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Comments on "The Decrease of Demodex Density After Nd:YAG Laser Application for Facial Telengiactasias: A Case Report". Dermatol Ther. 2020 Oct 27;: Authors: Clatici VG, Voicu C, Barinova E, Tatu AL PMID: 33107672 [PubMed - as supplied by publisher] {url} = URL to article

Amelioration of Compound 48/80-Mediated Itch and LL-37-Induced Inflammation by a Single-Stranded Oligonucleotide. Front Immunol. 2020;11:559589 Authors: Dondalska A, Rönnberg E, Ma H, Pålsson SA, Magnusdottir E, Gao T, Adam L, Lerner EA, Nilsson G, Lagerström M, Spetz AL Abstract Numerous inflammatory skin disorders display a high prevalence of itch. The Mas-related G protein coupled receptor X2 (MRGPRX2) has been shown to modulate itch by inducing non-IgE-mediated mast cell degranulation and the release of endogenous inducers of pruritus. Various substances collectively known as basic secretagogues, which include inflammatory peptides and certain drugs, can trigger MRGPRX2 and thereby induce pseudo-allergic reactions characterized by histamine and protease release as well as inflammation. Here, we investigated the capacity of an immunomodulatory single-stranded oligonucleotide (ssON) to modulate IgE-independent mast cell degranulation and, more specifically, its ability to inhibit the basic secretagogues compound 48/80 (C48/80)-and LL-37 in vitro and in vivo. We examined the effect of ssON on MRGPRX2 activation in vitro by measuring degranulation in a human mast cell line (LAD2) and calcium influx in MRGPRX2-transfected HEK293 cells. To determine the effect of ssON on itch, we performed behavioral studies in established mouse models and collected skin biopsies for histological analysis. Additionally, with the use of a rosacea mouse model and RT-qPCR, we investigated the effect on ssON on LL-37-induced inflammation. We reveal that both mast cell degranulation and calcium influx in MRGPRX2 transfected HEK293 cells, induced by the antimicrobial peptide LL-37 and the basic secretagogue C48/80, are effectively inhibited by ssON in a dose-dependent manner. Further, ssON demonstrates a capability to inhibit LL-37 and C48/80 activation in vivo in two mouse models. We show that intradermal injection of ssON in mice is able to block itch induced via C48/80 in a dose-dependent manner. Histological staining revealed that ssON inhibits acute mast cell degranulation in murine skin treated with C48/80. Lastly, we show that ssON treatment ameliorates LL-37-induced inflammation in a rosacea mouse model. Since there is a need for new therapeutics targeting non-IgE-mediated activation of mast cells, ssON could be used as a prospective drug candidate to resolve itch and inflammation in certain dermatoses. PMID: 33101278 [PubMed - in process] {url} = URL to article

The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb). 2020 Oct 23;: Authors: Forton FMN Abstract Rosacea is a common facial dermatosis but its definition and classification are still unclear, especially in terms of its links with demodicosis. Triggers of rosacea (ultraviolet light, heat, spicy foods, alcohol, stress, microbes) are currently considered to induce a cascading innate and then adaptive immune response that gets out of control. Recent histological and biochemical studies support the concept that this inflammatory response is a continuum, already present from the onset of the disease, even when no clinical signs of inflammation are visible. The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease. Molecular studies suggest that Demodex may induce tolerogenic dendritic cells and collaborate with vascular endothelial growth factor (VEGF) to induce T cell exhaustion and favor its own proliferation. These interactions among VEGF, Demodex, and immunity need to be explored further and the nosology of rosacea adapted accordingly. However, treating early rosacea, with only clinically visible vascular symptoms, with an acaricide may decrease early inflammation, limit potential flare-ups following laser treatment, and prevent the ultimate development of the papulopustules of rosacea. The effectiveness of this approach needs to be confirmed by prospective controlled clinical trials with long-term follow-up. Currently, the evidence suggests that patients with only vascular symptoms of rosacea should be carefully examined for the presence of follicular scales as signs of Demodex overgrowth or pityriasis folliculorum so that these patients, at least, can be treated early with an acaricidal cream. PMID: 33095403 [PubMed - as supplied by publisher] {url} = URL to article Synopsis More on Demodectic Rosacea

