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J Drugs Dermatol. 2022 Jan 1;21(1):31-36. doi: 10.36849/JDD.2022.6540. ABSTRACT BACKGROUND: Access to medical cannabis products (MCPs) has rapidly increased though literature on consumer behaviors and attitudes with regards to dermatologic use is limited. OBJECTIVE: We sought to address the gap of knowledge regarding consumer utilization and perspectives surrounding MCPs for dermatologic indications. METHODS: A survey was emailed via SurveyMonkey’s platform to adult users of their rewards panel asking about usage patterns and beliefs regarding MCP use to treat dermatologic conditions. RESULTS: 504 of 700 survey invitations sent out were completed (72% response rate). 17.6% of respondents used an over-the-counter (OTC) cannabis product without dermatologist recommendation to treat a skin condition [most common indications: acne (28.4%) and psoriasis (26.1%)]. Of those who had seen a dermatologist, 15.3% used an OTC product [most common indications: psoriasis (32%) and rosacea (30%)] and 7.8% used an MCP which required a Department of Health-approved card per their dermatologist’s recommendations [most common indications: acne (68%) and psoriasis (28%)]. 11.8% of respondents were not comfortable seeing a dermatologist who recommended MCPs. LIMITATIONS: Limitations include small sample size as well as selection bias. CONCLUSION: Consumers are interested in and are using MCPs for dermatologic indications, most commonly for inflammatory skin disorders. Targeted education for dermatologists is recommended. J Drugs Dermatol. 2022;21(1):31-36. doi:10.36849/JDD.6540. PMID:35005866 | DOI:10.36849/JDD.2022.6540 {url} = URL to article

Front Cell Dev Biol. 2021 Dec 21;9:751785. doi: 10.3389/fcell.2021.751785. eCollection 2021. ABSTRACT Although multiple evidences suggest that angiogenesis is associated with the pathophysiology of rosacea, its role is still in debate. Here, we showed that angiogenesis was enhanced in skin lesions of both rosacea patients and LL37-induced rosacea-like mice. Inhibition of angiogenesis alleviated LL37-induced rosacea-like features in mice. Mechanistically, we showed that mTORC1 was activated in the endothelial cells of the lesional skin from rosacea patients and LL37-induced rosacea-like mouse model. Inhibition of mTORC1 decreased angiogenesis and blocked the development of rosacea in mice. On the contrary, hyperactivation of mTORC1 increased angiogenesis and exacerbated rosacea-like phenotypes. Our in vitro results further demonstrated that inhibition of mTORC1 signaling significantly declined LL37-induced tube formation of human endothelial cells. Taken together, our findings revealed that mTORC1-mediated angiogenesis responding to LL37 might be essential for the development of rosacea and targeting angiogenesis might be a novel potential therapy. PMID:34993194 | PMC:PMC8724421 | DOI:10.3389/fcell.2021.751785 {url} = URL to article • Cytokines and Rosacea • Mast Cells and the Innate Immune System Disorder • Cathelicidin Peptide LL-37 and Vitamin D3 • If you experience error messages on the above links into our member area of the site, you may register an account to view the content.

Front Immunol. 2021 Dec 20;12:760019. doi: 10.3389/fimmu.2021.760019. eCollection 2021. ABSTRACT PURPOSE: Heterozygous missense STAT1 mutations leading to a gain of function (GOF) are the most frequent genetic cause of chronic mucocutaneous candidiasis (CMC). We describe the case of a patient presenting a new GOF mutation of STAT1 with the clinical symptoms of CMC, recurrent pneumonia, and persistent central erythema with papulopustules with ocular involvement related to rosacea-like demodicosis. METHODS: Genetic analysis via targeted next-generation sequencing (NGS; NGS panel DIPAI v.1) exploring the 98 genes most frequently involved in primary immunodeficiencies, including STAT1, was performed to identify an underlying genetic defect. RESULTS: NGS identified a novel variant of STAT1, c.884C>A (exon 10), p.T295Y, not previously described. This variant was found to be gain of function using an in vitro luciferase reporter assay. Rosacea-like demodicosis was confirmed by substantial Demodex proliferation observed via the microscopic examination of a cutaneous sample. A review of literature retrieved 20 other cases of STAT1 GOF mutations associated with early-onset rosacea-like demodicosis, most with ocular involvement. CONCLUSION: We describe a new STAT1 GOF mutation associated with a phenotype of CMC and rosacea-like demodicosis. Rosacea-like demodicosis appears as a novel and important clinical phenotype among patients with STAT1 GOF mutation. PMID:34987506 | PMC:PMC8721043 | DOI:10.3389/fimmu.2021.760019 {url} = URL to article

