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles1% Ivermectin Cream (Soolantra) for the Treatment of Rosacea. Skinmed. 2015 May-Jun;13(3):222-4 Authors: Scheinfeld N PMID: 26380509 [PubMed - in process] {url} = URL to article

Related ArticlesIvermectin 1% Cream for Rosacea. Skin Therapy Lett. 2015 Aug;20(4):9-11 Authors: Gupta G, Daigle D, Gupta AK, Gold LS Abstract The etiology of papulopustular rosacea (PPR) is not well understood yet appears to involve both the innate and adaptive immune response in addition to possible infestation with Demodex mites. Current treatments for PPR consist mainly of antibiotics. Ivermectin cream 1%, a new topical treatment for PPR, possesses both anti-inflammatory and anti-parasitic properties. After 12 weeks of treatment, subjects treated with ivermectin cream 1% had significantly greater reductions in PPR symptoms and enhanced diseaserelated quality of life improvements compared to subjects who received vehicle. Furthermore, PPR symptoms continued to improve with prolonged treatment (40 weeks). Ivermectin cream 1% offers a multi-pronged approach to combat the complex pathophysiology of rosacea. PMID: 26382711 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles[Cyclosporine eye drops: A 4-year retrospective study (2009-2013)]. J Fr Ophtalmol. 2015 Sep 11; Authors: Kauss Hornecker M, Charles Weber S, Brandely Piat ML, Darrodes M, Jomaa K, Chast F Abstract INTRODUCTION: The University Hospitals Paris Centre Pharmacy compounds three concentrations of cyclosporine eye drops: 20mg/mL (=2%); 5mg/mL (=0.5%) and 0.5mg/mL (=0.05%). Cyclosporine A 2% drops were developed in 1995 to prevent the rejection of high-risk cornea transplants after failure of topical steroids. The other concentrations of eye drops were developed for the treatment of various immune or inflammatory diseases of the cornea, conjunctiva and uvea. These eye drops are dispensed with a physician's prescription to hospitalized or ambulatory patients. A retrospective study over 4 years (2009-2013) was conducted to analyze the details of prescription and possible adverse events. MATERIALS AND METHODS: Dispensations made from January 1st, 2009 through December 31st, 2013 were studied, including patient age, dose of cyclosporine and practice location of prescribing physician. We also recorded the indications for cyclosporine eye drops in a sample of ambulatory patients. The analysis of local tolerability and the effect on visual comfort was based on questionnaires sent to the patients on cyclosporine 2% over a period of 2 months. RESULTS: Cyclosporine eye drops prescription grew continuously from 2009 through 2013 for all concentrations. In 2013, 5859patients were treated, among which 3616patients with topical cyclosporine 2%, 1681patients with 0.5%, and 562 patients with 0.05%. In total, this represents 62,621 eye drops. Treated patients ranged from 1 week to 100 years old. Topical 2% cyclosporine is indicated in 61% of cases to prevent high-risk corneal graft rejection. Other indications are corneal ulcer (6%), atopic keratoconjunctivitis (5%), vernal keratoconjunctivitis (5%) and herpetic keratitis (4%). Topical 0.5% cyclosporine is prescribed primarily for dry eye syndrome (20%) and to prevent rejection of high-risk corneal transplantation (11%), to treat ocular rosacea (10%), vernal keratoconjunctivitis (10%), atopic keratoconjunctivitis (8%) and Sjögren's syndrome (7%). Topical 0.05% cyclosporine is prescribed primarily for dry eye syndrome resistant to conventional treatment (47%) and Sjögren's syndrome (21%). Local tolerability of topical cyclosporine was evaluated in 388 patients. The majority of patients (63%) did not experience any adverse effects. The main side effects are redness, burning sensation and itching. CONCLUSION: Prescription of various formulations of topical cyclosporine is current practice for surgical indications: rejection of high-risk corneal transplantation; or medical indications: vernal or atopic keratoconjunctivitis and dry eye syndrome. Further prospective randomized studies would be necessary to validate formulations, doses and indications of cyclosporine eye drops. PMID: 26371985 [PubMed - as supplied by publisher] {url} = URL to article