"Fake news" in dermatology. Results from an observational, cross-sectional study. Int J Dermatol. 2020 Oct 23;: Authors: Iglesias-Puzas Á, Conde-Taboada A, Aranegui-Arteaga B, López-Bran E Abstract BACKGROUND: Social networks have become a means for disseminating information on health-related matters. OBJECTIVE: Describe the characteristics and analyze the accuracy of the dermatology content that is most often shared on the most popular social networks. MATERIALS AND METHODS: The content most often shared on social networks (Facebook, Pinterest, Twitter, and Reddit) between March 2019 and March 2020 was analyzed using the keywords: acne, alopecia/hair loss, psoriasis, eczema, melanoma, skin cancer, rash, and rosacea. The total number of interactions, skin disease, topic, and origin was collected from each of the records. The content was analyzed and was categorized as precise, confusing, or imprecise based on the scientific evidence available. RESULTS: A total of 385 websites were included. About 44.7% of the shared content was rated as imprecise, 20% as confusing, and 35.3% as precise. The records classified as imprecise obtained a higher mean number of interactions (P < 0.05). No differences were found in terms of the level of certainty and the dermatosis studied, whereas they did exist in relation to their topic and origin (P < 0.001). Of the contents classified as imprecise, the most frequent topic and origin were "alternative medicines" and "individual opinions, articles not affiliated with health institutions, nor peer reviewed," respectively. CONCLUSIONS: The majority of the contents often shared on social networks are below acceptable quality standards. Strategies are needed to discredit imprecise information and promote the dissemination of evidence-based dermatology information. PMID: 33095467 [PubMed - as supplied by publisher] {url} = URL to article This article is referenced in the post, What is the Butterfly Effect in Rosacea?

The Pro-Differentiation Effect of Doxycycline on Human SZ95 Sebocytes. Dermatology. 2020 Oct 22;:1-5 Authors: Zouboulis CC, Ní Raghallaigh S, Schmitz G, Powell FC Abstract BACKGROUND: Despite their widespread clinical use in both acne vulgaris and rosacea, the effects of tetracyclines on sebocytes have not been investigated until now. Sebaceous glands are central to the pathogenesis of acne and may be important in the development of rosacea. OBJECTIVE: The aim of this study was to assess the effects of doxycycline on the immortalized SZ95 sebaceous gland cell line as a model for understanding possible effectiveness on the sebaceous glands in vivo. METHODS: The effects of doxycycline on SZ95 sebocyte numbers, viability, and lipid content as well as its effects on the mRNA levels of peroxisome proliferator-activated receptors α and γ, in comparison to the peroxisome proliferator-activated receptor γ agonist troglitazone, were investigated. RESULTS: Doxycycline reduced the cell number and increased the lipid content of SZ95 sebocytes in vitro after 2 days of treatment. These doxycycline effects may be explained by an upregulation of peroxisome proliferator-activated receptor γ mRNA levels at 12 and 24 h, whereas troglitazone already upregulated peroxisome proliferator-activated receptor γ levels after 6 h. Both compounds did not influence peroxisome proliferator-activated receptor α mRNA levels. CONCLUSION: These new findings illustrate a previously unknown effect of doxycycline on sebocytes, which may be relevant to their modulation of disorders of the pilosebaceous unit, such as acne vulgaris and rosacea. PMID: 33091909 [PubMed - as supplied by publisher] {url} = URL to article

Granulomatous Rosacea in Korean Patients: Diagnosis Based on Combining Clinical and Histological Findings. Dermatology. 2020 Oct 22;:1-5 Authors: Yang JH, Cho SI, Suh DH Abstract BACKGROUND: Granulomatous rosacea (GR) is a rare inflammatory skin disease, which is considered a variant of rosacea, apart from other types of rosacea. OBJECTIVE: This study aimed to summarize the characteristics of Korean patients diagnosed with GR by combining clinical and histological findings. METHODS: Fifteen cases, both clinically and histologically consistent with GR, were selected and were subsequently analyzed to describe clinical and histological characteristics. RESULTS: A total of 20 patients showed granulomatous infiltration in skin biopsies, but only 15 of them were clinically consistent with GR. Five patients who showed granulomatous inflammation were clinically consistent with erythematotelangiectatic or papulopustular rosacea. Among 15 patients, 13 (86.7%) were female and 2 (13.3%) were male. The most frequently involved area was the cheek, and none of the patients showed extrafacial lesions. There seems to be a possibility that treatment duration may be associated with the treatment response. CONCLUSIONS: This study confirms clinical characteristics of GR based on the diagnosis combining both clinical and histological findings. PMID: 33091912 [PubMed - as supplied by publisher] {url} = URL to article