J Clin Aesthet Dermatol. 2021 Sep;14(9 Suppl 1):S39-S45. Epub 2021 Sep 1. ABSTRACT BACKGROUND: Due to the public health risk associated with SARS-CoV-2 (COVID-19) infection, universal use of face masks has been recommended to protect against viral spread. Adverse facial reactions from the utilization of masks in the general public are poorly characterized in literature. OBJECTIVE: We aimed to provide a systematic review of studies reporting adverse facial reactions associated with use of face masks during the COVID-19 pandemic. METHODS: PubMed and Cochrane databases were searched using the following search terms: "masks" AND "skin reactions, facial dermatosis, rash, acne, atopic dermatitis, rosacea, OR seborrheic dermatitis." METHODS: A total of 954 cases of dermatological adverse effects were reported. Over 17 different adverse facial reactions were found, including the top 10 in order: itch (370, 38.8%), indentation/ear pain (102, 10.7%), discomfort (90, 9.4%), erythema (72, 7.5%), dryness (62, 6.5%), rash (60, 6.3%), scarring (42, 4.4%), desquamation (22, 2.3%), pain (19, 2.0%), burning (19, 2.0%), and wheals (7, 0.7%). Face masks can increase acne (n=44), rosacea (n=14), and seborrheic dermatitis (n=9). LIMITATIONS: Publication bias of articles, with limited studies available regarding this topic. CONCLUSION: Wearing face masks to protect from COVID-19 can increase adverse facial dermatoses and exacerbate underlying dermatology conditions; however, several preventative measures may be taken. PMID:34980966 | PMC:PMC8562946 {url} = URL to article

J Cosmet Dermatol. 2022 Jan 4. doi: 10.1111/jocd.14713. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a common, chronic skin disorder with negative impacts on physical health and social function. The response to therapy plays a critical factor in determining the duration of treatment and developing new medicines. However, it is challenging to assess the efficacy due to its complicated clinical characteristics and nonspecific histopathological findings. AIMS: This study aims to review the efficacy evaluation tools for rosacea. METHODS: An extensive literature search was conducted using PubMed, Web of Science, and other databases for articles on efficacy evaluation methods for rosacea from 1995 to 2021. RESULTS: In clinical practice and scientific research, various methods are available for assessing the curative effect. Evaluation tools based on phenotypes are the most commonly used because they are cheap and straightforward. Various questionnaires also exist to evaluate health-related quality of life. However, the inevitable subjectivity makes it challenging to compare the curative effect among different studies. By contrast, objective assessment tools are more precise and repeatable, such as consecutive standardized skin surface biopsies, computer-aided image analysis, and biophysical parameter assessments. CONCLUSION: No single assessment method could balance convenience and accuracy. For improving outcomes and facilitating academic exchanges, a well-validated gold standard evaluation tool is still needed. This review provides an overview of the existing efficacy evaluation methods for rosacea and discusses the relevant details. PMID:34982849 | DOI:10.1111/jocd.14713 {url} = URL to article

2022 Mar 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. ABSTRACT The meibomian gland dysfunction (MGD) international workshop describes MGD as "chronic diffuse abnormality of the meibomian glands, characterized by terminal duct obstruction along with qualitative or quantitative changes in the glandular secretion." The obstruction of the terminal duct occurs because of hyperkeratinization of the duct epithelium and the viscous nature of the meibum. These can result in atrophy and drop out of the meibomian glands, thus decreasing secretion. The sequelae of MGD can be observed in the forms of tear film abnormalities, ocular surface irritation, inflammation, or ocular surface disease. These meibomian glands are a type of sebaceous glands that are located in the eyelids. These are named after a German physician and anatomist 'Heinrich Meibom.' These glands lie parallelly in a single row within the tarsal plates of the upper and lower lids. The proximal ends of the meibomian glands extend towards the proximal margin of the tarsal plates. The distal end of the tarsus receives the secretion, i.e., meibum, through the excretory duct into the lid margin. It is estimated that the upper lid contains approximately 20 to 30 separate glands, and the lower lid has about 40 to 50 glands. Meibomian glands produce lipids, which are the major component of the superficial lipid layer of the tear film. This lipid layer is known to protect the excessive evaporation of the tear film's aqueous layer. It also helps by lowering the surface tension and thus stabilizing the tear film. It acts as a lubricant during blinking and provides an outer barrier that prevents bacteria from entering the tear film. The functional disorders caused by the meibomian gland dysfunction resulting in alterations in the meibomian gland secretions are also referred to as posterior blepharitis. MGD can broadly be classified based on onset into congenital and neoplastic. Based on the duration, it can be classified into acute or chronic. Based on underlying etiology, it can be divided into: Low delivery High delivery The low delivery type can be hyposecretory (meibomian sicca) and obstructive (cicatricial or non-cicatricial). Meibomian sicca results from atrophy of the meibomian glands or secondary to medications. MG atrophy results in an overall reduction in functional meibomian glands. The most common form of MGD is the obstructive type. This results from hypertrophy and keratinization of the ductal epithelium. This is further classified into cicatricial or non-cicatricial. The high delivery type is also called hypersecretory (meibomian seborrhea) and results from excessive secretion of the lipids. Meibomian seborrhea occurs secondary to underlying systemic conditions such as seborrheic or atopic dermatitis and acne rosacea. PMID:35593799 | Bookshelf:NBK580474 {url} = URL to article

