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J Drugs Dermatol. 2021 Jun 1;20(6):660-664. doi: 10.36849/JDD.2021.5925. ABSTRACT BACKGROUND: Novel, effective, affordable therapies for rosacea are needed. Innovative methods of assessing response for rosacea treatments are needed as well. This trial was designed to evaluate efficacy and safety of ACU-D1, a novel inhibitor of the 26S protea-some for the treatment of moderate to severe rosacea in a first in human pilot study. In addition, this is the first trial to our knowledge to use Canfield imaging to quantitatively assess responses. METHODS: This was a 14-week, randomized, double-blinded, placebo-controlled study, performed at two well established rosacea clini-cal trial sites, which randomized 40 adult subjects with moderate to severe rosacea (Investigator’s Global Assessment [IGA]=3/4) to either ACU-D1 (27) or comparator vehicle (13) twice daily. In addition, Canfield imaging was used to assess responses both qualitatively and quantitatively Results: A total of 39 subjects participated, with 38 completing the study. ACU-D1 displayed efficacy in 92% (25 of 27) of patients in reducing inflammatory lesions and a 2 plus grade IGA reduction of clear to near clear in 27% of patients. There was a trend toward improvement in erythema as well in the active arm. CONCLUSION: This study demonstrates that topical ACU-D1 is safe and well-tolerated by patients in the study and demonstrates efficacy in reducing inflammatory lesions and erythema in patients with rosacea. Improvement was also noted on Canfield imaging, and this modality is likely to be used as an objective measure in the future. Further studies are warranted based on these initial positive results. ClinicalTrials.gov Identifier: NCT03064438 J Drugs Dermatol. 2021;20(6):660-664. doi:10.36849/JDD.5925. PMID:34076401 | DOI:10.36849/JDD.2021.5925 {url} = URL to article

Methods Enzymol. 2021;652:31-48. doi: 10.1016/bs.mie.2021.02.006. Epub 2021 Mar 12. ABSTRACT The transient receptor potential vanilloid-superfamily member 3 (TRPV3) channel is implicated in a variety of physiological processes, including temperature sensing, nociception and itch, maintenance of the skin barrier, wound healing, hair growth, and embryonic development. TRPV3 is also associated with various skin diseases, including Olmsted syndrome, atopic dermatitis, and rosacea. Studies of TRPV3 are of fundamental importance for structural pharmacology aimed at the design of drugs targeting this channel and for understanding the molecular basis of temperature sensing. Here we describe a detailed protocol for expression and purification of chemically pure and stable TRPV3 protein that is suitable for structural and functional characterization of this channel, in particular for cryo-EM sample preparation and high-resolution 3D reconstruction. PMID:34059288 | DOI:10.1016/bs.mie.2021.02.006 {url} = URL to article Ion Channel Theory and Rosacea

J Dermatolog Treat. 2021 May 31:1-21. doi: 10.1080/09546634.2021.1937480. Online ahead of print. ABSTRACT Background: Doxycycline is one of the most prescribed antibiotics by dermatologists. However, the concern regarding adverse events of doxycyline has been rising.Objective: To detect the adverse events of doxycycline using the Korea Adverse Events Reporting System (KAERS) database from January 2014 to December 2018 through a data mining method.Methods: A signal was defined as one satisfying all three indices; a proportional reporting ratio, a reporting odds ratio, and an information component. We further checked whether the detected signals exist in drug labels in Korea and five developed countries, the United States, the United Kingdom, Germany, Canada, and Japan.Results: A total of 3,365,186 adverse event-drug pairs were reported and of which 3,075 were associated with doxycycline. Among the thirty-seven signals, nineteen (malaise, ileus, confusion, malignant neoplasm, ectopic pregnancy, ovarian hyperstimulation, vaginal hemorrhage, bone necrosis, acne, rosacea, seborrheic dermatitis, folliculitis, skin ulceration, crusting, dry skin, paronychia, mottled skin, application site reaction, and application site edema) were not included on any of the drug labels of the six countries.Conclusion: We identified nineteen new doxycycline signals that did not appear on drug labels in six countries. Further studies are warranted to evaluate the causality of the adverse events with doxycycline. PMID:34057876 | DOI:10.1080/09546634.2021.1937480 {url} = URL to article