Systemic Comorbidities in Korean Patients with Rosacea: Results from a Multi-Institutional Case-Control Study. J Clin Med. 2020 Oct 17;9(10): Authors: Woo YR, Kim HS, Lee SH, Ju HJ, Bae JM, Cho SH, Lee JD Abstract Recent evidence links rosacea to systemic disease, but there are not enough methodologic studies addressing this association in Asians. Our aim was to identify rosacea comorbidities in Koreans and establish a reference database. A multi-center, case-control study was performed where a total of 12,936 rosacea patients and 12,936 age- and sex-matched control subjects were identified from 2007 to 2018. Logistic regression was performed to find significant association between rosacea and Sjögren syndrome (odds ratio [OR] 2.05; 95% confidence interval, 1.40-3.00), systemic sclerosis (OR 6.56; 95% CI, 1.50-28.7), rheumatoid arthritis (OR 1.72; 95% CI, 1.50-1.98), ankylosing spondylitis (OR 2.32; 95% CI, 1.42-3.84), autoimmune thyroiditis (OR 1.96; 95% CI, 1.40-2.73), alopecia areata (OR 1.77; 95% CI, 1.27-2.45), vitiligo (OR 1.90; 95% CI, 1.30-2.77), lung cancer (OR 1.54; 95% CI, 1.06-2.21), hepatobiliary cancer (OR 1.38; 95% CI, 1.06-1.77), alcohol abuse (OR 1.59; 95% CI, 1.05-2.39), diabetes mellitus (OR 1.11; 95% 1.02-1.19), obesity (OR 1.72; 95% CI, 1.22-2.41), allergic rhinitis (OR 1.65; 95% CI, 1.54-1.76), allergic conjunctivitis (OR 1.57; 95% CI, 1.27-1.94), chronic rhinosinusitis (OR 1.28; 95% CI, 1.14-1.42), herpes infection (OR 1.69; 95% CI, 1.53-1.86), and human papillomavirus infection (OR 2.50; 95% CI, 2.06-3.02). Higher odds for Sjogren syndrome, systemic sclerosis, ankylosing spondylitis, thyroiditis, vitiligo, hepatobiliary cancer, and obesity was exclusive in female subjects with rosacea, whereas increased prevalence of alopecia areata and alcohol abuse was confined to men. Only those who were 50 years and older exhibited higher odds for vitiligo, lung cancer, and gastroesophageal reflux disease while individuals younger than 50 were exclusively associated with hepatobiliary cancer, allergic conjunctivitis, and irritable bowel syndrome. Our study suggests that Koreans with rosacea are more likely to experience systemic comorbidity. Clinicians should acknowledge these interrelations and employ comprehensive care with an individual-based approach. PMID: 33080929 [PubMed] {url} = URL to article

Related ArticlesA warning against associating doxycycline with isotretinoin. Arq Bras Oftalmol. 2020 08;83(4):350 Authors: Costa AXD, Benchimol GL, Reis TF PMID: 32756781 [PubMed - indexed for MEDLINE] {url} = URL to article

Deep Learning for Diagnostic Binary Classification of Multiple-Lesion Skin Diseases. Front Med (Lausanne). 2020;7:574329 Authors: Thomsen K, Christensen AL, Iversen L, Lomholt HB, Winther O Abstract Background: Diagnosis of skin diseases is often challenging and computer-aided diagnostic tools are urgently needed to underpin decision making. Objective: To develop a convolutional neural network model to classify clinically relevant selected multiple-lesion skin diseases, this in accordance to the STARD guidelines. Methods: This was an image-based retrospective study using multi-task learning for binary classification. A VGG-16 model was trained on 16,543 non-standardized images. Image data was distributed in training set (80%), validation set (10%), and test set (10%). All images were collected from a clinical database of a Danish population attending one dermatological department. Included was patients categorized with ICD-10 codes related to acne, rosacea, psoriasis, eczema, and cutaneous t-cell lymphoma. Results: Acne was distinguished from rosacea with a sensitivity of 85.42% CI 72.24-93.93% and a specificity of 89.53% CI 83.97-93.68%, cutaneous t-cell lymphoma was distinguished from eczema with a sensitivity of 74.29% CI 67.82-80.05% and a specificity of 84.09% CI 80.83-86.99%, and psoriasis from eczema with a sensitivity of 81.79% CI 78.51-84.76% and a specificity of 73.57% CI 69.76-77.13%. All results were based on the test set. Conclusion: The performance rates reported were equal or superior to those reported for general practitioners with dermatological training, indicating that computer-aided diagnostic models based on convolutional neural network may potentially be employed for diagnosing multiple-lesion skin diseases. PMID: 33072786 [PubMed] {url} = URL to article