Turk J Ophthalmol. 2021 Dec 28;51(6):338-343. doi: 10.4274/tjo.galenos.2021.05031. ABSTRACT OBJECTIVES: To report the most frequent signs in ocular rosacea and evaluate their association with skin findings. MATERIALS AND METHODS: Fifty-one patients diagnosed with rosacea by a trained dermatologist were evaluated by an ocular surface specialist. A complete ophthalmological examination was performed. RESULTS: In our study, the prevalence of ocular signs in patients with rosacea was 74.5%. The average age at presentation was 50 years and women were more affected than men. The most common findings were lid margin erythema, meibomian gland dysfunction, and blepharitis. Fifteen patients had decreased visual acuity due to complications related to rosacea such as leukoma and corneal neovascularization. Interestingly, patients that had the lowest visual acuity presented with dermatological signs of papules and pustules (p=0.001) and rhinophyma (p=0.023). Two patients who showed subepithelial fibrosis and fornix foreshortening were diagnosed as having ocular cicatricial pemphigoid (OCP) by immunohistopathological analysis of conjunctival specimens. CONCLUSION: Ocular compromise is common in rosacea. Our study shows that there might be a relationship between the severity of ocular involvement and certain subtypes of cutaneous disease. Rosacea and OCP may coexist. In cases that present with conjunctival fibrotic changes, a diagnostic biopsy is mandatory. PMID:34963260 | DOI:10.4274/tjo.galenos.2021.05031 {url} = URL to article Other Co-Existing Conditions with Rosacea Phenotype 6 Rosacea

J Invest Dermatol. 2021 Dec 21:S0022-202X(21)02624-5. doi: 10.1016/j.jid.2021.12.009. Online ahead of print. ABSTRACT The infiltration of neutrophils is implicated in rosacea, which is a common chronic inflammatory facial disease. This study explores the biological function of neutrophils and their underlying mechanism in rosacea. A rosacea-like mouse model was established to explore the polarization of neutrophils. RNA sequencing was used to investigate the underlying mechanisms. Our results show that neutrophils partly switched to N2 phenotypes in both rosacea patients and rosacea-like mouse models. The rosacea-like phenotype and inflammation in both a genetic mutation (Genista mice) and the Gr-1 antibody-induced neutropenia mice were significantly aggravated compared to the control groups. In vitro, the LPS + IFN-γand IL4 stimulation of neutrophils successfully induced the N1 and N2 polarization of neutrophils, respectively. Replenishment of N2 neutrophils in the lesions of wild-type and Genista mice ameliorated the rosacea-like phenotype and inflammation. RNA-seq suggested that N2 neutrophils relieved the rosacea-like phenotype, possibly by regulating the expression of blood circulation-associated factors, such as ACE, AGTR2, and NOS1. Finally, N2 neutrophils regulated the proliferation of CD4+ lymphocytes, which could explain the remission of inflammation in mice. Our results suggest that N2 polarization of neutrophils in rosacea exerts anti-inflammatory effects by regulating vascular factors and proliferation of CD4+ T cells. PMID:34953863 | DOI:10.1016/j.jid.2021.12.009 {url} = URL to article

