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Integrative concepts of rosacea pathophysiology, clinical presentation, and new therapeutics. Exp Dermatol. 2016 Jul 4; Authors: Holmes AD, Steinhoff M Abstract Rosacea is a chronic relapsing inflammatory skin disease with high prevalence world-wide. Recent research suggests that dysregulation of innate and adaptive immune pathways as well as neuro-vascular changes are present, with different degrees of importance in the various subtypes. Neither the etiology, genetics, nor pathophysiological basis of the vascular, inflammatory or fibrotic changes are well understood. The clinical spectrum comprises a huge variability from erythema (vasodilation) to papules/pustules (inflammatory infiltrate) to phymata (fibrosis, glandular hyperplasia) making it a valuable human disease model to understand the interplay between the neurovascular and immune systems as well as the progression from chronic inflammation to fibrosis in skin. The lack of appropriate animal models emphasizes the importance of further translational research validating observed molecular pathways under disease conditions. A wide spectrum of physical (UV, temperature), biological (microbiota, food) and endogenous (genetic, stress) stimuli have been discussed as 'trigger factors' of rosacea. Novel findings implicate keratinocytes, smooth muscle cells, endothelial cells, macrophages, mast cells, fibroblasts, Th1/Th17 cells, antibody-producing B cells, and neurons in the pathobiology of rosacea. So far, pattern recognition receptors like TLR2, transient receptor potential ion channels (TRPV1, TRPA1), cytokines, chemokines, and proteases have been implicated as critical receptors/mediators. However, our understanding of the interactive networks on the molecular level is very limited. Identification of critical molecular components of the inflammatory cascade including antimicrobial peptides, the IL-1β inflammasome, TNF, IFNγ, proteases, and neuropeptides may provide the basis for novel pathomechanism-based therapeutic approaches for this frequent and bothersome skin disease. This article is protected by copyright. All rights reserved. PMID: 27376863 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Shiitake dermatitis: the tale of an under-recognised, undercooked fungus. Med J Aust. 2016 Feb 15;204(3):124-6.e1 Authors: McNally A, Ross C, Wayte J PMID: 26866554 [PubMed - indexed for MEDLINE] {url} = URL to article

Related Articles Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. J Drugs Dermatol. 2015 Sep;14(9):964-8 Authors: Schulte BC, Wu W, Rosen T Abstract Azelaic acid is a complex molecule with many diverse activities. The latter include anti-infective and anti-inflammatory action. The agent also inhibits follicular keratinization and epidermal melanogenesis. Due to the wide variety of biological activities, azelaic acid has been utilized as a management tool in a broad spectrum of disease states and cutaneous disorders. This paper reviews the clinical utility of azelaic acid, noting the quality of the evidence supporting each potential use. PMID: 26355614 [PubMed - indexed for MEDLINE] {url} = URL to article

Related Articles Laser and Light-Based Aesthetics in Men. J Drugs Dermatol. 2015 Sep;14(9):1061-4 Authors: Green JB, Metelitsa AI, Kaufman J, Keaney T Abstract Men represent an important evolving segment of the cosmetic market. With the growing acceptability of cosmetic procedures along with societal and workplace pressure to maintain youthfulness, men increasingly seek the advice of aesthetic practitioners. Despite this so-called "Menaissance," there is a paucity of published literature regarding laser and light treatments of male skin. Herein the differences in male cutaneous physiology are addressed, followed by a review of light-based treatment of conditions largely unique to male skin, pseudofolliculitis barbae, and rhinophyma. Next, the publications related to laser treatment of male skin specifically are examined. We conclude with a discussion of personal observations derived from clinical experience with laser and light-based treatments in men. PMID: 26355628 [PubMed - indexed for MEDLINE] {url} = URL to article

Related Articles Orofacial granulomatosis. Clin Dermatol. 2016 Jul-Aug;34(4):505-13 Authors: Miest R, Bruce A, Rogers RS Abstract Orofacial granulomatosis (OFG) is an uncommon chronic granulomatous condition with a multifactorial etiology and pathogenesis. Genetic, immunologic, allergic, and infectious mechanisms have been implicated. OFG is often used as a descriptor to encompass all entities with orofacial swelling and histologic evidence of noncaseating granulomas. The diagnosis of OFG should prompt evaluation for provocative factors. The cause of most cases of OFG remains obscure. The clinician must consider mycobacterial infections, deep fungal infections, sarcoidosis, rosacea, and Crohn disease (CD). In addition, OFG should be considered synonymous with previously described conditions, including granulomatous cheilitis and Miescher cheilitis, as well as Melkersson-Rosenthal syndrome and its monosymtomatic or oligosymptomatic variants. The relationship of OFG to CD is currently debated, with recent evidence suggesting the possibility of three entities: classic oral CD (established gastrointestinal CD with oral involvement), OFG with gastrointestinal involvement (OFG with subclinical or asymptomatic gastrointestinal endoscopy changes), and OFG without bowel involvement. Childhood onset, presence of certain phenotypic features, laboratory abnormalities, or gastrointestinal symptoms may indicate the need for further evaluation to assess for concurrent or future CD. Although multiple therapies have been found to be effective in small numbers of patients, treatment should be tailored to each patient. PMID: 27343966 [PubMed - in process] {url} = URL to article

Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917. World J Gastroenterol. 2016 Jun 21;22(23):5415-21 Authors: Manzhalii E, Hornuss D, Stremmel W Abstract AIM: To evaluate the effect of oral Escherichia coli (E. coli) Nissle application on the outcome of intestinal-borne dermatoses. METHODS: In a randomized, controlled, non-blinded prospective clinical trial 82 patients with intestinal-borne facial dermatoses characterized by an erythematous papular-pustular rash were screened. At the initiation visit 37 patients entered the experimental arm and 20 patients constituted the control arm. All 57 patients were treated with a vegetarian diet and conventional topical therapy of the dermatoses with ointments containing tetracycline, steroids and retinoids. In the experimental arm patients received a one month therapy with oral E. coli Nissle at a maintenance dose of 2 capsules daily. The experimental group was compared to a non-treatment group only receiving the diet and topical therapy. The primary outcome parameter was improvement of the dermatoses, secondary parameters included life quality and adverse events. In addition the immunological reaction profile (IgA, interleucin-8 and interferon-α) was determined. Furthermore the changes of stool consistency and the microbiota composition over the time of intervention were recorded. RESULTS: Eighty-nine percent of the patients with acne, papular-pustular rosacea and seborrhoic dermatitis responded to E. coli Nissle therapy with significant amelioration or complete recovery in contrast to 56% in the control arm (P < 0.01). Accordingly, in the E. coli Nissle treated patients life quality improved significantly (P < 0.01), and adverse events were not recorded. The clinical improvement was associated with a significant increase of IgA levels to normal values in serum as well as suppression of the proinflammatory cytokine IL-8 (P < 0.01 for both parameters). In the E. coli Nissle treated group a shift towards a protective microbiota with predominance of bifidobacteria and lactobacteria (> 10(7) CFU/g stool) was observed in 79% and 63% of the patients, respectively (P < 0.01), compared to no change in the control group without E. coli Nissle. Moreover, the detection rate of a pathogenic flora dropped from 73% to 14 % of the patients in the experimental arm (P < 0.01) with no significant change in the control arm (accounting 80% before and 70% after the observation period, P > 0.05). Accordingly, stool consistency, color and smell normalized in the E. coli Nissle treated patients. CONCLUSION: E. coli Nissle protects the mucus barrier by overgrowth of a favorable gut microbiota with less immunoreactive potential which finally leads to clinical improvement of intestinal borne dermatoses. PMID: 27340358 [PubMed - in process] {url} = URL to article

The relationship between rosacea and insulin resistance and metabolic syndrome. Eur J Dermatol. 2016 Jun 1;26(3):260-4 Authors: Akin Belli A, Ozbas Gok S, Akbaba G, Etgu F, Dogan G Abstract Rosacea is a chronic inflammatory skin disease affecting the face. A positive correlation has been found between rosacea and cardiovascular diseases. We sought to investigate the relation between rosacea and metabolic syndrome (MS) and insulin resistance (IR). Between January and June 2015, a case-control study including 47 age-, gender-, and body mass index (BMI)-matched rosacea patients and 50 controls was conducted. Demographic data, clinical features of rosacea patients, anthropometric measures, laboratory findings, blood pressure levels, BMI, smoking history, alcohol consumption, sports life, family history of cardiovascular disease, and presence of MS and IR were recorded. Forty-seven rosacea patients (12 men and 35 women; age range: 35-68 years) and 50 controls (11 men and 39 women; age range: 38-78 years) were included in our study. Of 47 rosacea patients, 24 had erythematotelangiectatic type, 22 had papulopustular type, and one had phymatous type. Whereas the rate of IR was significantly higher in the rosacea group, there was no significant difference in the rate of MS between rosacea and the control group (p = 0.009 and p = 0.186, respectively). In addition, the rosacea group had significantly higher fasting blood glucose, total cholesterol, and systolic and diastolic blood pressure levels (p<0.05). Mean levels of LDL, triglyceride, total cholesterol and CRP were significantly higher than in the control group (p<0.05). Our findings suggest that there is a relationship between rosacea and IR and some parameters of cardiovascular risk factors. We recommend investigation of IR in rosacea patients. PMID: 27328660 [PubMed - in process] {url} = URL to article