Cardiovascular Risk and Comorbidities in Patients with Rosacea: A Systematic Review and Meta-analysis. Acta Derm Venereol. 2020 Oct 19;: Authors: Tsai TY, Chiang YY, Huang YC Abstract The association between rosacea and cardiovascular disease remains controversial. A systematic review and meta-analysis of the literature, from inception to 15 February 2020, was performed to compare cardiovascular risk and comorbidities in individuals with and without rosacea. Twelve studies, involving 40,752 patients with rosacea, were included. Compared with controls, patients with rosacea had higher systolic blood pressure (standardized mean difference (SMD) 0.293, 95% confidence interval (CI) 0.054-0.532), diastolic blood pressure (SMD 0.309, 95% CI 0.003-0.615), total cholesterol (SMD 1.147, 95% CI 0.309-1.984), low-density lipoprotein (SMD 0.792, 95% CI 0.174-1.409), C-reactive protein (SMD 0.26, 95% CI 0.099-0.421), greater epicardial fat thickness (SMD 1.945, 95% CI 1.595-2.296), and higher incidence of hypertension (odds ratio (OR) 1.204, 95% CI 1.097-1.332) and insulin resistance (OR 2.338, 95% CI 1.187-4.605). This study reveals that patients with rosacea are predisposed to increased subclinical cardiovascular risk. PMID: 33073295 [PubMed - as supplied by publisher] {url} = URL to article

Related ArticlesPublication of national dermatology guidelines as a Research Letter in the BJD: can less ever be enough? Br J Dermatol. 2020 06;182(6):1319-1320 Authors: van Zuuren EJ, Arents BWM, Flohr C, Ingram JR PMID: 32476154 [PubMed - indexed for MEDLINE] {url} = URL to article

Holistic care of patients with rosacea. J Cosmet Dermatol. 2020 Oct 14;: Authors: Searle T, Al-Niaimi F, Ali FR Abstract We thank the authors for their commentary on our article Rosacea and the Cardiovascular System.1 The authors discuss the risk of "excessive health examination". Whilst we do not advocate over investigation or over treatment of any patient, the association between cardiovascular disease and rosacea is evident2,3 and any dermatologist or clinician treating patients with rosacea should be aware of these associations as well as other extracutaneous associations of rosacea. PMID: 33051962 [PubMed - as supplied by publisher] {url} = URL to article

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life. Dis Mon. 2020 Oct 08;:101103 Authors: Greydanus DE, Azmeh R, Cabral MD, Dickson CA, Patel DR Abstract Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne. PMID: 33041056 [PubMed - as supplied by publisher] {url} = URL to article

Brazilian Society of Dermatology consensus on the use of oral isotretinoin in dermatology. An Bras Dermatol. 2020 Oct 03;: Authors: Bagatin E, Costa CS, Rocha MADD, Picosse FR, Kamamoto CSL, Pirmez R, Ianhez M, Miot HA Abstract BACKGROUND: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated. PMID: 33036809 [PubMed - as supplied by publisher] {url} = URL to article

Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview. Dermatol Ther (Heidelb). 2020 Oct 08;: Authors: Errichetti E Abstract Besides the well-known use in supporting the non-invasive diagnosis of non-tumoral dermatoses (general dermatology), dermoscopy has been shown to be a promising tool also in predicting and monitoring therapeutic outcomes of such conditions, with the consequent improvement/optimization of their treatment. In the present paper, we sought to provide an up-to-date overview on the use of dermoscopy in highlighting response predictor factors and evaluating therapeutic results in the field of general dermatology according to the current literature data. Several dermatoses may somehow benefit from such applications, including inflammatory conditions (psoriasis, lichen planus, dermatitis, granulomatous conditions, erythro-telangiectatic rosacea, Zoon balanitis and vulvitis, cutaneous mastocytosis, morphea and extra-genital lichen sclerosus), pigmentary disorders (vitiligo and melasma) and infectious dermatoses (scabies, pediculosis, demodicosis and viral warts). PMID: 33030661 [PubMed - as supplied by publisher] {url} = URL to article • Full Text Methods for Quantifying Demodex Mites