Am J Ophthalmol. 2021 Dec 20:S0002-9394(21)00645-0. doi: 10.1016/j.ajo.2021.12.006. Online ahead of print. ABSTRACT PURPOSE: To report outcomes of tape splint tarsorrhaphy (TST) for persistent corneal epithelial defects (PCED). DESIGN: Retrospective, interventional case series. METHODS: Setting: tertiary cornea clinic. INTERVENTION: consecutive patients with a PCED (≥14 days) treated at a tertiary cornea clinic with a TST. STUDY POPULATION: Included were patients with a corneal epithelial defect that did not respond to treatment with a BCL. Excluded were patients with a follow-up time of less than three months. MAIN OUTCOME MEASURE: time to PCED resolution. RESULTS: Thirty-four eyes of 33 patients, mean age of 62.9±17.8 years (range 27 to 90 years) were included in this study. The main etiologies of the PCED were post keratoplasty (n=15), herpes simplex virus (n=4), superficial keratectomy (n=3), neurotrophic cornea (n=4), fungal keratitis (n=2), exposure keratopathy (n=2), failed graft (n=1), peripheral ulcerative keratitis (n=1), rosacea (n=1) and stitch abscess (n=1). Time from PCED presentation to TST was 58.9±106.3 days (range 14 to 390 days) with the area of the PCED being 25.1±15.7 mm2 (range 0.50 to 42.0mm2). Following TST, resolution of the PCED was achieved in 29/34 eyes (85.3%) without the need for additional interventions within 22.5±24.3 days (range 2 to 105 days). logMAR BCVA significantly improved from 1.11±0.41 to 0.83±0.70 (p=0.02). There were no complications attributed to TST and two patients elected to discontinue due to discomfort. CONCLUSIONS: Tape splint tarsorrhaphy achieved resolution of PCEDs secondary to various etiologies in 85.3% of eyes with a significant improvement in vision demonstrated. This simple, inexpensive, non-invasive technique may be considered for patients with PCEDs. PMID:34942108 | DOI:10.1016/j.ajo.2021.12.006 {url} = URL to article

Am J Ophthalmol. 2021 Dec 20:S0002-9394(21)00643-7. doi: 10.1016/j.ajo.2021.12.004. Online ahead of print. ABSTRACT PURPOSE: To describe clinical, meibographic and interferometric signs in children with ocular rosacea. DESIGN: Prospective case-control study METHODS: Setting: Monocentric (Fondation Ophtalmologique Rothschild, Paris, France) Population: 42 children with ocular rosacea and 44 healthy volunteers (median age 10 and 11 y.o., respectively). INTERVENTION: Infrared meibography images of lower lids and tear lipid layer thickness measurement with the LipiView II® device (Tearscience). MAIN OUTCOME: Clinical severity was graded on a 0-4 scale, and compared to meiboscores (0-4) and tear film lipid layer thickness (0-100nm). RESULTS: 7 patients presented with a unilateral disease and 29 had an asymmetrical form. 24 patients had an associated cutaneous rosacea. 10/84 eyes presented with a loss of vision < 20/25. Mean clinical severity grade was 2.5 ± 1.4. Meibographic abnomalities were significantly more important in children with ocular rosacea (mean meiboscore 2.1 ± 1.36) than in healthy volunteers (0.61 ± 0.78), p-value <0.001. Clinical severity (r=+0.44; p<0.001), duration of the disease (r= +0.28, p = 0.011) and a past history of chalazia (r= +0.30, p = 0.006) were correlated to meibographic severity. Mean lipid layer thickness was not significantly different between cases and controls (74.4 ± 18.7 nm and 76.6 ± 18 nm, respectively; p = 0.47). CONCLUSION: Meibomian structural alterations in children can be severe, and are correlated to ocular rosacea severity. Meibography is an essential tool for diagnosis and follow-up, whereas tear film interferometry contribution is uncertain. PMID:34942110 | DOI:10.1016/j.ajo.2021.12.004 {url} = URL to article

Eur J Dermatol. 2021 Dec 21. doi: 10.1684/ejd.2021.4165. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is one of the most common skin diseases causing great distress in affected patients. For optimal patient care, epidemiological studies on disease distribution and clinical aspects are essential. OBJECTIVES: The goal of this study was to provide an updated perspective on the current state of rosacea epidemiology in Germany. MATERIALS & METHODS: A cohort of 777 rosacea patients was assessed based on a detailed online questionnaire. Information regarding patients' demographics, course and clinical presentation of rosacea, trigger factors, dermatological consultations, treatment adherence and satisfaction as well as quality of life were obtained. RESULTS: There was a very high self-reported prevalence of primary and secondary rosacea features (flushing: n = 726, 93.4%; papules/pustules: n = 613, 79.0%; telangiectasia: n = 590, 75.9%; sub jective symptoms: n = 691, 88.9%). However, these clinical findings were often underdiagnosed by the treating physicians, while changes in temperature and ultraviolet radiation were potent triggers across all patients (86.3%, 77.7%, respectively). Disease-related quality of life decreased with the number of drugs prescribed as well as with uncontrolled symptom activity, and was reduced in female patients. CONCLUSION: This study is the largest German-based assessment exclusively focusing on rosacea patients covering a variety of clinical aspects to optimize patient care. PMID:34935620 | DOI:10.1684/ejd.2021.4165 {url} = URL to article

