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Rosacea Pathogenesis. Dermatol Clin. 2018 Apr;36(2):81-86 Authors: Ahn CS, Huang WW Abstract Rosacea is a chronic inflammatory skin disorder that is not fully understood but involves the complex interplay of genetic factors, immune dysregulation, neurovascular dysregulation, presence of microorganisms, and environmental factors. Increased activation of the immune system occurs through multiple stimuli, including increased levels of cathelicidin and kallikrein 5, Toll-like receptor 2, matrix metalloproteinases, and mast cells within the skin. Their effects are enhanced by the presence of microorganisms and external triggers, such as UV radiation. PMID: 29499802 [PubMed - in process] {url} = URL to article

Genetic Predisposition to Rosacea. Dermatol Clin. 2018 Apr;36(2):87-92 Authors: Awosika O, Oussedik E Abstract Rosacea is a common inflammatory skin disease with a multifaceted pathophysiology, including environmental stressors and neurovascular and immune dysfunction affected by the presence of pathogens. The genetic component of this disorder is not well understood. However, a possible genetic origin in Northern European descendants, family inheritance, twin concordance, and genetic associations with autoimmune disorders attest the genetic predisposition to rosacea. Currently, one single-nucleotide polymorphism has been identified in association with rosacea and is intergenic between HLA-DRA and BTNL2. Additional associations with HLA alleles and immune-mediated disorders support the role of immune-regulating genes and innate and adaptive immunity in rosacea. PMID: 29499803 [PubMed - in process] {url} = URL to article

Validity and Reliability of a Rosacea Self-Assessment Tool. Dermatol Clin. 2018 Apr;36(2):93-96 Authors: Moradi Tuchayi S, Alinia H, Lan L, Awosika O, Cline A, Cardwell LA, Hopkinson D, Richardson I, Huang KE, Feldman SR Abstract The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies. PMID: 29499804 [PubMed - in process] {url} = URL to article

Measurement of Disease Severity in a Population of Rosacea Patients. Dermatol Clin. 2018 Apr;36(2):97-102 Authors: Alinia H, Tuchayi SM, James SM, Cardwell LA, Nanda S, Bahrami N, Awosika O, Richardson I, Huang KE, Feldman SR Abstract Severity of rosacea in populations is not well characterized. A validated self-assessment tool was used to study the relationship between rosacea severity and demographic factors. Subjects were adult patients with a clinical diagnosis of rosacea. Self-assessment severity scores were significantly higher in participants less than 60 years old (mean 3.43 ± 1.07) compared with those greater than or equal to 60 years old (mean 3.09 ± 1.13; P = .04). Self-assessment severity scores were significantly higher in men (3.6 ± 1.3) than women (3.2 ± 1.0; P = .04). The authors conclude that rosacea is more severe in men and younger patients. PMID: 29499805 [PubMed - in process] {url} = URL to article

Complexities of Rosacea. Dermatol Clin. 2018 Apr;36(2):xiii Authors: Feldman SR, Cardwell LA, Taylor SL PMID: 29499806 [PubMed - in process] {url} = URL to article

A Review of the Current Modalities for the Treatment of Papulopustular Rosacea. Dermatol Clin. 2018 Apr;36(2):135-150 Authors: McGregor SP, Alinia H, Snyder A, Tuchayi SM, Fleischer A, Feldman SR Abstract Papulopustular rosacea is characterized by papules and pustules in the central facial region. We review the literature surrounding the treatment of papulopustular rosacea. PubMed, EMBASE, and Cochrane (Central) databases searches of articles published from 1980 to 2015 were performed using the MeSH terms or keywords "rosacea" and "clinical trial." Additional searches were performed to include rosacea and each treatment modality used. Topical metronidazole, azelaic acid, ivermectin, and oral doxycycline have the most robust data to support their use. Variation in assessment tools and a lack of clinical trial standardization makes comparison of therapeutic options difficult. PMID: 29499797 [PubMed - in process] {url} = URL to article

Revisiting Rosacea Criteria: Where Have We Been, Where Are We Going, and How Will We Get There? Dermatol Clin. 2018 Apr;36(2):161-165 Authors: Saleem MD Abstract Rosacea is one of the most common and misunderstood dermatologic conditions. Currently, rosacea criteria are based on expert opinion; the definition of rosacea is primarily a reflection of opinion that is prone to bias. It has been more than a decade since the initial criteria were created by the National Rosacea Society. Revisiting the criteria and incorporating evidence-based techniques used by rheumatology and psychiatry can improve the validity and reliability of rosacea criteria. Literature from other specialties is reviewed and a method proposed for developing valid criteria. Examples are provided to motivate and highlight the importance of implementing such techniques. PMID: 29499799 [PubMed - in process] {url} = URL to article

