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Case Rep Dermatol. 2021 Feb 16;13(1):121-128. doi: 10.1159/000511984. eCollection 2021 Jan-Apr. ABSTRACT We present 2 cases of rosacea that were successfully managed with off-label treatment. The first is a case of painful, exuding papulopustular lesions of the nose treated with rifaximin, and the other is a case of severe, debilitating and painful flushing treated with sumatriptan. The cases support previous notions that gastrointestinal comorbidities may be related to papulopustular lesions and that flushing may be related to neurogenic inflammation and migraine. The cases also imply that a new approach to rosacea management, based on endotypes and comorbidities, may be warranted. "Interestingly, infusion of CGRP in patients with migraine induces flushing and can trigger migraine attacks. The anti-migraine drug sumatriptan has been found to block release of CGRP, which may explain the effect in the presented case." PMID:33790755 | PMC:PMC7989675 | DOI:10.1159/000511984 {url} = URL to article • Full Text Sumatriptan has been added to the list of prescription treatments for flushing avoidance

J Cosmet Dermatol. 2021 Mar 31. doi: 10.1111/jocd.14116. Online ahead of print. ABSTRACT INTRODUCTION: Minéral 89 (M89), comprised of 89% Vichy mineralizing water and hyaluronic acid, has been formulated to help strengthen and restore skin barrier. AIM: Assess tolerance and efficacy of M89 in post-aesthetic procedures and dry skin-related facial dermatoses. METHOD: Adults post-aesthetic procedure or presenting with inflammatory dermatoses (47 subjects; mean age 40.9 ± 13.2 years; any Fitzpatrick or skin phototype), applied M89 for 4 weeks, once or twice daily, as an adjuvant treatment. Information on clinical signs and subject-reported symptoms, skin characteristics, tolerance, and subject and investigator satisfaction were collected. RESULTS: Following 4 weeks of M89 use, significant decreases with complete resolution of erythema (27.6%), desquamation (29.8%), irritation (32%), and skin dehydration (35.8%), as compared to baseline signs and symptoms, were observed. Overall grading improvements for erythema (84.8%; p < 0.001), desquamation (91.7%; %; p < 0.003), irritation (91.7%; %; p < 0.015), and skin hydration (46.2%; p < 0.015) were noted. There was no significant improvement in papules and pustules. Evaluation of subjective signs demonstrated significant decreases in skin sensations such as burning (-73%; p < 0.0001), itching (-71%; p < 0.0001), stinging-tingling (-66.7%; p < 0.0001), as well as in skin dryness (-60%; p < 0.0001). M89 texture was rated very pleasant by 90% of patients. Investigators assessed M89 tolerance to be either good or very good (93%), and satisfactory or highly satisfactory impact on patient's skin (91.5%). CONCLUSION: M89 is a highly tolerable adjuvant treatment that significantly improved clinical signs and symptoms related to a compromised skin barrier in various facial dermatoses and post-aesthetic procedures. PMID:33786979 | DOI:10.1111/jocd.14116 {url} = URL to article

Ophthalmology. 2021 Mar 27:S0161-6420(21)00235-9. doi: 10.1016/j.ophtha.2021.03.030. Online ahead of print. ABSTRACT OBJECTIVE: Certain systemic conditions are reported to be risk factors for dry eye disease (DED), but their associations with DED severity are not well-studied. We evaluated whether systemic conditions reported to be DED risk factors are associated with severity of DED signs and symptoms. DESIGN: Secondary analysis of data from the DREAM Study, a large-scale multi-center randomized clinical trial of patients with moderate-to-severe DED. SUBJECTS: 535 adult patients with moderate-to-severe DED from 27 US centers. METHODS: Patients reported their medical history at baseline. They underwent ocular surface exams and symptom evaluation using standardized protocols at baseline, 6 months, and 12 months. We analyzed the associations of systemic conditions (a systemic disease or smoking history) reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models adjusted by age, sex, race, and visit. To be included, conditions had at least 25 patients. MAIN OUTCOME MEASURES: DED symptoms assessed using the Ocular Surface Disease Index (OSDI), six DED signs (tear break-up time, anesthetized Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining, tear osmolarity, and meibomian gland dysfunction), and a composite signs severity score with range 0-1 (1 most severe) calculated from the six DED signs. RESULTS: The mean±SD age was 58±13.2 years, and 81% were female. More severe DED signs were significantly associated with Sjögren's syndrome (mean±SD of composite signs severity score: 0.52±0.17 with disease vs. 0.43±0.13 without disease, p<0.001), facial rosacea (0.47±0.13 vs. 0.43±0.13, p=0.002), rheumatoid arthritis (0.47±0.14 vs. 0.42±0.12, p=0.002), peripheral artery disease (0.50±0.14 vs. 0.43±0.13, p<0.001), and daily smoking history (0.45±0.13 vs. 0.43±0.13, p=0.047). Thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, and hypertriglyceridemia were not significantly associated with DED signs. No conditions were significantly associated with OSDI. CONCLUSION: In this large, well-characterized cohort of DED patients assessed under standardized procedures, patients with certain systemic diseases and smoking had more severe DED signs compared to patients without the condition. The profile of significant DED signs varied by systemic condition, reflecting different DED etiologies. Understanding the systemic conditions and underlying etiologies that predispose some patients to severe DED can improve management. PMID:33785415 | DOI:10.1016/j.ophtha.2021.03.030 {url} = URL to article Other Systemic Cormorbidities in Rosacea