[Manifestaciones clínicas y evolución a largo plazo de tres casos de rosácea ocular atendidos en un hospital de alta especialidad del sureste de México]. Biomedica. 2020 Sep 01;40(3):448-455 Authors: Xacur-García F, Díaz-Novelo R, Herrera-David L, Moreno-Arjona P, Méndez-Domínguez N Abstract La rosácea es una alteración cutánea crónica que se ha asociado con factores etiológicos inespecíficos y diversas manifestaciones sistémicas. La rosácea cutánea suele evolucionar a rosácea ocular del 6 al 72 % de los pacientes. Al no existir criterios específicos que la caractericen, la rosácea ocular implica un reto diagnóstico. Para fortalecer la sospecha diagnóstica temprana, se presentan tres casos de pacientes con evolución clínica distinta, pero que tuvieron en común el retraso diagnóstico, lo que se tradujo en manifestaciones graves y daño ocular extenso. PMID: 33030822 [PubMed - as supplied by publisher] {url} = URL to article

Rosacea in acne vulgaris patients: subtype distribution and triggers assessment--a cross-sectional study. J Cosmet Dermatol. 2020 Oct 06;: Authors: Chen H, Lai W, Zheng Y Abstract BACKGROUND: Recent studies have reported that the incidence of acne combined with rosacea is increasing. However, the clinical feature and inducing factor of this two diseases co-occurrence is remain unclear. This study aims to investigate the classification and severity of female patients combining with acne and rosacea. METHODS: Female Patients with facial acne combined with rosacea, 15-50 years old, were included from dermatology out-patient department from January 2019 to December 2019. The severity of acne was classified according to the Pillsbury grading system. Rosacea was diagnosed and classified according to the Standard issued by National Rosacea Society Expert Committee. Questionnaire was designed to collect the information of rosacea triggers from each patient. RESULTS: 563 vulgaris acne combined with rosacea patients (mean age 23.2±43), included 70.33% severe acne (n=396)，15.81% moderate acne(n=89) and 13.85% mild acne(n=78), had finished the study. In severe acne group 72.47% combine with erythematotelangiectatic rosacea (ETR), 22.47% combined with papulopustular rosacea (PPR) and 5.05% combine with phymatous rosacea (PHR). In moderate acne group, 53.93% combine with ETR, 43.82% combined with papulopustular rosacea (PPR) and 2.24%combine with PHR. All patients in moderate acne subject group was combined with ETR (100%). Patients that did not use skin care produces presented 12.79 times higher rate to combine with ETR than that frequently using skin care products (P = 0.014). DISCUSSION/CONCLUSIONS: Erythema telangiectasia rosacea is the most common rosacea type in female acne patients. There is a need to be vigilant about the combination of sever /moderate acne and papulopustular rosacea. Rational daily use of skin care products can reduce the incidence of rosacea in acne patients. For acne patients without family history of rosacea, dermatologists should also not ignore the healthy education to avoid potential triggers of rosacea. PMID: 33025720 [PubMed - as supplied by publisher] {url} = URL to article

Rationale for Use of Combination Therapy in Rosacea. J Drugs Dermatol. 2020 Oct 01;19(10):929-934 Authors: Stein Gold L, Baldwin H, Harper JC Abstract BACKGROUND: Rosacea is a chronic skin condition characterized by primary and secondary manifestations affecting the centrofacial skin. The primary diagnostic phenotypes for rosacea are fixed centrofacial erythema with periodic intensification, and phymatous changes. Major phenotypes, including papules and pustules, flushing, telangiectasia, and ocular manifestations, may occur concomitantly or independently with the diagnostic features. The phenotypes of rosacea patients may evolve between subtypes and may require multiple treatments concurrently to be effectively managed. We report the proceedings of a roundtable discussion among 3 dermatologists experienced in the treatment of rosacea and present examples of rosacea treatment strategies that target multiple rosacea symptoms presenting in individual patients. METHODS: Three hypothetical cases describing patients representative of those commonly seen by practicing dermatologists were developed. A roundtable discussion was held to discuss overall and specific strategies for treating rosacea based on the cases. RESULTS/DISCUSSION: With few exceptions, the dermatologists recommended combination therapy targeting each manifestation of rosacea for each case. These recommendations are in agreement with the current American Acne and Rosacea Society treatment guidelines for rosacea and are supported by several studies demonstrating beneficial results from combining rosacea treatments. CONCLUSIONS: Rosacea is an evolving condition; care should take into account all clinical signs and symptoms of rosacea that are present in an individual patient, understanding that symptoms may change over time, and utilize combination therapy when applicable to target all rosacea symptoms. J Drugs Dermatol. 2020;19(10): 929-934. doi:10.36849/JDD.2020.5367. PMID: 33026776 [PubMed - as supplied by publisher] {url} = URL to article