Related Articles Feelings of stigmatization in patients with rosacea. J Eur Acad Dermatol Venereol. 2016 Jun 21; Authors: Halioua B, Cribier B, Frey M, Tan J Abstract BACKGROUND: Rosacea is a chronic facial disease that may lead to feelings of stigmatization, which can negatively impact psychological and social well-being. OBJECTIVE: The aim of this study was to evaluate different aspects of rosacea that could contribute to feelings of stigmatization. METHODS: An online survey of a representative sample of the adult population in the UK, France, Germany and US was conducted to identify patients with rosacea based on presence of three or more clinical features. RESULTS: Among the patients who completed the survey (n = 807), mean age at first sign/symptom of rosacea was 31.3 ± 14.5 years; mean duration of disease was 102 ± 119 months. One-third of patients reported feelings of stigmatization (FS; n = 275). Male patients were more likely to experience FS (49% vs. 37.2% in non-FS population; P = 0.0037). Those with FS were more likely to avoid social situations (54.2% vs. 2.0%, P < 1.00(E-10) ) and had a higher rate of depression (36.7% vs. 21.1%, P < 1.00(E-10) ). CONCLUSIONS: Stigmatization is important in the daily lives of those with rosacea and should be taken into consideration in the management of these patients. PMID: 27323701 [PubMed - as supplied by publisher] {url} = URL to article

Topical cyclosporin A as a steroid-sparing agent for ocular rosacea. Acta Ophthalmol. 2016 Jun 17; Authors: Ong HS, Patel KV, Dart JK, Praestegaard M PMID: 27312057 [PubMed - as supplied by publisher] {url} = URL to article

Light Emitting Diodes Down-regulates Cathelicidin, Kallikrein, and Toll-like Receptor 2 Expressions in Keratinocytes and Rosacea-like Mouse Skin. Exp Dermatol. 2016 Jun 17; Authors: Lee JB, Bae SH, Moon KR, Na EY, Yun SJ, Lee SC Abstract BACKGROUND: Cathelicidin (LL-37), Toll-like receptor 2 (TLR 2), and kallikreins (KLKs) are key inflammatory mediators in rosacea. Laser or light-based devices have been successfully used for rosacea. OBJECTIVE: We investigated the effects of light-emitting diodes (LED) on LL-37, KLKs, TLR 2, and protease activity in cultured normal human epidermal keratinocytes(NHEKs) and rosacea-like mouse skin(RLMS). METHODS: LL-37, KLK 5, KLK 7, and vitamin D receptor were induced by 1α,25-dihydroxyvitaminD3 (VD3 ) and TLR 2 by Ad-CMV transfection in cultured NHEKs. NHEKs were subjected to LED irradiation at differing wavelengths (480-940 nm) and fluences (1-80 40 J/cm(2) ). Inflammatory mediators were analysed with RT-PCR and real-time PCR and protease activity analysis and immunocytofluorescence staining were performed for NHEKs. Changes in RLMS induced by LL-37 peptide were evaluated with real time PCR, immunohistochemical staining, and enzyme linked immunosorbent assay. RESULTS: In NHEKs, LED at 630 and 940 nm significantly attenuated LL37, KLK 5 and TLR 2 mRNA expressions. Protease activity was significantly suppressed at 630, 850, and 940 nm. In the RLMS, LL-37, KLK 5, and PAR 2 mRNA expressions significantly decreased at 24 and 48 h after LED irradiation was performed three times thrice at 630 and 940 nm. mCAMP and IL-8 protein levels and protease activity after LED irradiation were lower than those in RLMS control groups. CONCLUSION: LED at 630 and 940 nm down-regulated TLR 2, KLK 5, and LL-37 expressions and protease activity in NHEK and RLMS. Thus, LEDs may be promising for rosacea treatment. However, clinical trials are required for further study. This article is protected by copyright. All rights reserved. PMID: 27315464 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Atypical rosacea in a male patient: case study. Dermatol Online J. 2016;22(2) Authors: Debroy Kidambi A, Tiffin NJ, Ramsay HM Abstract Rosacea fulminans is a rare disorder of unknown cause, almost exclusively affecting women. There are only a few reported cases in men. The condition is characterized by the abrupt onset of pustules and nodules predominantly affecting the cheeks or chin without any systemic upset. We report the case of a 37-year-old man who presented with papulopustules, predominantly localized to his nose. Histopathological features were consistent with rosacea fulminans. The patient was managed with treatments including oral prednisolone, isotretinoin, and trimethioprim. PMID: 27267199 [PubMed - in process] {url} = URL to article