Clin Case Rep. 2021 Jan 18;9(3):1462-1465. doi: 10.1002/ccr3.3803. eCollection 2021 Mar. ABSTRACT Keratosis lichenoides chronica (KLC) is a rare dermatosis which represents different clinical characteristics between adult- and pediatric-onset cases. We described a childhood case of KLC with features typical for adult-onset disease. Acitretin led to partial improvement of her skin, but not mucosal, lesions. PMID:33768868 | PMC:PMC7981629 | DOI:10.1002/ccr3.3803 {url} = URL to article

PLoS One. 2021 Mar 24;16(3):e0248650. doi: 10.1371/journal.pone.0248650. eCollection 2021. ABSTRACT BACKGROUND: Acne vulgaris and rosacea are common inflammatory complications of the skin, both characterized by abnormal infiltration of immune cells. The two diseases can be differentiated based on characteristic profile of the immune cell infiltrates at the periphery of disease lesions. In addition, dysregulated infiltration of immune cells not only occur in the acne lesions but also in non-lesional areas of patients with the disease, thus characterizing the immune infiltration in these sites can further enhance our understanding on the pathogenesis of acne. METHODS: Five microarray data-sets (GSE108110, GSE53795, GSE65914, GSE14905 and GSE78097) were downloaded from Gene Expression Omnibus. After removing the batch effects and normalizing the data, we applied the CIBERSORT algorithm combined with signature matrix LM22, to describe 22 types of immune cells' infiltration in acne less than 48 hour (H) old, in comparation with non-lesional skin of acne patients, healthy skin and rosacea (including erythematotelangiectatic rosacea, papulopustular rosacea and phymatous rosacea) and we compared gene expression of Th1 and Th17-related molecules in acne, rosacea and healthy control. RESULTS: Compared with the non-lesional skin of acne patients, healthy individuals and rosacea patients, there is a significant increase in infiltration of neutrophils, monocytes and activated mast cells around the acne lesions, less than 48 H after their development. Contrarily, few naive CD4+ T cells, plasma cells, memory B cells and resting mast cells infiltrate acne sites compared to the aforementioned groups of individuals. Moreover, the infiltration of Regulatory T cells (Tregs) in acne lesions is substantially lower, relative to non-lesional sites of acne patients and skin of healthy individuals. In addition, non-lesional sites of acne patients exhibit lower infiltration of activated memory CD4+ T cells, plasma cells, memory B cells, M0 macrophages, neutrophils, resting mast cells but higher infiltration of Tregs and resting dendritic cells relative to skin of healthy individuals. Intriguingly, we found that among the 3 rosacea subtypes, the immune infiltration profile of papulopustular rosacea is the closest to that of acne lesions. In addition, through gene expression analysis of acne, rosacea and skin tissues of healthy individuals, we found a higher infiltration of Th1 and Th17 cells in acne lesions, relative to non-lesional skin areas of acne patients. CONCLUSIONS: Our study provides new insights into the inflammatory pathogenesis of acne, and the difference between acne and rosacea, which helps in differentiating the two diseases. Our findings also guide on appropriate target therapy of the immune cell infiltrates in the two disease conditions. PMID:33760854 | DOI:10.1371/journal.pone.0248650 {url} = URL to article

Hautarzt. 2021 Mar 24. doi: 10.1007/s00105-021-04793-6. Online ahead of print. ABSTRACT The case of a 32-year-old female with ulcerative colitis who developed severe papulopustular dermatitis while undergoing treatment with the Janus kinase (JAK) inhibitor tofacitinib. Despite intensive topical therapy, treatment with oral corticosteroids and oral doxycycline was unable to achieve sufficient improvement. Hence, tofacitinib treatment needed to be discontinued. It is well known that the class of JAK inhibitors can cause infectious and allergic cutaneous side effects. However, sterile papulopustular dermatitis as a side-effect has rarely been reported to date. PMID:33760960 | DOI:10.1007/s00105-021-04793-6 {url} = URL to article Full Text