Int J Surg Case Rep. 2021 Nov 12;90:106597. doi: 10.1016/j.ijscr.2021.106597. Online ahead of print. ABSTRACT INTRODUCTION: Ocular rosacea is a multifactorial disease. Its pathophysiology remains unclear. The ocular manifestations of rosacea are not specific and can range from simple blepharoconjunctivitis to sight-threatening such as corneal perforation. CASE REPORT: We report the case of a 10-year-old child who presented with a red painful right eye. Based on the clinical findings, we concluded that she had a corneal perforation on ocular rosacea. She benefited from an ipsilateral lamellar autokeratoplasty by lamellar autograft. The evolution was marked by a good healing and a good visual recovery despite a corneal scar. DISCUSSION: Ocular rosacea is a multifactorial disease, with an unclear physiopathology. Corneal involvement remains the least common, but the most challenging since serious complications can occur. Corneal perforation is the most severe. Several techniques have been reported and used in the management of corneal perforations such as conjunctival flap, amniotic membrane grafting, and the use of a corneal patch. The later, corneal autografting, remains a simple and effective technique with satisfactory anatomical results. CONCLUSION: Ocular rosacea is a pathology that is still poorly understood and of delayed diagnosis. It can lead to serious vision-threatening complications such as corneal perforation. The corneal patch is a simple, effective and efficient technique that has given good results in our case. PMID:34920319 | DOI:10.1016/j.ijscr.2021.106597 {url} = URL to article

Int J Dermatol. 2021 Dec 12. doi: 10.1111/ijd.15989. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a common chronic skin condition, but data on its epidemiology and related comorbidities are scarce. OBJECTIVES: To analyze the prevalence and associated cutaneous comorbidities of rosacea in Germany. METHODS: Voluntary dermatological full-body examinations were conducted between 2001 and 2016 in more than 500 German companies by experienced dermatologists and documented electronically. Point-prevalence rates were calculated, and associations were tested with chi-squared tests and logistic regression analysis. RESULTS: A total of 161,269 participants (mean age was 43.2 ± 10.9 years; 55.5% male) were included; 2.1% had rosacea (men: 2.1%, women 2.1%, mean age 50.7 ± 9.3 years). The prevalence of rosacea increased significantly with age (16-29 years: 0.3%; 30-39 years: 0.9%; 40-49 years: 2.0%; 50-59 years: 3.5%; 60-70 years: 5.7%). Furthermore, there was a significant decreasing prevalence from skin type I toward type IV (skin type I: 3.2%; II: 2.2%; III: 1.5%; IV: 0.4%). The most frequent dermatological comorbidities were: telangiectasia (OR = 2.5), folliculitis (OR = 1.8), seborrheic dermatitis (OR = 1.6), acne (OR = 1.6), tinea pedis (OR = 1.4), psoriasis (OR = 1.4), spider veins (OR = 1.1), and hemangioma (OR = 1.1). CONCLUSIONS: Rosacea is a common skin condition that is most prevalent above the age of 65 years. Rosacea patients have an increased risk for associated comorbidities. Therefore, the diagnostic and therapeutic process for rosacea patients must ensure an integrated, complete dermatological approach in terms of medical care. PMID:34897653 | DOI:10.1111/ijd.15989 {url} = URL to article More information on Cormorbidities (Systemic) in Rosacea

Front Immunol. 2021 Nov 23;12:756550. doi: 10.3389/fimmu.2021.756550. eCollection 2021. ABSTRACT Rosacea is significantly associated with dementia, particularly Alzheimer's disease (AD). However, the common underlying molecular mechanism connecting these two diseases remains limited. This study aimed to reveal the common molecular regulatory networks and identify the potential therapeutic drugs for rosacea and AD. There were 747 overlapped DEGs (ol-DEGs) that were detected in AD and rosacea, enriched in inflammation-, metabolism-, and apoptosis-related pathways. Using the TF regulatory network analysis, 37 common TFs and target genes were identified as hub genes. They were used to predict the therapeutic drugs for rosacea and AD using the DGIdb/CMap database. Among the 113 predicted drugs, melatonin (MLT) was co-associated with both RORA and IFN-γ in AD and rosacea. Subsequently, network pharmacology analysis identified 19 pharmacological targets of MLT and demonstrated that MLT could help in treating AD/rosacea partly by modulating inflammatory and vascular signaling pathways. Finally, we verified the therapeutic role and mechanism of MLT on rosacea in vivo and in vitro. We found that MLT treatment significantly improved rosacea-like skin lesion by reducing keratinocyte-mediated inflammatory cytokine secretion and repressing the migration of HUVEC cells. In conclusion, this study contributes to common pathologies shared by rosacea and AD and identified MLT as an effective treatment strategy for rosacea and AD via regulating inflammation and angiogenesis. PMID:34899707 | PMC:PMC8657413 | DOI:10.3389/fimmu.2021.756550 {url} = URL to article Buy Melatonin from Amazon More Information (Register an account to view!)