Related Articles Morphological and Functional Evaluation of Meibomian Gland Dysfunction in Rosacea Patients. Curr Eye Res. 2016 Jun 6;:1 Authors: Palamar M, Degirmenci C, Ertam I, Yagci A PMID: 27268769 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Paradoxical Erythema Reaction of Long-term Topical Brimonidine Gel for the Treatment of Facial Erythema of Rosacea. J Drugs Dermatol. 2016 Jun 1;15(6):763-5 Authors: Lowe E, Lim S Abstract In 2013 brimonidine tartrate gel 0.33% (Mirvaso Gel, Galderma Laboratories, LP, Fort Worth, TX) was approved by the US Food and Drug Administration for the treatment of facial erythema of rosacea. It is the first and only drug on the market to address the hallmark redness of this chronic, inflammatory disease. Commonly reported adverse events include erythema/flushing worse than at baseline, most often occurring with the first application. We report a unique case of facial erythema of rosacea that responded to brimonidine gel with effective blanching for two years until the patient developed a paradoxical erythema reaction. This is an adverse reaction physicians should be aware of with continued prescription of brimonidine gel for their rosacea patients.<br /><br /> <em>J Drugs Dermatol</em>. 2016;15(6):763-765. PMID: 27272086 [PubMed - in process] {url} = URL to article

Related Articles A Sequential Approach to the Treatment of Severe Papulopustular Rosacea Not Responding to Traditional Treatment. J Drugs Dermatol. 2016 Jun 1;15(6):769-71 Authors: Dirschka T, Schmitz L, Bartha Á Abstract We report the case of a German female patient presenting with papulopustular rosacea (PPR) with a high count of facial inflammatory lesions and severe erythema who had not responded well to treatment with traditional therapies for a decade. In this patient, a sequential therapy consisting of oral modified-release doxycycline 40 mg (initially as monotherapy, then in combination with topical metronidazole), followed by topical ivermectin 10 mg/g was both rapidly active and effective. Following reduction of the inflammation with modified-release doxycycline 40 mg upfront and the disease becoming moderate in severity, the dose of this agent could be reduced and combination therapy with metronidazole 7.5 mg/g lotion started to continue decreasing inflammatory lesions count and erythema severity, before treatment with the recently approved agent ivermectin 10 mg/g was implemented to provide almost complete clearance. This sequential treatment was effective in reducing both the number of papules and pustules and the severity of erythema, with a good safety profile. In addition, a large improvement was documented in the patient's DLQI score, contributing to her overall wellbeing.<br /><br /> <em>J Drugs Dermatol</em>. 2016;15(6):769-771. PMID: 27272088 [PubMed - in process] {url} = URL to article

Inflammatory and glandular skin disease in pregnancy. Clin Dermatol. 2016 May-Jun;34(3):335-343 Authors: Yang CS, Teeple M, Muglia J, Robinson-Bostom L Abstract A switch from cell-mediated to humoral immunity (helper T 1 [Th1] to helper T 2 [Th2] shift) during gestation plays a key role in placental immune tolerance. As a result, skin diseases that are Th2 mediated often worsen, whereas skin diseases that are Th1 mediated often improve during gestation. Also, due to fluctuations in glandular activity, skin diseases involving sebaceous and eccrine glands may flare, whereas those involving apocrine glands may improve during pregnancy. Despite these trends, inflammatory and glandular skin diseases do not always follow the predicted pattern, and courses are often diverse. We review the gestational course of inflammatory skin diseases, such as atopic dermatitis (atopic eruption of pregnancy), psoriasis, impetigo herpetiformis, urticaria, erythema annulare centrifugum, pityriasis rosea, sarcoidosis, Sweet syndrome, and erythema nodosum, as well as glandular skin diseases, including acne vulgaris, acne rosacea, perioral dermatitis, hidradenitis suppurativa, Fox-Fordyce disease, hyperhidrosis, and miliaria. For each of these diseases, we discuss the pathogenesis, clinical presentation, and management with special consideration for maternal and fetal safety. PMID: 27265071 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Centrofacial Balamuthiasis: Case Report of a Rare Cutaneous Amebic Infection. J Cutan Pathol. 2016 Jun 2; Authors: Chang OH, Liu F, Knopp E, Muehlenbachs A, Cope JR, Ali I, Thompson R, George E Abstract Free-living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life-threatening central nervous system (CNS) involvement. We report a case of a 91-year-old woman, who presented with a non-healing red plaque over her right cheek. Several punch biopsies exhibited non-specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin-eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by Balamuthia mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis. PMID: 27251900 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Rosacea and dementia: relative vs. absolute effect sizes. Int J Clin Pract. 2016 Jun;70(6):428-9 Authors: Citrome L PMID: 27238959 [PubMed - in process] {url} = URL to article