Am J Clin Dermatol. 2021 Mar 23. doi: 10.1007/s40257-021-00595-7. Online ahead of print. ABSTRACT Rosacea is a chronic inflammatory dermatosis mainly affecting the cheeks, nose, chin, and forehead. Rosacea is characterized by recurrent episodes of flushing or transient erythema, persistent erythema, phymatous changes, papules, pustules, and telangiectasia. The eyes may also be involved. Due to rosacea affecting the face, it has a profound negative impact on quality of life, self-esteem, and well-being. In addition to general skin care, there are several approved treatment options available for addressing these features, both topical and systemic. For some features, intense pulse light, laser, and surgery are of value. Recent advances in fundamental scientific research have underscored the roles of the innate and adaptive immune systems as well as neurovascular dysregulation underlying the spectrum of clinical features of rosacea. Endogenous and exogenous stimuli may initiate and aggravate several pathways in patients with rosacea. This review covers the new phenotype-based diagnosis and classification system reflecting pathophysiology, and new and emerging treatment options and approaches. We address new topical and systemic formulations, as well as recent evidence on treatment combinations. In addition, ongoing studies investigating novel therapeutic interventions will be summarized. PMID:33759078 | DOI:10.1007/s40257-021-00595-7 {url} = URL to article

J Invest Dermatol. 2021 Mar 18:S0022-202X(21)01009-5. doi: 10.1016/j.jid.2021.02.745. Online ahead of print. ABSTRACT Rosacea is a chronic inflammatory skin disease characterized by immune response-dependent erythema and pustules. Although the precise etiology of rosacea remains elusive, its pathogenesis is reportedly associated with an increased level of antimicrobial peptide LL-37. However, molecular mechanisms underlying the progression of rosacea via LL-37 remain poorly understood. Here, we examined the potential role of LL-37 in rosacea-like skin inflammatory phenotypes at a molecular level. Our in vitro data demonstrated that LL-37 promotes NLRP3-mediated inflammasome activation in lipopolysaccharide-primed macrophages, indicated by the processing of caspase-1 and interleukin-1β. LL-37 was internalized into the cytoplasm of macrophages through P2X7 receptor-mediated endocytosis. Intracellular LL-37 triggered the assembly and activation of NLRP3-ASC inflammasome complex by facilitating lysosomal destabilization. Consistent with these in vitro results, intradermal LL-37 administration induced in vivo caspase-1 activation and ASC speck formation in the skin of Nlrp3-expressing but not in Nlrp3-deficient mice. Interestingly, intradermal injection of LL-37 elicited profound recruitment of inflammatory Gr1+ cells and subsequent skin inflammation. However, LL-37-induced rosacea-like skin inflammation was significantly abrogated in Nlrp3-deficient mice. Furthermore, NLRP3-specific inhibitor, MCC950, markedly reduced LL-37-triggered rosacea-like phenotypes. Taken together, our findings clearly indicate that NLRP3 inflammasome activation plays a crucial role in LL-37-induced skin inflammation and rosacea pathogenesis. PMID:33745908 | DOI:10.1016/j.jid.2021.02.745 {url} = URL to article Etcetera Cathelicidin Peptide LL-37 and Vitamin D3 Cathelicidin

Int Immunopharmacol. 2021 Mar 17;95:107558. doi: 10.1016/j.intimp.2021.107558. Online ahead of print. ABSTRACT Rosacea is a chronic, relapsing inflammatory skin disease featured by abnormal activation of immune responses, vascular dysfunction and prominent permeability barrier alterations. Aspirin, as the first nonsteroidal anti-inflammatory drug (NSAID), is widely used for various inflammatory conditions due to its anti-inflammatory and anti-angiogenic properties. However, its effects on rosacea are unclear. In this study, we demonstrated that aspirin dramatically improved pathological phenotypes in LL37-induced rosacea-like mice. The RNA-sequencing analysis revealed that aspirin alleviated rosacea-like skin dermatitis mainly via modulating immune responses. Mechanically, we showed that aspirin decreased the production of chemokines and cytokines associated with rosacea, and suppressed the Th1- and Th17-polarized immune responses in LL37-induced rosacea-like mice. Besides, aspirin administration decreased the microvessels density and the VEGF expression in rosacea-like skin. We further demonstrated that aspirin inhibited the activation of NF-κB signaling and the release of its downstream pro-inflammatory cytokines. Collectively we showed that aspirin exerts a curative effect on rosacea by attenuating skin inflammation and angiogenesis, suggesting a promising therapeutic candidate for the treatment of rosacea. PMID:33743316 | DOI:10.1016/j.intimp.2021.107558 {url} = URL to article Etcetera Angiogenesis & VEGF Aspirin for Rosacea Aspirin For Rosacea Flushing Cytokines and Rosacea