Curr Drug Res Rev. 2021 May 26. doi: 10.2174/2589977513666210526122909. Online ahead of print. ABSTRACT BACKGROUND: Azelaic acid (AZA) is a white crystalline dicarboxylic acid naturally found in grains, rye and barley. AZA has substantial biological and therapeutic abilities (viz a viz) its anti-inflammatory, anti-oxidant, anti-keratinizing, anti-microbial properties, etc. which contribute to its applicability in the management of mild to harsh dermatological complications (acne, rosacea, dermatitis, hyper-pigmentation, carcinomas, etc.). AZA has shown its effectiveness against varied non-inflammatory and inflammatory lesions by normalizing the hyper-keratinization statie and attenuating the increased levels of microbial content. Topically AZA, either alone or in conjunction with other active moieties, has proved to be effective in preventing acne and several other hyper-pigmentary conditions. OBJECTIVES: Chronic applicability of AZA has been evidenced with the effects like itching, burning, stinging, redness, etc. To deal with the former issues, research is being conducted to substitute the conventional formulations with novel preparations (liposome's, niosomes, micro sponges, lipid nanocarriers, etc.), which could enhance the overall pharmaceutical and pharmacological profile of the drug. CONCLUSION: This article is an attempt to highlight the basic physiochemical properties of AZA, its physiological role (especially in dermatology), various commercial preparations and recent novel approaches that are in research with an aim to augment the therapeutic and safety profile of AZA. PMID:34042044 | DOI:10.2174/2589977513666210526122909 {url} = URL to article More information on AZA

Mol Vis. 2021 May 13;27:323-353. eCollection 2021. ABSTRACT Rosacea is a chronic inflammatory disease that affects the face skin. It is clinically classified into the following four subgroups depending on its location and severity: erythematotelangiectatic, papulopustular, phymatous, and ocular. Rosacea is a multifactorial disease triggered by favoring factors, the pathogenesis of which remains imperfectly understood. Recognized mechanisms include the innate immune system, with the implication of Toll-like receptors (TLRs) and cathelicidins; neurovascular deregulation involving vascular endothelial growth factor (VEGF), transient receptor potential (TRP) ion channels, and neuropeptides; and dysfunction of skin sebaceous glands and ocular meibomian glands. Microorganisms, genetic predisposition, corticosteroid treatment, and ultraviolet B (UVB) radiation are favoring factors. In this paper, we review the common and specific molecular mechanisms involved in the pathogenesis of cutaneous and ocular rosacea and discuss laboratory and clinical studies, as well as experimental models. PMID:34035646 | PMC:PMC8131178 {url} = URL to article More information on Phenotype 6 - Ocular Manifestations

Bioeng Transl Med. 2020 Oct 31;6(2):e10191. doi: 10.1002/btm2.10191. eCollection 2021 May. ABSTRACT Choline geranate deep eutectic solvent/ionic liquid (CAGE) has shown several desirable therapeutic properties including antimicrobial activity and ability to deliver drugs transdermally in research laboratories. Here, we describe the first report of clinical translation of CAGE from the lab into the clinic for the treatment of rosacea, a common chronic inflammatory skin disorder that affects the face. We describe the seven steps of clinical translation including (a) scale-up, (b) characterization, (c) stability analysis, (d) mechanism of action, (e) dose determination, (f) GLP toxicity study, and (g) human clinical study. We describe the challenges and outcomes in these steps, especially those that uniquely arise from the deep eutectic nature of CAGE. Our translational efforts led to a 12-week open-label phase 1b cosmetic study with CAGE1:2 gel (CGB400) in mild-moderate facial rosacea in 26 patients where CGB400 exhibited a marked reduction in the number of inflammatory lesions. These results demonstrate the therapeutic potential of CGB400 for treating rosacea as well as it provides insights into the translational journey of deep eutectic solvents, in particular CAGE, for dermatological applications. PMID:34027084 | PMC:PMC8126811 | DOI:10.1002/btm2.10191 {url} = URL to article