Association between Demodex folliculorum and Metabolic Syndrome. J Cosmet Dermatol. 2020 Oct 05;: Authors: Toka Özer T, Akyürek Ö, Durmaz S Abstract BACKGROUND: Demodex folliculorum mite infestation is associated with many diseases such as rosacea, pityriasis found with acne vulgaris, and blepharitis. AIM: In this research, the aim of this study was to investigate an association between patients who have metabolic syndrome and presence of Demodex folliculorum. PATIENTS/METHODS: This research was planned prospectively as a case-control study. Fifty cases who have metabolic syndrome and 50 control subjects in good health were included. Metabolic syndrome was diagnosed according to the NCEP Adult Treatment Panel III criteria. Standard superficial skin biopsy was performed for the presence of Demodex folliculorum mite infestation. RESULTS: It was detected that number of Demodex affected from the glucose level and each increase in glucose level cause an increase on Demodex as 0.190 (P = .00, t = 4.746, B = 0.190, r = 0.57, Durbin-Watson = 1.801, confidence interval = 0.110 to 0.271 (for glucose)). CONCLUSION: In this study, the presence of Demodex folliculorum was found to be higher in the cases who have metabolic syndrome compared to the healthy group. These results show that in cases with metabolic syndrome, high blood sugar levels make them more susceptible to infestation of Demodex folliculorum. PMID: 33017081 [PubMed - as supplied by publisher] {url} = URL to article More information on Demodectic Rosacea

Diagnostic and Management Considerations for 'Maskne' in the Era of COVID-19. J Am Acad Dermatol. 2020 Oct 01;: Authors: Teo WL PMID: 33011321 [PubMed - as supplied by publisher] {url} = URL to article

Ocular rosacea. Curr Opin Ophthalmol. 2020 Nov;31(6):503-507 Authors: Redd TK, Seitzman GD Abstract PURPOSE OF REVIEW: To revisit ocular rosacea as an underappreciated condition which can cause permanent blindness if inadequately treated, and to review data supporting improved diagnostic and treatment strategies. RECENT FINDINGS: Ocular rosacea has an underrecognized prevalence in children and individuals with darker skin tone. Rosacea has several associations with other significant systemic diseases. Variations in local and systemic microbiome, including demodex infestation, may play a role in pathogenesis, severity, and in explaining the different phenotypes of rosacea. The National Rosacea Society Expert Committee established an updated classification system of rosacea in 2017. New treatment algorithms based on these clinical subtypes are suggested. SUMMARY: With continued advancements in the understanding of the epidemiology and pathogenesis of rosacea, randomized controlled trials specific for ocular rosacea remain lacking. There is overall consensus that rosacea and ocular rosacea require chronic maintenance treatment strategies involving combination topical and systemic therapies. PMID: 33009083 [PubMed - as supplied by publisher] {url} = URL to article