J Cosmet Dermatol. 2021 Mar 20. doi: 10.1111/jocd.14085. Online ahead of print. ABSTRACT AIMS: The pro-yellow laser is a yellow light wavelength (577-nm) laser system. Rosacea is a chronic inflammatory disorder that occurs with facial flushing, erythema, papules, pustules, and telangiectasia. Demodex parasites (Demodex folliculorum and brevis) also play a role in the pathogenesis of rosacea. The aim of our study is to evaluate the effect of pro-yellow laser on demodex density (Dd) in patients with rosacea. METHODS: This retrospective study was planned for the patients with rosacea whose demodex mite densities were examined and treated with pro-yellow laser and were evaluated between 2019 and 2020 in the cosmetology unit. The laser light was applied at a dose of 20 j / cm2 in the scanner mode (The 80% coverage) in all the patients. The demodex density per cm2 was routinely evaluated before the treatment, and the demodex density values in the fourth week after the treatment were recorded from the patients' files. RESULTS: There were 27 females (79.4%) and 7 males (20.6%) evaluated in the study. While the demodex density was 18.1 ± 10.7 (min: 0 - max: 48, Q1:12 - Q3:22) per cm2 before the pro-yellow laser treatment in the cases, the demodex density was 10.2 ± 7.9 (min: 0 - max: 30, Q1:4.75 - Q3:12) per cm2 in the fourth week after the treatment. After the pro-yellow laser treatment, the demodex intensity decreased significantly compared to before the laser treatment (p = 0.001). There was no significant correlation between the decrease in the density of the demodex mite and the success of the treatment (p = 0.46). CONCLUSION: This is the first study in the literature investigating the change in demodex density in rosacea patients treated with pro-yellow laser therapy. In this study, it was shown that pro-yellow laser treatment is effective in reducing the density of demodex. PMID:33742514 | DOI:10.1111/jocd.14085 {url} = URL to article Et Cetera Demodex Density Count - What are the Numbers? Increased Blood Glucose Level Shows Increase in Demodex Density Count

EMBO Mol Med. 2021 Mar 18:e13560. doi: 10.15252/emmm.202013560. Online ahead of print. ABSTRACT Rosacea is a chronic inflammatory skin disorder whose pathogenesis is unclear. Here, several lines of evidence were provided to demonstrate that mTORC1 signaling is hyperactivated in the skin, especially in the epidermis, of both rosacea patients and a mouse model of rosacea-like skin inflammation. Both mTORC1 deletion in epithelium and inhibition by its specific inhibitors can block the development of rosacea-like skin inflammation in LL37-induced rosacea-like mouse model. Conversely, hyperactivation of mTORC1 signaling aggravated rosacea-like features. Mechanistically, mTORC1 regulates cathelicidin through a positive feedback loop, in which cathelicidin LL37 activates mTORC1 signaling by binding to Toll-like receptor 2 (TLR2) and thus in turn increases the expression of cathelicidin itself in keratinocytes. Moreover, excess cathelicidin LL37 induces both NF-κB activation and disease-characteristic cytokine and chemokine production possibly via mTORC1 signaling. Topical application of rapamycin improved clinical symptoms in rosacea patients, suggesting mTORC1 inhibition can serve as a novel therapeutic avenue for rosacea. PMID:33734592 | DOI:10.15252/emmm.202013560 {url} = URL to article EMBO Molecular Medicine Journal European Molecular Biology Organization Etcetera Cytokines and Rosacea

Br J Dermatol. 2021 Mar 17. doi: 10.1111/bjd.20067. Online ahead of print. ABSTRACT BACKGROUND: Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD). OBJECTIVE: To explore the association between CKD stages 3-5 and atopic eczema, psoriasis, rosacea, and hidradenitis suppurativa. METHODS: We undertook two complementary analyses; a prevalent case-control and a cohort study using routinely collected primary care data (UK Clinical Practice Research Datalink [CPRD]). We matched individuals with CKD3-5 in CPRD on March 2018 with up to five individuals without CKD on GP practice, age and sex. We compared the prevalence of CKD3-5 among individuals with and without each inflammatory skin disease. We included individuals in CPRD with diabetes mellitus (2004-2018) in a cohort analysis to compare the incidence of CKD3-5 among people with and without atopic eczema and psoriasis. RESULTS: There were 56,602 cases with CKD3-5 and 268,305 controls without. Cases were more likely than controls to have a history of atopic eczema (odds ratio [OR] 1.14; 99% confidence interval 1.11-1.17), psoriasis (1.13; 1.08-1.19), or hidradenitis suppuritiva (1.49; 1.19-1.85), but were slightly less likely to have been diagnosed with rosacea (0.91; 0.86-0.95), after adjusting for age, sex, practice (matching factors), index of multiple deprivation, diabetes, smoking, harmful alcohol use and obesity. Results remained similar after adjusting for hypertension and cardiovascular disease. In the cohort with diabetes (N=335,827), there was no evidence that CKD3-5 incidence was associated with atopic eczema or psoriasis. CONCLUSIONS: Atopic eczema, psoriasis, and hidradenitis suppurativa are weakly associated with CKD3-5. Future research is needed to elucidate potential mechanisms and clinical significance of our findings. PMID:33730366 | DOI:10.1111/bjd.20067 {url} = URL to article