Mil Med. 2021 May 24:usab208. doi: 10.1093/milmed/usab208. Online ahead of print. ABSTRACT In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use. PMID:34027971 | DOI:10.1093/milmed/usab208 {url} = URL to article More information on minocycline for rosacea

Phys Ther. 2021 May 17:pzab133. doi: 10.1093/ptj/pzab133. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this case report was to describe the use of complete decongestive therapy (CDT) with a new approach in the management of a male patient with facial edema related to Morbus Morbihan Syndrome (MMS). METHODS: An 18-year-old male patient with MMS after acne treatment was the subject of this case report. Volume assessment was performed with distance measurements of the facial area using standard reference points, the overflow method, and the measurement of the percentage of subdermal fluid. Patient-reported symptoms of lymphedema (feeling of swelling and tightness) and body image perception were evaluated with the "Visual Analogue Scale (VAS)", and the severity of anxiety was evaluated with the "State and Trait Anxiety Inventory (STAI)". In addition, the patient's perception of improvement was determined using a Likert-type scale. Evaluations were performed at baseline, week-4 (during the treatment) and week-8 (immediately after treatment). CDT was applied to the patient in a total of 24 sessions, 3 days a week for 8 weeks. RESULTS: Compared to the baseline measurement, the facial distances (tragus-mental cavity, tragus-mouth corner, mandibula-nasal canal, mandibula-internal orbita, mandibula-external orbita, mental cavity-internal orbita, mental cavity-mandibula, right-left tragus, and hairline in the forehead-mental cavity), the volume and the percentage of subdermal fluid of facial area were found to be decreased at the 4th and 8th week measurements. The anxiety score, patient reports of feelings of swelling and tightness, and body image perception improved after the 8-weeks of treatment compared to baseline. CONCLUSION: This case report described the use of CDT in treating edema and patient symptoms in a patient with facial lymphedema related to MMS. Body image and level of anxiety improved. PMID:34003282 | DOI:10.1093/ptj/pzab133 {url} = URL to article More information on Morbihan Disease (Rosacea Variant)

Cureus. 2021 Apr 12;13(4):e14443. doi: 10.7759/cureus.14443. ABSTRACT The long-term use of topical corticosteroids can result in rosacea-like dermatitis or facial perioral dermatitis. The case of a 54-year-old man is described who developed topical corticosteroid-induced perioral dermatitis (TOP STRIPED), and the features of topical corticosteroid-induced rosacea-like dermatitis are reviewed. The man presented with a painful erythematous facial eruption. Additional history revealed that he had been applying a high-potency topical corticosteroid twice daily to the affected area. Correlation of the clinical history and cutaneous examination established a diagnosis of topical corticosteroid-induced rosacea-like dermatitis (TOP SIDE RED). Treatment of the patient's TOP SIDE RED included not only discontinuing the high-potency corticosteroid but also initiating topical and oral antibiotics. In addition, a low-potency topical corticosteroid and metronidazole gel were also applied to the affected area. His facial rash resolved within three months and has not recurred. TOP STRIPED, also referred to as TOP SIDE RED, is an adverse side effect associated with the use of high-potency topical corticosteroids to the face. Management includes discontinuing the corticosteroid. Additional treatment may include a low-potency topical corticosteroid, antibiotics (systemic or topical or both), and/or topical calcineurin inhibitors, such as tacrolimus or pimecrolimus. PMID:33996307 | PMC:PMC8115187 | DOI:10.7759/cureus.14443 {url} = URL to article More Information on Steroid Rosacea