Medical Management of Facial Redness in Rosacea. Dermatol Clin. 2018 Apr;36(2):151-159 Authors: Cline A, McGregor SP, Feldman SR Abstract Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea. PMID: 29499798 [PubMed - in process] {url} = URL to article

A Review of the Current Modalities for the Treatment of Papulopustular Rosacea. Dermatol Clin. 2018 Apr;36(2):135-150 Authors: McGregor SP, Alinia H, Snyder A, Tuchayi SM, Fleischer A, Feldman SR Abstract Papulopustular rosacea is characterized by papules and pustules in the central facial region. We review the literature surrounding the treatment of papulopustular rosacea. PubMed, EMBASE, and Cochrane (Central) databases searches of articles published from 1980 to 2015 were performed using the MeSH terms or keywords "rosacea" and "clinical trial." Additional searches were performed to include rosacea and each treatment modality used. Topical metronidazole, azelaic acid, ivermectin, and oral doxycycline have the most robust data to support their use. Variation in assessment tools and a lack of clinical trial standardization makes comparison of therapeutic options difficult. PMID: 29499797 [PubMed - in process] {url} = URL to article

Revisiting Rosacea Criteria: Where Have We Been, Where Are We Going, and How Will We Get There? Dermatol Clin. 2018 Apr;36(2):161-165 Authors: Saleem MD Abstract Rosacea is one of the most common and misunderstood dermatologic conditions. Currently, rosacea criteria are based on expert opinion; the definition of rosacea is primarily a reflection of opinion that is prone to bias. It has been more than a decade since the initial criteria were created by the National Rosacea Society. Revisiting the criteria and incorporating evidence-based techniques used by rheumatology and psychiatry can improve the validity and reliability of rosacea criteria. Literature from other specialties is reviewed and a method proposed for developing valid criteria. Examples are provided to motivate and highlight the importance of implementing such techniques. PMID: 29499799 [PubMed - in process] {url} = URL to article

Patient Costs Associated with Rosacea. Dermatol Clin. 2018 Apr;36(2):167-170 Authors: Turbeville JG, Alinia H, Tuchayi SM, Bahrami N, Cardwell LA, Awosika O, Richardson I, Huang KE, Feldman SR Abstract The recalcitrance of rosacea to many treatment options may prompt patients to spend exorbitant amounts of money on unsubstantiated treatment regimens in an effort to achieve relief. The authors examine the relationship between disease severity and treatment cost across several demographic and socioeconomic strata. Familiarization of evidence-based clinical recommendations and consensus guidelines may equip physicians to educate patients about the most efficacious and cost-effective treatment options to assist patients in making cost-conscious decisions in the management of their rosacea. PMID: 29499800 [PubMed - in process] {url} = URL to article

Coping Mechanisms and Resources for Patients Suffering from Rosacea. Dermatol Clin. 2018 Apr;36(2):171-174 Authors: Cardwell LA, Nyckowski T, Uwakwe LN, Feldman SR Abstract Rosacea has significant quality of life impact. The authors review the literature and Internet sources pertaining to rosacea to identify coping mechanisms and resources available to rosacea patients. MEDLINE and PsycINFO databases were searched to identify pertinent articles. The term "rosacea" was searched in combination with "patient resources," "coping," "dealing with," "blog," "forum," "support," "nonpharmacologic," and "psychological." There are several social and educational coping resources available to rosacea patients. These may optimize quality of life and psychosocial outcomes in patients with rosacea. PMID: 29499801 [PubMed - in process] {url} = URL to article

Rosacea Pathogenesis. Dermatol Clin. 2018 Apr;36(2):81-86 Authors: Ahn CS, Huang WW Abstract Rosacea is a chronic inflammatory skin disorder that is not fully understood but involves the complex interplay of genetic factors, immune dysregulation, neurovascular dysregulation, presence of microorganisms, and environmental factors. Increased activation of the immune system occurs through multiple stimuli, including increased levels of cathelicidin and kallikrein 5, Toll-like receptor 2, matrix metalloproteinases, and mast cells within the skin. Their effects are enhanced by the presence of microorganisms and external triggers, such as UV radiation. PMID: 29499802 [PubMed - in process] {url} = URL to article