JMIR Med Inform. 2021 Mar 15;9(3):e23415. doi: 10.2196/23415. ABSTRACT BACKGROUND: Rosacea is a chronic inflammatory disease with variable clinical presentations, including transient flushing, fixed erythema, papules, pustules, and phymatous changes on the central face. Owing to the diversity in the clinical manifestations of rosacea, the lack of objective biochemical examinations, and nonspecificity in histopathological findings, accurate identification of rosacea is a big challenge. Artificial intelligence has emerged as a potential tool in the identification and evaluation of some skin diseases such as melanoma, basal cell carcinoma, and psoriasis. OBJECTIVE: The objective of our study was to utilize a convolutional neural network (CNN) to differentiate the clinical photos of patients with rosacea (taken from 3 different angles) from those of patients with other skin diseases such as acne, seborrheic dermatitis, and eczema that could be easily confused with rosacea. METHODS: In this study, 24,736 photos comprising of 18,647 photos of patients with rosacea and 6089 photos of patients with other skin diseases such as acne, facial seborrheic dermatitis, and eczema were included and analyzed by our CNN model based on ResNet-50. RESULTS: The CNN in our study achieved an overall accuracy and precision of 0.914 and 0.898, with an area under the receiver operating characteristic curve of 0.972 for the detection of rosacea. The accuracy of classifying 3 subtypes of rosacea, that is, erythematotelangiectatic rosacea, papulopustular rosacea, and phymatous rosacea was 83.9%, 74.3%, and 80.0%, respectively. Moreover, the accuracy and precision of our CNN to distinguish rosacea from acne reached 0.931 and 0.893, respectively. For the differentiation between rosacea, seborrheic dermatitis, and eczema, the overall accuracy of our CNN was 0.757 and the precision was 0.667. Finally, by comparing the CNN diagnosis with the diagnoses by dermatologists of different expertise levels, we found that our CNN system is capable of identifying rosacea with a performance superior to that of resident doctors or attending physicians and comparable to that of experienced dermatologists. CONCLUSIONS: The findings of our study showed that by assessing clinical images, the CNN system in our study could identify rosacea with accuracy and precision comparable to that of an experienced dermatologist. PMID:33720027 | DOI:10.2196/23415 {url} = URL to article

Dermatol Ther. 2021 Mar 15:e14946. doi: 10.1111/dth.14946. Online ahead of print. ABSTRACT OBJECTIVE: A higher incidence of gastrointestinal diseases has been well established in patients with rosacea. However, no screening tool has been introduced for gastrointestinal disease development in rosacea. Fecal calprotectin (FC) is a calcium-binding protein, mainly derived from polymorpho-nuclear cells, such as neutrophils. It has been established as a marker of gastrointestinal inflammation. The aim of the present study was to evaluate FC levels in patients with rosacea without any gastrointestinal diseases. METHODS: A prospective, case-control study was planned to investigate the relationship between rosacea and gastrointestinal involvement by evaluating FC levels and the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS: A total of 47 patients with rosacea and 39 healthy control subjects were included in the study. The FC levels were statistically significantly higher in rosacea group than in the control group (65.96 ± 58.86 ng/mL vs. 31.99 ± 20.12 ng/mL, p = 0.026, respectively). A statistically significant difference was also observed in GSRS values between the patient and the control groups (30.26 ± 12.48 vs. 22.62 ± 7.64, p = 0.001, respectively). A positive correlation was noted between FC levels and the values of GSRS in the study group (r: 0.354; p = 0.001) and in the rosacea group (r = 0.392, p = 0.006). CONCLUSIONS: The measurement of FC may be useful in the early detection of gastrointestinal system (GIS) diseases that may accompany rosacea and may provide a pathway to develop treatment strategies targeting both skin and intestinal mucosa. This article is protected by copyright. All rights reserved. PMID:33719160 | DOI:10.1111/dth.14946 {url} = URL to article Etcetera Gastrointestinal Rosacea [GR], aka, Gut Rosacea Do You Have A Gut Feeling About Your Rosacea?

Am Fam Physician. 2021 Mar 15;103(6):337-343. ABSTRACT Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis. Topical corticosteroids are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions. The risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals. When prescribing topical corticosteroids for use in children, lower potencies and shorter durations should be used. Topical corticosteroids can work safely and effectively in patients who are pregnant or lactating. They are available in formulations such as ointments, creams, lotions, gels, foams, oils, solutions, and shampoos. The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated. Correct patient application is critical to successful use. Patients may be taught application using the fingertip unit method. One fingertip unit is the amount of medication dispensed from the tip of the index finger to the crease of the distal interphalangeal joint and covers approximately 2% body surface area on an adult. Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids. There is no specified time limit for low-potency topical corticosteroid use. PMID:33719380 {url} = URL to article