Br J Dermatol. 2021 May 15. doi: 10.1111/bjd.20485. Online ahead of print. ABSTRACT The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of rosacea. The document aims to: offer an appraisal of all relevant literature up to February 2020 focusing on any key developments address important, practical clinical questions relating to the primary guideline objective provide guideline recommendations and if appropriate research recommendations. PMID:33993465 | DOI:10.1111/bjd.20485 {url} = URL to article

Dermatol Ther. 2021 May 16:e14986. doi: 10.1111/dth.14986. Online ahead of print. ABSTRACT Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared to 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. 40 mg/week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50-90% improvement) in additional 29.2% of patients. 20 mg/week isotretinoin and 100 mg/day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs. 8.3% and partial response of 28.6% vs. 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease. This article is protected by copyright. All rights reserved. PMID:33993601 | DOI:10.1111/dth.14986 {url} = URL to article More information on low dose isotretinoin

Clin Exp Dermatol. 2021 May 13. doi: 10.1111/ced.14731. Online ahead of print. ABSTRACT BACKGROUND: Dermoscopic findings of papulopustular rosacea include follicular plugs, white scales and follicle dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators mainly found in primary demodicosis and, less frequently, in rosacea. AIM: The aim of this study was to describe the dermoscopic features of papulopustular rosacea and investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. METHODS: We conducted a prospective study of subjects affected by almost clear, mild and moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. RESULTS: Out of a group of 60 patients, the most frequent dermoscopic findings were: yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea showed more Demodex follicular openings compared to patients with mild rosacea (p=0.016). Patients affected by mild rosacea showed more frequent follicular scales than patients with almost clear rosacea (p=0.007). Moreover, patients with moderate rosacea showed more Demodex follicular openings (p=0.018), follicular scales (p<0.0001), honeycomb pigment pattern (p=0.001) and follicular pustules ( p<0.0001) than patients with almost clear rosacea. No significant dermoscopic differences were observed between patients with and without concomitant Demodex infestation. CONCLUSIONS: Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not the best method for the diagnosis of Demodex mites proliferation in rosacea. Methods for Quantifying Demodex Mites PMID:33987859 | DOI:10.1111/ced.14731 {url} = URL to article

J Cosmet Dermatol. 2021 May 10. doi: 10.1111/jocd.14209. Online ahead of print. ABSTRACT BACKGROUND: Treatment options for erythematotelangiectatic rosacea (ETR) are still scarce. Tranexamic acid (TXA) is an antifibrinolytic drug that was recently used for the treatment of ETR. AIMS: to evaluate the efficacy and safety of intradermal microinjections of TXA for ETR. PATIENTS/METHODS: This was a retrospective study enrolling patients, treated with TXA intradermal microinjections for ETR, from January 2019 to February 2020. Response to treatment was assessed based on subjective symptoms, clinical photographs and the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS). RESULTS: Six patients were included. The mean number of monthly intradermal TXA microinjections was 5.1±1.3. The mean decrease of IGA-RSS was 2.4±0.5. Local side effects, mainly transient erythema and swelling, were noticed in three cases. No systemic effects were noted. Clinical improvement, in respondent patients, lasted after 3 months of follow-up. CONCLUSION: Intradermal TXA microinjections is a safe and effective treatment option for ETR. The optimal number of monthly sessions has yet to be determined. PMID:33973361 | DOI:10.1111/jocd.14209 {url} = URL to article More information on TXA