Ann Dermatol Venereol. 2021 Dec 7:S0151-9638(21)00098-3. doi: 10.1016/j.annder.2021.11.001. Online ahead of print. ABSTRACT Over the past 15 years, numerous clinical, epidemiological and physiopathological articles have been published on rosacea. There is now increasing evidence that rosacea is an inflammatory disease characterised by abnormal innate immune response, major vascular changes, and increased colonisation by Demodex mites, along with a genetic predisposition and multiple external aggravating factors. It is thus possible to define treatment targets and possible treatments: 1) permanent vascular changes (medical and instrumental treatments); 2) flushing (betablockers, botulinum toxin); 3) innate immunity (antibiotics, nonspecific antioxidants and anti-inflammatory molecules); 4) a neurovascular component (analgesics, antidepressants); 5) Demodex (antiparasitic drugs); 6) microbiome; 7) skin barrier impairment (cosmetics and certain systemic drugs); 8) sebaceous glands (isotretinoin, surgery); 9) environmental factors (alcohol, coffee, UV exposure). Treatment recommendations are now available in many countries and benefit from the new phenotypic approach to rosacea, in which every sign or symptom is considered separately rather than having to deal with overlapping subtypes. Since the 2000s, many good quality clinical trials have been published in the field of rosacea and many others are still ongoing. Rosacea is a complex disease involving many different mechanisms and with numerous possible treatments, but there are still some important unmet needs with regard to optimal care. PMID:34893359 | DOI:10.1016/j.annder.2021.11.001 {url} = URL to article

J Affect Disord. 2021 Dec 5:S0165-0327(21)01325-2. doi: 10.1016/j.jad.2021.12.008. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is associated with several comorbidities, but its relationship with psychiatric disorders remains controversial. We aimed to investigate the association of rosacea with depression and anxiety. METHODS: A systematic review was performed of relevant observational studies in the PubMed, Web of Science, Embase, and Wanfang databases from inception to June 8, 2021. The inclusion criteria for eligible studies were observational studies comparing the incidence or prevalence of depression or anxiety between patients with rosacea and individuals without rosacea. We conducted meta-analyses with a random-effects model. The main outcome was pooled analysis of prevalence or incidence of depression and anxiety in patients with rosacea. RESULTS: We included nine studies with 101,114,209 patients with rosacea. A pooled analysis from cross-sectional and case-control studies revealed that patients with rosacea were significantly more likely to have depression (crude odds ratio [OR], 2.855; 95% confidence interval [CI], 1.258-6.481) and anxiety (crude OR, 2.373; 95% CI, 1.448-3.888) than matched controls; however, adjusted ORs showed no significant association. Furthermore, the meta-analysis from cohort studies indicated that patients with rosacea have significantly higher risks of developing depression (adjusted incidence rate ratio [IRR], 2.443; 95% CI, 1.603-3.723) and anxiety (adjusted IRR, 2.181; 95% CI, 1.660-2.864). LIMITATIONS: Data for a subgroup analysis based on different demographic factors were insufficient. CONCLUSIONS: Current findings provide more evidence that rosacea is significantly associated with depression and anxiety, and rosacea may predispose patients to develop depression and anxiety. Clinicians should be aware of the psychological aspects of rosacea. PMID:34879261 | DOI:10.1016/j.jad.2021.12.008 {url} = URL to article

J Dermatol. 2021 Dec 1. doi: 10.1111/1346-8138.16254. Online ahead of print. ABSTRACT Topical metronidazole is not currently approved in Japan as a treatment for the indication of rosacea, although 0.75% metronidazole gel was authorized in 2014 for the management of cancerous skin ulcers. We conducted a randomized, double-blind, vehicle-controlled study to evaluate the efficacy and safety of 0.75% metronidazole gel in Japanese patients with inflammatory lesions (papules/pustules) and erythema associated with moderate to severe rosacea. Overall, 130 patients were randomly assigned to receive 0.75% metronidazole gel (n = 65) or vehicle (n = 65), and 120 patients completed 12 weeks of treatment. The primary efficacy outcome was the proportion of patients who achieved both of the following at week 12: an improvement of >50% in the number of inflammatory lesions (papules/pustules) and a positive change of at least one degree in erythema severity. This composite outcome was achieved by 72.3% of metronidazole-treated patients versus 36.9% of vehicle-treated patients, with the between-group difference demonstrating significant improvement with 0.75% metronidazole gel (p < 0.0001). All secondary efficacy endpoints (patients achieving a score of ≥3 for percent change in the number of inflammatory lesions at week 12; patients achieving a score of ≥3 for change in erythema severity at week 12; patients achieving an Investigator's Global Assessment score of 0 or 1 at week 12; percent change over time in the number of inflammatory lesions; change over time in erythema severity) also showed improvement in the 0.75% metronidazole gel group. The incidence of adverse events was higher with metronidazole (40.0%) than with vehicle (29.2%). Of these, treatment-related, treatment-emergent adverse events occurred in 9.2% and 6.2% in the metronidazole and the vehicle group, respectively, but there were no new safety concerns. Overall, the results of this study have confirmed the efficacy and safety of 0.75% metronidazole gel in Japanese patients with rosacea. PMID:34854112 | DOI:10.1111/1346-8138.16254 {url} = URL to article