Case Rep Dermatol. 2021 Feb 1;13(1):62-68. doi: 10.1159/000511495. eCollection 2021 Jan-Apr. ABSTRACT Rosacea is a chronic inflammatory skin disease characterized by central facial erythema with or without ocular involvement. It is often difficult to distinguish rosacea from other malar rashes, one of which is acute cutaneous lupus erythematosus (CLE), particularly when there is an increase in antinuclear antibody (ANA) level. We report the case of a 16-year old woman with facial erythematous plaque accompanied by papules and pustules, reddened eyes, and swollen eyelids since the last one year. Dermoscopic examination revealed telangiectasia, and skin scraping examination with 20% potassium hydroxide identified the presence of Demodex folliculorum. Further ocular examination also revealed blepharitis, dysfunction of Meibomian gland, cicatrix, and corneal neovascularization. The ANA titer was positive (1:320), while the anti-dsDNA was negative. The patient was treated according to standard treatment for rosacea. The patient showed a satisfactory response following 2 weeks of therapy. Signs of recurring red patches with papules, pustules, telangiectasia, and identification of D. folliculorum on skin scraping examination led to the diagnosis of papulopustular rosacea. A positive ANA test may also be present in other diseases, e.g. acute CLE. Therefore, the diagnosis of rosacea remains a challenge. Thorough observation and examination must be done in order to yield an accurate diagnosis of rosacea. PMID:33708085 | PMC:PMC7923712 | DOI:10.1159/000511495 {url} = URL to article

Aesthet Surg J. 2021 Mar 4:sjab109. doi: 10.1093/asj/sjab109. Online ahead of print. ABSTRACT BACKGROUND: Lipofilling has become popular as a treatment to improve aging related skin characteristics (eg, wrinkles, pigmentation spots, pores, or rosacea). Different additives such as platelet-rich plasma (PRP) or stromal vascular fraction (SVF) have been added to lipofilling to increase the therapeutic effect of adipose derived stromal cells (ASCs). OBJECTIVES: In this study, we hypothesized that mechanical isolated SVF augments the therapeutic effect of PRP supplemented lipofilling to improve facial skin quality. METHODS: This prospective, double-blinded, placebo-controlled, randomized trial was conducted between 2016 and 2019. In total, 28 female subjects were enrolled with 25 completing the follow-up. All patients received PRP supplemented lipofilling with either mechanical isolated SVF or saline. SVF was isolated by means of the fractionation of adipose tissue (FAT) procedure (tissue-SVF). Results were evaluated by changes in skin elasticity and transepidermal water loss, changes in skin aging related features, ie, superficial spots, wrinkles, skin texture, pores, vascularity, and pigmentation as well as patient satisfaction (FACE-Q), recovery, and number of complications up to 1 year postoperative. RESULTS: The addition of tSVF to PRP supplemented lipofilling did not improve skin elasticity, transepidermal water loss nor skin aging related features. No improvement in patient satisfaction with overall facial appearance nor facial skin quality was seen when tSVF was added to PRP supplemented lipofilling. CONCLUSIONS: PRP supplemented lipofilling with tSVF compared to PRP supplemented lipofilling alone does not improve facial skin quality nor patient satisfaction in a healthy population. PRP supplemented lipofilling with tSVF can be considered a safe procedure. PMID:33687052 | DOI:10.1093/asj/sjab109 {url} = URL to article

J Dermatol Sci. 2021 Feb 27:S0923-1811(21)00017-7. doi: 10.1016/j.jdermsci.2021.02.005. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a complex, chronic, and recurrent dermatologic condition that adversely affects quality of life and self-esteem. However, clinical relevance and molecular mechanisms underlying NEAT1 influence in rosacea remain unclear. OBJECTIVE: The present study aims to investigate the dynamics and influences of lncRNAs, miRNAs, and mRNAs in rosacea patients, and to explore the impacts of NEAT1 treatments on miR-196a-5p and S100A9 expression in LL37-treated HaCaT cells. METHODS: RNA-sequencing of skin tissues from rosacea patients and integrative analyses facilitated comprehensive exploration of lncRNA, mRNA, and miRNA networks. We identified differentially expressed lncRNAs in paired rosacea afflicted and non-lesioned tissues by hub lncRNAs in the ceRNA network. The role of NEAT1 in LL37-treated HaCaT cells was identified by in vitro experiments. RESULTS: There were 237 lncRNAs, 38 miRNAs, and 1784 mRNAs in lesioned skin compared to non-lesioned skin in six rosacea patients. NEAT1 was upregulated in rosacea skin and in LL37-treated HaCaT cells. Moreover, inflammatory damage was able to be reduced in vitro after knockdown of NEAT1. Finally, NEAT1 was able to directly interact with miR-196a-5p, and downregulating miR-196a-5p was efficient in reversing the influence of NEAT1 siRNA on S100A9. CONCLUSION: We have completed the first genome-wide lncRNA profiling of paired lesioned and non-lesioned samples from rosacea afflicted patients. The NEAT1/miR-196a-5p/S100A9 axis may have played an important role in the dynamics underlying inflammatory responses of rosacea. NEAT1 may have functioned as a competing endogenous RNA which regulated inflammatory responses in rosacea by sponging miR-196a-5p and upregulating S100A9 expression. PMID:33678493 | DOI:10.1016/j.jdermsci.2021.02.005 {url} = URL to article