J Dermatol. 2021 May 9. doi: 10.1111/1346-8138.15910. Online ahead of print. ABSTRACT Demodex folliculorum and brevis are commensal mites that live in low densities in human pilosebaceous follicles as part of the normal adult microbiota, but that give rise to demodicosis and, possibly, rosacea, when they proliferate excessively. This proliferation is favored by various factors, including age, marked immunosuppression, sebaceous gland hyperplasia, and hypervascularization-related factors. To study possible factors influencing mite proliferation, we explored the effects of different variables on Demodex densities (Dd) in a retrospective study of two groups of subjects selected on the basis of their clinical diagnosis: Demodex+, consisting of subjects with demodicosis or with centro-facial papulopustules suggesting rosacea (n = 844, mean Dd 263.5 ± 8.9 D/cm2 ), and Demodex-, consisting of subjects with other facial dermatoses or healthy facial skin (n = 200, mean Dd 2.3 ± 0.4 D/cm2 ). Demodex densities were measured using two consecutive standardized skin surface biopsies (SSSB1 [superficial] and SSSB2 [deep]) taken from the same facial site on each subject. In the Demodex+ group: the SSSB1 decreased with age in women (p = 0.004), and the SSSB2 increased with age in men (p = 0.001) (the pattern was similar for SSSB1 + 2, but not statistically significant); Dds were lower in those who had received cortisone (either topically or systemically); 13 subjects (1.5%) had known immunosuppression, 62 (7.3%) had hypothyroidism, and in 20 (3.6% of the women) there was a reported link with pregnancy; 78 of the subjects (9.2%) were part of a pair from the same family or household; when associated bacterial infection was suspected, Staphylococcus epidermidis was often isolated. Our results suggest close interactions between the mite, sebaceous gland size and function, and subtle variations of immune status. Potential factors influencing Demodex proliferation should be further investigated, including hypothyroidism, pregnancy, corticosteroid administration, Staphylococcus epidermidis, contagiousity, and genetic background. PMID:33969532 | DOI:10.1111/1346-8138.15910 {url} = URL to article

Clin Cosmet Investig Dermatol. 2021 Apr 30;14:407-417. doi: 10.2147/CCID.S307013. eCollection 2021. ABSTRACT BACKGROUND: Rosacea is a chronic skin disorder characterized by erythema, flushing, telangiectasia, papules and pustules, phymatous changes, and ocular involvement. The aim of this study was to examine all published research articles in which botulinum toxin was used to treat rosacea and to evaluate the efficacy and safety of this treatment. METHODS: PubMed, Embase, Cochrane Library, and Web of Science database were used to identify articles eligible for systematic review on March 26, 2021. Prospective or retrospective studies which directly used botulinum toxin to treat rosacea were included and reviewed. RESULTS: Nine studies were included in this systematic review. Two were randomized controlled trials, graded as Level 2 for the quality of evidence. The total number of participants was 130, and the number of participants in each study ranged from 1 to 25. The improvement was observed in all studies in signs and symptoms compared with baseline. Adverse events were transitory and self-limited. CONCLUSION: Botulinum toxin could have overall satisfying efficacy and safety in the treatment of rosacea, though limited by small sample size, imperfect study design, and short follow-up visits. PMID:33958886 | PMC:PMC8096341 | DOI:10.2147/CCID.S307013 {url} = URL to article More information on Botox for Rosacea

J Allergy Clin Immunol. 2021 May 3:S0091-6749(21)00721-1. doi: 10.1016/j.jaci.2021.03.049. Online ahead of print. ABSTRACT Cutaneous mast cells (MCs) express Mas-related G protein-coupled receptor-X2 (MRGPRX2; mouse ortholog MrgprB2), which is activated by an ever-increasing number of cationic ligands. Antimicrobial host defense peptides (HDPs) generated by keratinocytes contribute to host defense likely by two mechanisms; one involving direct killing of microbes and the other via MC activation through MRGPRX2. However, its inappropriate activation may cause pseudoallergy and likely contribute to the pathogenesis of rosacea, atopic dermatitis, allergic contact dermatitis, urticaria and mastocytosis. Gain- and loss-of-function missense single nucleotide polymorphisms in MRGPRX2 have been identified. The ability of certain ligands to serve as balanced or G protein-biased agonists have been defined. Small molecule HDP mimetics have been developed that display both direct antimicrobial activity and activate MCs via MRGPRX2. In addition, antibodies and reagents have been generated that modulate MRGPRX2 expression and signaling. In this article, we provide a comprehensive update on MrgprB2 and MRGPRX2 biology. We propose that harnessing MRGPRX2's host defense function by small molecule HDP mimetics may provide a novel approach for the treatment of antibiotic-resistant cutaneous infections. By contrast, MRGPRX2-specific antibodies and inhibitors could be utilized for the modulation of allergic and inflammatory diseases that are mediated via this receptor. PMID:33957166 | DOI:10.1016/j.jaci.2021.03.049 {url} = URL to article More information on Mast Cells and the Innate Immune System Disorder