Postepy Dermatol Alergol. 2021 Oct;38(5):855-857. doi: 10.5114/ada.2020.99367. Epub 2020 Oct 13. ABSTRACT INTRODUCTION: Rhinophyma is a relatively rare form of rosacea, while basal cell carcinoma (BCC) is the most frequent skin cancer in humans - both diseases prevail in the elderly. AIM: To analyse patients with rhinophyma treated surgically in the Dermatosurgery Unit and look for possible cases with BCC within the rhinophyma. MATERIAL AND METHODS: We performed a retrospective review of all treated rhinophymas in the Dermatosurgery Unit in 2004-2019. RESULTS: Among 140 rhinophyma patients 2 (1.4%) subjects with concomitant clinically diagnosed and histologically confirmed BCC were found, with BCC located in the hypertrophic tissue of the nose. There were no patients with BCC located in other anatomical regions of the skin. Both of these patients were in more advanced age. CONCLUSIONS: Taking into consideration these two conditions: advanced age and anatomical location, typical for BCC, one may speculate that the development of BCC within rhinophyma is rather a simple coincidence. However, more numerous series of patients with rhinophyma are needed to clear the controversy of BCC within rhinophyma hypertrophic tissue. PMID:34849134 | PMC:PMC8610061 | DOI:10.5114/ada.2020.99367 {url} = URL to article

Postepy Dermatol Alergol. 2021 Oct;38(5):903-905. doi: 10.5114/ada.2020.94743. Epub 2020 Apr 25. NO ABSTRACT PMID:34849142 | PMC:PMC8610035 | DOI:10.5114/ada.2020.94743 {url} = URL to article

Cutis. 2021 Oct;108(4):E5-E10. doi: 10.12788/cutis.0377. ABSTRACT Noninfectious facial papular granulomas can be the presentation of several conditions, including granulomatous periorificial dermatitis, granulomatous rosacea, lupus miliaris disseminatus faciei, and papular sarcoidosis. Although these entities are treated distinctly from one another, they share several clinical and histological characteristics. We present 2 cases of facial papular granuloma: one patient presented with granulomatous rosacea, and the other had a presentation consistent with sarcoidosis but also demonstrated features of granulomatous periorificial dermatitis and had a protracted course of treatment. Such cases exemplify heterogeneity in the evaluation and management of this cutaneous lesion and highlight the necessity of appreciating its various potential causes. PMID:34847006 | DOI:10.12788/cutis.0377 {url} = URL to article

J Clin Aesthet Dermatol. 2021 Jul;14(7):16-21. Epub 2021 Jul 1. ABSTRACT BACKGROUND: Rosacea is a difficult-to-manage chronic inflammatory skin condition reported to have a negative psychosocial impact on patients. Novel approaches are sought to target the many signs and symptoms of the condition while also improving the quality of life of patients. OBJECTIVE: We assessed the efficacy of the Kleresca® biophotonic platform (KLOX Technologies Inc., Laval, Canada), which creates fluorescent light energy (FLE), to induce a novel form of photobiomodulation for treating rosacea. We also assessed patient satisfaction with their facial appearance and concerns about perceptions of others before and after treatment. METHODS: Nine patients were treated once a week for four weeks with FLE. Patients and the treating clinician completed questionnaires throughout and after the treatment to grade the rosacea signs and symptoms and capture patients' perceptions of the treatment and their condition. RESULTS: FLE significantly reduced the inflammatory erythematous reaction of the face, improved flushing and erythema associated with rosacea, and had a positive impact on patients' self-perception and emotional wellbeing. CONCLUSION: Our results support FLE as an effective, noninvasive treatment modality for rosacea. PMID:34840644 | PMC:PMC8570353 {url} = URL to article More on FLE