J Family Med Prim Care. 2020 Dec 31;9(12):5862-5866. doi: 10.4103/jfmpc.jfmpc_1393_20. eCollection 2020 Dec. ABSTRACT COVID-19 has affected those disciplines where close contact is required and where there is no need for urgent care such as the field of dermatology. Due to the contagious nature of the virus, front line health care workers such as family health care physicians and primary health care doctors are using personal protective measures (PPE), which might result in skin disorders. In addition, social distancing has also resulted in the compromise of teaching and learning mainly bedside teaching in the dermatology wards. Moreover, there is also uncertainty about the guidelines different to be followed by primary health care and family physicians while assessing patients of dermatology. We aim to provide an overview of how COVID-19 has affected the primary health care workers and physicians. We have highlighted the challenges faced by the family health care physicians from the perspective of dermatology along with recommendations and future directions for family health care physicians. Results reveal that wearing PPE measures might be challenging for primary health care workers and family physicians as it can cause facial inflammatory papules, acne rosacea, seborrheic dermatitis, and facial itching. They cannot escape encounter with the patients, and they need to be careful by undertaking some precautionary measures while taking care of the patients in general with a specific focus on COVID-19. COVID-19 has also affected all teaching and learning in the field of dermatology. However, academic institutions can use digital tools such as zoom or skype to continue learning dermatology during the crisis of COVID-19. PMID:33681009 | PMC:PMC7928112 | DOI:10.4103/jfmpc.jfmpc_1393_20 {url} = URL to article

Biomedicines. 2021 Feb 19;9(2):210. doi: 10.3390/biomedicines9020210. ABSTRACT The use of silver preparations in medicine is becoming increasingly popular. The basic aim of this evaluation was to review the literature on the clinical (in vivo) and antibacterial potential of silver preparations in ophthalmic diseases. The second goal was to summarize the results of experimental research on the use of silver preparations in ophthalmology. The third objective was to present a method for stabilizing eye drops containing silver (I) complex. Analysis of the pH stability of the silver (I) complex with metronidazole in the prepared dosage form (eye drops) was carried out. Most silver preparations are clinically used for topical application. Few experimental results indicate the usefulness of intraocular or systemic administration of silver (I) preparations as an alternative or additional therapy in infectious and angiogenic eye diseases. The development of a new formulation increases the stability of the dosage form. New forms of silver (I) products will certainly find application in the treatment of many ophthalmic diseases. One of the most important features of the silver (I) complex is its capacity to break down bacterial resistance. The new eye drops formula can significantly improve comfort of use. Due to their chemical nature, silver (I) compounds are difficult to stabilize, especially in the finished dosage form. PMID:33669740 | DOI:10.3390/biomedicines9020210 {url} = URL to article

Microorganisms. 2021 Feb 11;9(2):353. doi: 10.3390/microorganisms9020353. ABSTRACT The microbiome plays an important role in a wide variety of skin disorders. Not only is the skin microbiome altered, but also surprisingly many skin diseases are accompanied by an altered gut microbiome. The microbiome is a key regulator for the immune system, as it aims to maintain homeostasis by communicating with tissues and organs in a bidirectional manner. Hence, dysbiosis in the skin and/or gut microbiome is associated with an altered immune response, promoting the development of skin diseases, such as atopic dermatitis, psoriasis, acne vulgaris, dandruff, and even skin cancer. Here, we focus on the associations between the microbiome, diet, metabolites, and immune responses in skin pathologies. This review describes an exhaustive list of common skin conditions with associated dysbiosis in the skin microbiome as well as the current body of evidence on gut microbiome dysbiosis, dietary links, and their interplay with skin conditions. An enhanced understanding of the local skin and gut microbiome including the underlying mechanisms is necessary to shed light on the microbial involvement in human skin diseases and to develop new therapeutic approaches. PMID:33670115 | DOI:10.3390/microorganisms9020353 {url} = URL to article

J Clin Med. 2021 Feb 18;10(4):834. doi: 10.3390/jcm10040834. ABSTRACT Inflammatory skin diseases, such as rosacea and acne, are major causes of facial erythema and accompanying skin barrier dysfunction. Several methods to restore the impaired skin barrier and improve facial erythema, such as medication, radiofrequency, laser, and ultrasound therapy were attempted. This study evaluated the efficacy and safety of dual-frequency ultrasound with impulse mode, for improving skin hydration and erythema in Asian subjects with rosacea and acne. Twenty-six subjects with facial erythema received an ultrasound treatment once per week, for 4 weeks, over both cheeks. The erythema index and transepidermal water loss (TEWL) were measured at each visit. Clinicians assessed the erythema improvement and patients evaluated their satisfaction level. The average decrease in TEWL and erythema index at 6 weeks was 5.37 ± 13.22 g·h-1·m-2 (p = 0.020) and 39.73 ± 44.21 (p = 0.010), respectively. The clinician's erythema assessment and the subject satisfaction questionnaire score significantly improved at final follow-up (p < 0.001; p = 0.003, respectively). No serious adverse effects were observed during the treatment and follow-up periods. The dual-frequency ultrasound with impulse mode appears to be effective and safe for improving skin hydration and erythema in patients with rosacea and acne. PMID:33670631 | DOI:10.3390/jcm10040834 {url} = URL to article