Int J Dermatol. 2021 May 5. doi: 10.1111/ijd.15570. Online ahead of print. NO ABSTRACT PMID:33951183 | DOI:10.1111/ijd.15570 {url} = URL to article

JAAD Case Rep. 2021 Apr 2;11:106-108. doi: 10.1016/j.jdcr.2021.03.033. eCollection 2021 May. NO ABSTRACT PMID:33948471 | PMC:PMC8081872 | DOI:10.1016/j.jdcr.2021.03.033 {url} = URL to article

Front Med (Lausanne). 2021 Apr 16;8:626369. doi: 10.3389/fmed.2021.626369. eCollection 2021. ABSTRACT Background: Numerous studies have attempted to apply artificial intelligence (AI) in the dermatological field, mainly on the classification and segmentation of various dermatoses. However, researches under real clinical settings are scarce. Objectives: This study was aimed to construct a novel framework based on deep learning trained by a dataset that represented the real clinical environment in a tertiary class hospital in China, for better adaptation of the AI application in clinical practice among Asian patients. Methods: Our dataset was composed of 13,603 dermatologist-labeled dermoscopic images, containing 14 categories of diseases, namely lichen planus (LP), rosacea (Rosa), viral warts (VW), acne vulgaris (AV), keloid and hypertrophic scar (KAHS), eczema and dermatitis (EAD), dermatofibroma (DF), seborrheic dermatitis (SD), seborrheic keratosis (SK), melanocytic nevus (MN), hemangioma (Hem), psoriasis (Pso), port wine stain (PWS), and basal cell carcinoma (BCC). In this study, we applied Google's EfficientNet-b4 with pre-trained weights on ImageNet as the backbone of our CNN architecture. The final fully-connected classification layer was replaced with 14 output neurons. We added seven auxiliary classifiers to each of the intermediate layer groups. The modified model was retrained with our dataset and implemented using Pytorch. We constructed saliency maps to visualize our network's attention area of input images for its prediction. To explore the visual characteristics of different clinical classes, we also examined the internal image features learned by the proposed framework using t-SNE (t-distributed Stochastic Neighbor Embedding). Results: Test results showed that the proposed framework achieved a high level of classification performance with an overall accuracy of 0.948, a sensitivity of 0.934 and a specificity of 0.950. We also compared the performance of our algorithm with three most widely used CNN models which showed our model outperformed existing models with the highest area under curve (AUC) of 0.985. We further compared this model with 280 board-certificated dermatologists, and results showed a comparable performance level in an 8-class diagnostic task. Conclusions: The proposed framework retrained by the dataset that represented the real clinical environment in our department could accurately classify most common dermatoses that we encountered during outpatient practice including infectious and inflammatory dermatoses, benign and malignant cutaneous tumors. PMID:33937279 | PMC:PMC8085301 | DOI:10.3389/fmed.2021.626369 {url} = URL to article More information on Tests to Differentiate Rosacea