Azelaic acid stimulates catalase activation and promotes hair growth through upregulation of Gli1 and Gli2 mRNA and Shh protein. Avicenna J Phytomed. 2020 Sep-Oct;10(5):460-471 Authors: Amirfakhryan E, Davarnia B, Jeddi F, Najafzadeh N Abstract Objective: Although azelaic acid is effective for treatment of acne and rosacea, the biological activity of azelaic acid and the effect of its combination therapy with minoxidil were not elucidated with regard to hair growth. Materials and Methods: In this study, mouse vibrissae follicles were dissected on day 10 after depilation. Then, the bulb and bulge cells of the hair follicle were treated with minoxidil and azelaic acid for 10 days to evaluate Sonic hedgehog (Shh) protein expression. Moreover, bulge and bulb cells of the hair follicles were cultivated and the expression of Gli1, Gli2, and Axin2 mRNA levels was evaluated using real-time polymerase chain reaction (PCR) analysis. We further investigated the protective effects of azelaic acid against ultraviolet B (UVB) irradiation in cultured bulb and bulge cells by determining catalase activity. An irradiation dose of 20 mJ/cm2 UVB for 4 sec was chosen. Results: The results showed that catalase activity significantly (p<0.05) increased in the bulge cells after exposure to 2.5 mM and 25 mM azelaic acid. Meanwhile, treatment of the bulb cells with azelaic acid (2.5 and 25 mM) did not cause significant changes in catalase activity. We also found that azelaic acid (25 mM) alone upregulated Gli1 and Gli2 expression in the bulge cells and 100 µ minoxidil caused Gli1 and Axin2 overexpression in the bulb region of the hair follicle. Moreover, minoxidil (100 µM) alone and in combination with azelaic acid (25 mM) led to Shh protein overexpression in the hair follicles in vitro and in organ culture. Conclusion: Our results indicated a potential role for azelaic acid in the protection of bulge cells from UVB damage and its combination with minoxidil may activate hair growth through overexpression of Shh protein. PMID: 32995324 [PubMed] {url} = URL to article

Related Articles A new facial rash. Aust J Gen Pract. 2020 Jan-Feb;49(1-2):36-37 Authors: Sun C, Muir J PMID: 32008265 [PubMed - indexed for MEDLINE] {url} = URL to article Full Text of this article with photos, showing a differential diagnosis of rosacea with other skin conditions.

Evaluation of the efficacy of subantimicrobial dose doxycycline in rosacea: a systematic review of clinical trials and meta-analysis. J Dtsch Dermatol Ges. 2020 Sep 28;: Authors: Husein-ElAhmed H, Steinhoff M Abstract BACKGROUND: Low-dose doxycycline (SDD) is an antimicrobial agent that appears to improve common inflammatory skin diseases. Few data are available regarding the overall effectiveness, appropriate length of treatment and optimal patient selection for rosacea. We therefore reviewed the efficacy of sub-antimicrobial doses of SDD in papulopustular rosacea (PPR) and aimed to determine the most suitable patients for this approach. METHODS: From July to September 2019, we carried out a comprehensive search of literature from five databases, using a combination of "rosacea" AND "doxycycline". RESULTS: Our search yielded 532 potentially relevant studies. Our meta-analysis showed no significant difference between SDD and a comparator (RR: 1.12, 95 % CI: 0.78-1.62, I2 = 86 %). Subgroup analysis of studies comparing doxycycline with placebo yielded a clear difference in favor of doxycycline (RR: 1.45, 95 % CI: 1.22-1.72, I2 = 31 %), while subgroup analysis of studies comparing active drugs revealed no difference between interventions (RR: 0.52, 95 % CI: 0.17-1.63, I2 = 90 %). CONCLUSIONS: There is strong evidence that SDD is more effective than placebo. However, other drugs such as minocycline or isotretinoin have shown outcomes at least similar to that of SDD. We suggest that the anti-inflammatory properties of SDD may be of more value for mild cases of rosacea than for moderate to severe cases, for which higher (antimicrobial) doses of doxycycline may be a more suitable choice. PMID: 32989925 [PubMed - as supplied by publisher] {url} = URL to article More info on low dose doxycycline

Related ArticlesBlemished noses in the art of three masters: Ghirlandaio, Rembrandt, and Warhol. Clin Dermatol. 2020 May - Jun;38(3):360-364 Authors: Mohammed TO, Hassan S, Hamideh N, Mahmoud A, Waugh MA, Plewig G, Parish LC, Hoenig LJ Abstract Blemished noses are portrayed in the paintings of such noted artists as Ghirlandaio, Rembrandt, and Andy Warhol. Sometimes, the deformity results from a skin disorder such as rhinophyma as in Ghirlandaio's An Old Man and his Grandson or a saddle nose deformity from congenital syphilis as in Rembrandt's Portrait of Gerard de Lairesse. Andy Warhol's Before and After portrays a large nose before and after cosmetic surgery. This contribution explores some of the lessons that can be learned, both artistically and medically, from these famous works of art. PMID: 32563351 [PubMed - indexed for MEDLINE] {url} = URL to article