J Cosmet Dermatol. 2021 Mar 2. doi: 10.1111/jocd.14039. Online ahead of print. ABSTRACT BACKGROUND: Rosacea is a common chronic inflammatory dermatosis with uncertainty of etiology. Although clinical features and risk factors of the disease in Caucasians have been reported, this information in Chinese is largely unavailable. OBJECTIVE: To analyze the clinical features and associated risk factors of rosacea in Chinese. METHODS: A questionnaire was given to outpatients with rosacea who visited the dermatology department of the first affiliated hospital of Kunming Medical University from June 2018 to March 2019. Analyses included demographic characteristics of subjects, clinical characteristics, risk factors of rosacea. RESULTS: A total of 254 outpatients completed questionnaire. The ratio of female to male was 5.68:1.00. The mean age at onset was 31.18 ± 10.23 years. Erythematotelangiectatic subtype accounted for 51.60% while 39% of the subjects were the papulopustular subtype. The rest were phymatous type (9.40%). Subjects with flushing, persistent facial erythema and telangiectasia accounted for 87.80%, 84.65%, and 79.13%, respectively. One hundred and six subjects (41.73%) had papules or pustules, and 24 subjects (9.40%) were with phymatous changes. The most common involved site were the cheeks (92.91%), followed by the nose (81.10%), the perioral area (60.23%), and the forehead (50.79%). The clinical symptoms included burning (70.08%), dryness (48.03%), and itching (31.89%). The main risk factors were sun exposure (90.55%), temperature change (87.40%),and etc. Fifty-one (20.08%) patients had comorbidities. CONCLUSIONS: Rosacea mainly affects young females. The common signs and symptoms include flushing, persistent facial erythema, burning. Sun exposure, temperature changes are the common risk factors. Patients can have comorbidities of systemic disorders. PMID:33655687 | DOI:10.1111/jocd.14039 {url} = URL to article

J Cosmet Laser Ther. 2021 Mar 2:1-5. doi: 10.1080/14764172.2021.1880599. Online ahead of print. ABSTRACT Facial erythema from rosacea and acne is one of the most common problems encountered in dermatologic clinics. Effective therapeutic interventions for persistent erythema, which can cause patients frustration and psychological distress, are needed. The aim of this study was to evaluate the efficacy and safety of an invasive short pulsed-type bipolar radiofrequency device (IPBRF) for the treatment of intractable facial erythema. Thirty-one patients who had been diagnosed with rosacea or acne vulgaris and combined erythema underwent at least two IPBRF treatment sessions (maximum: 5) at 2-week intervals. Treatment outcomes were evaluated by investigator global assessment (IGA) based on clinical photographs, patient global assessment (PGA) score, and skin biophysical parameters including erythema index (EI), melanin index (MI), and transepidermal water loss (TEWL). Most patients showed significant clinical improvement. IGA scores for erythema, pores and smoothness improved after treatment. PGA also showed a trend toward improvement. Mean EI was significantly improved after the second treatment compared to baseline, which maintained until the study period. MI and TEWL showed a tendency toward improvement. There were no serious adverse events reported during the study. IPBRF led to rapid clinical improvement in facial erythema associated with rosacea and acne vulgaris and could be an effective and safe treatment option. PMID:33650938 | DOI:10.1080/14764172.2021.1880599 {url} = URL to article

Br J Hosp Med (Lond). 2021 Feb 2;82(2):1-8. doi: 10.12968/hmed.2020.0417. Epub 2021 Feb 27. ABSTRACT Rosacea is a common cutaneous condition affecting predominantly the face. It is historically characterised into four subtypes: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. This article describes the pathophysiology, clinical features and current treatment options for rosacea, and discusses updated diagnostic criteria. General guidance is required on the need to avoid possible triggers including dietary and environmental triggers. The strongest evidence supports the use of 0.75% metronidazole, topical azelaic acid or topical ivermectin for inflammatory rosacea. Erythema should be treated with brimonidine tartrate gel, oral medication such as beta blockers or vascular laser and light-based therapy. Oral doxycycline 40 mg modified release can be used as monotherapy or in combination with other treatments for recalcitrant disease. Further understanding of the pathogenesis of rosacea could allow identification and targeted avoidance of triggers and the development of new treatment modalities. PMID:33646026 | DOI:10.12968/hmed.2020.0417 {url} = URL to article