Arch Dermatol Res. 2021 May 2. doi: 10.1007/s00403-021-02225-y. Online ahead of print. ABSTRACT Although various treatments have been proposed for the management of rosacea, achieving complete remission of persistent erythema remains challenging. Short-wave radiofrequency (SWRF) treatment has been shown to repair skin barriers and reduce chronic inflammation. However, limited studies have evaluated the effectiveness of SWRF treatment for erythematotelangiectatic rosacea (ETR). A prospective, open-label pilot study using SWRF therapy was conducted on 30 patients with mild-to-moderate ETR. During the first stage, the patients underwent a single, full-face treatment and were evaluated before and after the session, as well as on the 7th and 15th day post-treatment. During the second stage, ten treatment sessions were administered, and the patients were evaluated before and after the tenth session, as well as 1 month after the treatment. Adverse events were recorded during each treatment session, and the patients were followed up for 3 months after the last session. Twenty-eight patients completed the entire trial. On the 7th day after the single treatment, the global score (total score of flushing, persistent erythema, and telangiectasia) of ETR improved from 5.23 ± 1.09 to 4.00 ± 0.76 relative to the baseline value (p < 0.05); moreover, the overall treatment satisfaction improved from 7.27 ± 0.89 to 4.90 ± 0.91 (p < 0.05). 1 month after the tenth treatment session, the global score improved from 5.30 ± 1.01 to 3.85 ± 0.93 (p < 0.05), and the overall treatment satisfaction improved from 7.13 ± 0.85 to 5.17 ± 1.19 (p < 0.05). During the 3 month follow-up period, there were two cases of recurrence. Therefore, this report indicates that SWRF might be an effective auxiliary treatment for mild-to-moderate ETR. PMID:33934172 | DOI:10.1007/s00403-021-02225-y {url} = URL to article Etcetera Radiofrequency (RF) for Rosacea

J Cosmet Dermatol. 2021 Apr;20 Suppl 1:28-31. doi: 10.1111/jocd.14098. ABSTRACT BACKGROUND: Topical azelaic acid (AzA) is a common treatment for mild/moderate inflammatory rosacea. AIMS: To assess the efficacy and tolerability of a novel formulation cream containing 15% AzA (anti-inflammatory/anti-oxidant/anti-microbial agent) combined with 1% dihydroavenanthramide D (anti-inflammatory/anti-itch) in inflammatory rosacea using clinical/instrumental evaluation. METHODS: In this multicentre, prospective, open-label trial, 45 patients with mild/moderate inflammatory rosacea enrolled at the Dermatology Clinic of the University of Catania, Naples, and Rome (Italy) were instructed to apply the cream twice daily for 8 weeks. Clinical evaluation was performed at baseline (T0) and at 8 weeks (T1) by (1) Investigator Global Assessment (IGA) score based on a 5-point scale (from 0 = clear/no erythema/papules/pustules to 4 = severe erythema/several papules/pustules) and (2) inflammatory lesions count. Instrumental evaluation of erythema degree was performed by erythema-directed digital photography (EDDP) by a 5-point scale (from 0 = no redness to 4 = severe redness) at all time points. Tolerability was assessed by a self-administered questionnaire at 8 weeks. Statistical analysis was performed using SAS version 9. RESULTS: Forty-four patients completed the study. At week 8, a significant decrease in baseline of IGA scores [median from 3 (T0) to 1 (T1)] and inflammatory lesions count [median from 8 (T0) to 1 (T1)] was recorded along with a significant reduction of erythema scores [median from 2 (T0) to 1 (T1)]. No relevant side effects were recorded. CONCLUSIONS: Our results suggest that this new non-irritating product represents a valid therapeutic option for mild/moderate inflammatory rosacea, and EDDP is able to provide a more defined evaluation of erythema changes. PMID:33934475 | DOI:10.1111/jocd.14098 {url} = URL to article Etcetera More on Azelaic Acid

J Am Acad Dermatol. 2021 Apr 28:S0190-9622(21)00921-X. doi: 10.1016/j.jaad.2021.04.076. Online ahead of print. NO ABSTRACT PMID:33932536 | DOI:10.1016/j.jaad.2021.04.076 {url} = URL to article