Genetic Predisposition to Rosacea. Dermatol Clin. 2018 Apr;36(2):87-92 Authors: Awosika O, Oussedik E Abstract Rosacea is a common inflammatory skin disease with a multifaceted pathophysiology, including environmental stressors and neurovascular and immune dysfunction affected by the presence of pathogens. The genetic component of this disorder is not well understood. However, a possible genetic origin in Northern European descendants, family inheritance, twin concordance, and genetic associations with autoimmune disorders attest the genetic predisposition to rosacea. Currently, one single-nucleotide polymorphism has been identified in association with rosacea and is intergenic between HLA-DRA and BTNL2. Additional associations with HLA alleles and immune-mediated disorders support the role of immune-regulating genes and innate and adaptive immunity in rosacea. PMID: 29499803 [PubMed - in process] {url} = URL to article

Validity and Reliability of a Rosacea Self-Assessment Tool. Dermatol Clin. 2018 Apr;36(2):93-96 Authors: Moradi Tuchayi S, Alinia H, Lan L, Awosika O, Cline A, Cardwell LA, Hopkinson D, Richardson I, Huang KE, Feldman SR Abstract The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies. PMID: 29499804 [PubMed - in process] {url} = URL to article

Measurement of Disease Severity in a Population of Rosacea Patients. Dermatol Clin. 2018 Apr;36(2):97-102 Authors: Alinia H, Tuchayi SM, James SM, Cardwell LA, Nanda S, Bahrami N, Awosika O, Richardson I, Huang KE, Feldman SR Abstract Severity of rosacea in populations is not well characterized. A validated self-assessment tool was used to study the relationship between rosacea severity and demographic factors. Subjects were adult patients with a clinical diagnosis of rosacea. Self-assessment severity scores were significantly higher in participants less than 60 years old (mean 3.43 ± 1.07) compared with those greater than or equal to 60 years old (mean 3.09 ± 1.13; P = .04). Self-assessment severity scores were significantly higher in men (3.6 ± 1.3) than women (3.2 ± 1.0; P = .04). The authors conclude that rosacea is more severe in men and younger patients. PMID: 29499805 [PubMed - in process] {url} = URL to article

Complexities of Rosacea. Dermatol Clin. 2018 Apr;36(2):xiii Authors: Feldman SR, Cardwell LA, Taylor SL PMID: 29499806 [PubMed - in process] {url} = URL to article

Medical Management of Facial Redness in Rosacea. Dermatol Clin. 2018 Apr;36(2):151-159 Authors: Cline A, McGregor SP, Feldman SR Abstract Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea. PMID: 29499798 [PubMed - in process] {url} = URL to article

StatPearls Book. 2018 01 Authors: Abstract Kaposi varicelliform eruption, also called eczema herpeticum, refers to a disseminated skin infection due to a virus that usually leads to localized vesicular eruptions, occurring in a patient with an underlying cutaneous disease. Although rare, it is potentially life-threatening disorder. Herpes simplex virus is considered the main causative agent. The most commonly reported cases occur in patients with atopic dermatitis. However, it has been described in association with other skin conditions such as pemphigus foliaceus, ichthyosis vulgaris, bullous pemphigoid, Darier disease, Grover disease, Hailey-Hailey disease, dyskeratosis follicularis, mycosis fungoides, Sezary syndrome, psoriasis, pityriasis rubra pilaris, rosacea, seborrheic dermatitis, contact dermatitis (both allergic and irritant), second degree burns and skin grafts. Clinical features of Kaposi varicelliform eruption include widespread clusters of umbilicated vesicles and pustules that evolve into crusted skin erosions. The most frequently affected sites are the trunk, neck, and head. The diagnosis of Kaposi varicelliform eruption is made primarily on clinical findings. The Tzanck smear, viral cultures, skin biopsy, or detection of viral DNA by Polymerase Chain Reaction may be helpful in doubtful cases. Antiviral therapy has been effective but should be started as soon as possible after diagnosis to reduce morbidity and mortality. PMID: 29494039 {url} = URL to article More on Kaposi varicelliform eruption: J Am Acad Dermatol. 2004 Nov;51(5 Suppl):S169-72. doi: 10.1016/j.jaad.2004.05.011. Kaposi's Varicelliform Eruption in Association With Rosacea Isil Kucukyilmaz, Erkan Alpsoy, Sahin Yazar