J Clin Aesthet Dermatol. 2021 Aug;14(8):14-21. Epub 2021 Aug 1. ABSTRACT Rosacea is one of the most common inflammatory skin diseases in the United States, with a complex pathophysiology. One of the major components of the pathophysiology of rosacea is an abnormal immune detection and response to stimuli. Tetracyclines and their derivatives, including minocycline and doxycycline, have anti-inflammatory properties independent of their antibacterial activity that correlate with certain aspects of the pathophysiology, and these drugs are often used by dermatologists to treat rosacea. Biological actions of tetracyclines correlating with rosacea include anti-inflammatory and antioxidative activities, inhibitory effects on angiogenesis, and proteolysis. The objective of this review is to re-establish the current understanding of tetracyclines and their mechanism of action as they relate to the pathophysiology and treatment of rosacea for clinicians. This includes reviewing the inflammatory aspects of rosacea that correlate with the known nonantibiotic properties of tetracyclines and providing the most up-to-date clinical evidence supporting the use of tetracyclines to treat rosacea. Given the evolving and multifactorial nature of pathophysiology, this review offers clinicians a unified picture that includes research on the links between rosacea pathophysiology and clinical presentation, the nonantibiotic properties of tetracyclines that relate to pathophysiologic pathways in rosacea, and the potential for clinical application of tetracyclines in rosacea therapy. PMID:34840653 | PMC:PMC8570659 {url} = URL to article

Clin Dermatol. 2021 Oct 27:S0738-081X(21)00216-9. doi: 10.1016/j.clindermatol.2021.10.004. Online ahead of print. ABSTRACT Rosacea is a common chronic inflammatory cutaneous disorder, primarily manifesting on the cheeks, nose, chin, and forehead with a classic relapsing-remitting course that affects mostly fair skin types (Fitzpatrick I and II). The pathogenesis remains unclear, but the complex interplay between environmental and genetic factors may augment the innate immune response and neurovascular dysregulation. Different nutrients may play a role in the pathogenesis of rosacea. Many dietary triggers, including hot beverages, alcohol, spicy foods, caffeine, vanilla, cinnamon, niacin, marinated meats, and dairy products, have been postulated for this disease; however, there is a lack of well-designed and controlled studies evaluating the causal relationship between rosacea and dietary factors. We have explored the available evidence and hypotheses based on trigger-food categories of rosacea, the role of the skin-gut microbiome axis, and potentially benefiting dietary factors such as probiotics, prebiotics, and high-fiber diets. PMID:34819228 | DOI:10.1016/j.clindermatol.2021.10.004 {url} = URL to article

Clin Dermatol. 2021 Jul-Aug;39(4):695-700. doi: 10.1016/j.clindermatol.2020.08.006. Epub 2020 Aug 11. ABSTRACT Rosacea is a common inflammatory skin condition with four main clinical subtypes: erythematotelangiectatic, papulopustular, rhinophymatous, and ocular. Although several genetic and environmental factors have been linked with triggering rosacea, the pathogenesis still remains poorly understood. There is an increasing evidence in the literature to support that rosacea is a harbinger of several systemic comorbidities and may represent a chronic, systemic, inflammatory state. We have provided the most up-to-date evidence on the association between rosacea and several systemic diseases, discussing that rosacea is not just a skin disorder but a systemic disease process. PMID:34809774 | DOI:10.1016/j.clindermatol.2020.08.006 {url} = URL to article Systemic Comorbidities in Rosacea

Clin Dermatol. 2021 Jul-Aug;39(4):714-717. doi: 10.1016/j.clindermatol.2021.05.018. Epub 2021 May 19. ABSTRACT Disorders with dermatologic features are intractable and rife in Shakespeare's world. For this reason, they occupy an unusual position in culture. "The plague" and "leprosy" are popular insults and epithets-indictments of not external pathogens but of moral failure. It may be no surprise to identify, as a present-day reader, syphilis and the plague in early modern England, but what about other dermatologic conditions at the time? "The plague," "leprosy," "the pox," and "measles" are commonly used terms, although ultimately interchangeable in Shakespeare's plays. Rosacea and scurvy, however, are described by Shakespeare before they become named entities. Bardolph's skin characterizes his alcohol addiction and thievery, and Caliban's "monstrous" form mirrors his state as an untouchable in society. Shakespeare also documents the "royal touch" in Macbeth, which links the ability of a monarch to heal the skin lesions of extrapulmonary tuberculosisto political legitimacy. Shakespeare does little more than document this historic ritual around the skin, but he does catalogue the ways these acquired diseases of the skin are used in daily speech and character writing. At the end of Macbeth, the "royal touch" gives Prince Malcolm the backstory and political precedent to march on Dunsinane Hill to reclaim the Scottish throne. PMID:34809779 | DOI:10.1016/j.clindermatol.2021.05.018 {url} = URL to article Bardolph's rosacea: skin disorders that define personality in Shakespeare's plays