Ann R Coll Surg Engl. 2021 May;103(5):e165-e168. doi: 10.1308/rcsann.2020.7081. ABSTRACT Rhinophyma affects predominantly the Caucasian population and is rare in those with Fitzpatrick skin type IV-VI. Diagnosis is based on clinical evaluation. Prominent features include abnormal coloration and texture of skin, impaired vascularity, irregular nodular exophytic growth and telangiectasia. Management can be surgical or dermatological. Surgery remains the mainstay of treatment but achieving an acceptable aesthetic result can be challenging, particularly in those with pigmented skin. Postsurgical hyper- and hypopigmentation make for unpredictable outcomes requiring appropriate preoperative counselling. We present a case that exemplifies this issue and discuss our recommended approach to counselling, consenting and managing such dilemmas in these patients, and a proposal for further investigation into the role of autologous melanocyte transplantation in reducing the effect particularly of hypopigmentation on aesthetic outcomes in this group. PMID:33930281 | DOI:10.1308/rcsann.2020.7081 {url} = URL to article Treatment for Phenotype 5

Ann Dermatol. 2020 Jun;32(3):189-196. doi: 10.5021/ad.2020.32.3.189. Epub 2020 Apr 24. ABSTRACT BACKGROUND: Rosacea is a common skin disease associated with increased expression of cathelicidin, kallikrein 5 (KLK5), toll-like receptor (TLR) 2, and abnormal barrier function. Recently, it was reported that hyaluronan (HA) could influence immune function via various receptors and HA oligosaccharides (oligo-HAs) could suppress TLR-dependent cytokine expression. OBJECTIVE: We investigated if oligo-HAs could influence on inflammation and epidermal barrier induced by LL-37, which had a major role in rosacea. METHODS: We cultured normal human keratinocytes and treated them with LL-37 and oligo-HAs or the LL-37 alone. A rosacea-like BALB/c mouse model injected with LL-37 was used to determine the role of oligo-HAs in rosacea in vivo. RESULTS: Interleukin-8 (IL-8) and tumor necrosis factor (TNF)-α release was suppressed when keratinocytes were co-treated with oligo-HAs and LL-37 compared with keratinocytes treated with LL-37 only. Treatment with oligo-HAs resulted in decreased transepidermal water loss as well as improved redness. Decreased inflammatory cell infiltration, IL-17A and KLK5 expression and increased CD44 and filaggrin expression were also noted. CONCLUSION: Our findings suggest that oligo-HA improves rosacea-like phenotype through anti-inflammatory and epidermal barrier improving effect. PMID:33911737 | PMC:PMC7992622 | DOI:10.5021/ad.2020.32.3.189 {url} = URL to article

Ann Dermatol. 2020 Jun;32(3):247-250. doi: 10.5021/ad.2020.32.3.247. Epub 2020 Apr 24. ABSTRACT Rosacea is a chronic inflammatory skin disease of unknown etiology. We noticed a series of patients who were diagnosed with rosacea as well as obstructive sleep apnea syndrome (OSAS), for which they used a continuous positive airway pressure (CPAP) mask. This case series aims to give insight in the possible relationship between rosacea and the use of a CPAP mask for OSAS. We present five patients with OSAS who developed or worsened rosacea symptoms after use of a CPAP mask covering nose and mouth. Two patients showed centrofacial symptoms consistent with the shape of the CPAP mask; three patients had nasal cutaneous symptoms. It is postulated that the occlusive effect of the CPAP mask, increasing skin humidity and temperature, can induce primary symptoms in patients with an underlying sensibility for rosacea. This could have implications for choice of CPAP mask type and topical therapeutic options for rosacea. PMID:33911746 | PMC:PMC7992619 | DOI:10.5021/ad.2020.32.3.247 {url} = URL to article