Use of the microdebrider in the surgical management of rhinophyma. Ear Nose Throat J. 2018 Jan-Feb;97(1-2):E42-E45 Authors: Chow W, Jeremic G, Sowerby L Abstract Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities-including scalpel surgery, dermabrasion, CO2 laser ablation, and electrocautery-have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients-a 65-year-old man and a 74-year-old man-who presented with rhinophyma. The instrument we used was the Medtronic Straightshot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option. PMID: 29493731 [PubMed - in process] {url} = URL to article

The Rosacea-specific Quality-of-Life instrument (RosQol): Revision and validation among Chinese patients. PLoS One. 2018;13(2):e0192487 Authors: Deng Y, Peng Q, Yang S, Jian D, Wang B, Huang Y, Xie H, Li J Abstract Rosacea is a common chronic facial disorder that affects patients' health-related quality of life; the only questionnaire designed specifically for rosacea is the Rosacea-specific Quality-of-Life instrument (RosQol). However, the questionnaire has not been validated among Chinese patients. This study aimed to validate the Chinese version of the RosQol. First, we translated the questionnaire into Chinese. Then, rosacea patients completed the RosQol and Dermatology Life Quality Index, indicating the disease's impact on their lives. We also collected patients' demographic and clinical data, including symptom self-evaluation scores and rosacea severity scores. Internal consistency was determined by using Cronbach's alpha, test-retest reliability, and Spearman's correlation. Criterion-related validity and internal construct validity were also determined. Most RosQol items showed good internal consistency. However, items 13 and 19 were not sufficiently sensitive for use in the Chinese population; we deleted them and constructed the adjusted Chinese-version RosQol, which had good reliability and validity. When patients' clinical symptoms changed, the scores on the relevant dimensions of the adjusted RosQol also changed. Some RosQol items were not suitable for use in the Chinese sample. The adjusted Chinese-version RosQol was easy to complete, well received by patients, and demonstrated acceptable validity and reliability. PMID: 29489857 [PubMed - in process] {url} = URL to article

Related Articles The association between cigarettes smoke, small intestine bacterial overgrowth and rosacea. G Ital Dermatol Venereol. 2018 Feb 26;: Authors: Drago F, Ciccarese G, Herzum A, Drago F, Rebora A, Parodi A PMID: 29485256 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Syndr. 2018;10:9 Authors: Stefanadi EC, Dimitrakakis G, Antoniou CK, Challoumas D, Punjabi N, Dimitrakaki IA, Punjabi S, Stefanadis CI Abstract There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation. PMID: 29483947 [PubMed] {url} = URL to article

Related Articles Seeking new acne treatment from natural products, devices and synthetic drug discovery. Dermatoendocrinol. 2017;9(1):e1356520 Authors: Yang JH, Yoon JY, Kwon HH, Min S, Moon J, Suh DH Abstract Despite lots of research on the pathogenesis of acne, the development of new therapeutic agents is still stagnant. Conventional agents which target multiple pathological processes have some serious side effects and this makes seeking new treatment options important for treating acne. As new therapeutic options, researchers are focusing on natural products, synthetic drugs and devices. From natural products, epigallocatechin-3 gallate, lupeol, cannabidiol and Lactobacillus fermented Chamaecyperis obtusa were reported to be possible candidates for novel drugs, targeting multiple pathogenic factors. Synthetic anti-P.acnes agent, nitric oxide nanoparticles and α-mangostin nanoparticles are shown to be effective in acne treatment. Device or procedural methods such as fractional microneedling radiofrequency, cryolysis, photothermolysis and daylight photodynamic therapy have potential as new treatment options for acne. Further large clinical trials comparing these new treatments with existing agents will be necessary in the future. PMID: 29484092 [PubMed] {url} = URL to article

Related Articles Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574 Authors: Rainer BM, Kang S, Chien AL Abstract Rosacea is a chronic relapsing inflammatory skin disease with a high prevalence among adults of Northern European heritage with fair skin. Symptoms present in various combinations and severity, often fluctuating between periods of exacerbation and remission. Based on morphological characteristics, rosacea is generally classified into four major subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Diverse environmental and endogenous factors have been shown to stimulate an augmented innate immune response and neurovascular dysregulation; however, rosacea's exact pathogenesis is still unclear. An evidence-based approach is essential in delineating differences between the many available treatments. Because of the diverse presentations of rosacea, approaches to treatment must be individualized based on the disease severity, quality-of-life implications, comorbidities, trigger factors, and the patient's commitment to therapy. PMID: 29484096 [PubMed] {url} = URL to article