Related Articles Compliance and Subjective Patient Responses to Eyelid Hygiene. Eye Contact Lens. 2016 May 26; Authors: Alghamdi YA, Camp A, Feuer W, Karp CL, Wellik S, Galor A Abstract OBJECTIVES: Lid hygiene is a commonly prescribed first-line therapy in patients with lid margin disease, yet compliance with therapy is not well characterized. The goals of this study were to assess patient compliance with lid hygiene and evaluate which factors predict a favorable symptomatic response to treatment. METHODS: This was a cross-sectional study of patients seen in the Miami Veterans Affairs eye clinic between August and December 2014. An evaluation was performed to assess dry eye symptoms and lid margin signs. All patients were then instructed to perform warm compresses and lid scrubs. A follow-up phone survey assessed compliance and subjective therapeutic response 6 weeks later. RESULTS: Two hundred seven of 211 (98%) patients (94% male, 60% white) completed the survey. Of the 207 patients, 188 (91%) completed the follow-up survey. Compliance with therapy was reported in 104 patients (55%); 66 reported complete improvement, 30 partial improvement, and 8 no improvement in symptoms. Patients who self-reported dry eye symptoms at first visit (n=86, 74%) were more likely to be compliant with lid hygiene than those who did not report symptoms (n=18, 25%) (P<0.0005). The only factor associated with poorer response to lid hygiene was longer time of self-reported dry eye symptoms. None of the other signs studied, including the presence of skin rosacea and lid margin telangiectasia, were associated with a differential response to lid hygiene. CONCLUSIONS: Patients with dry eye symptoms were moderately compliant with lid hygiene, and patients who performed the routine noted improvement in symptoms. PMID: 27243349 [PubMed - as supplied by publisher] {url} = URL to article

Cost-Effectiveness of Ivermectin 1% Cream in Adults with Papulopustular Rosacea in the United States. J Manag Care Spec Pharm. 2016 Jun;22(6):654-665 Authors: Taieb A, Gold LS, Feldman SR, Dansk V, Bertranou E Abstract BACKGROUND: Papulopustular rosacea is a chronic skin disease involving central facial erythema in combination with papules and pustules. Papulopustular rosacea is treated with topical, systemic, or a combination of topical and systemic therapies. Currently approved topical therapies include azelaic acid gel/cream/foam twice daily (BID) and metronidazole cream/gel/lotion BID. Ivermectin 1% cream once daily (QD) is a new topical agent for the treatment of papulopustular rosacea that has been approved for the management of inflammatory lesions of rosacea and offers an alternative to current treatments. OBJECTIVE: To evaluate the cost-effectiveness of ivermectin 1% cream QD compared with current topical treatments in order to understand the cost of adding ivermectin as a treatment option that would bring additional clinical benefit for adults with papulopustular rosacea in the United States. METHODS: The cost-effectiveness of ivermectin 1% cream QD was compared with metronidazole 0.75% cream BID and azelaic acid 15% gel BID for adults in the United States with moderate-to-severe papulopustular rosacea using a Markov cohort state transition structure with 2 mutually exclusive health states (rosacea and no rosacea) and 5 phases. Patients could succeed or fail to respond to treatment and experience a relapse after treatment success. The model took a health care payer perspective (direct medical costs of topical and/or systemic therapy plus health care costs for physician and specialist visits) and used a 3-year time horizon. The model was run for a cohort of 1,000 patients. Costs (2014 U.S. dollars) and benefits (disease-free days and quality-adjusted life-years [QALYs]) were discounted at a rate of 3% per annum. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER) and measured in terms of incremental cost per QALY gained (estimated from health state utilities for patients with and without rosacea). Univariate and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of model outcomes. RESULTS: Compared with metronidazole 0.75% cream BID, ivermectin 1% cream QD was associated with higher costs but provided greater clinical benefit, with an ICER of $13,211 per QALY gained. For a cohort of 1,000 patients, ivermectin 1% cream QD provided an additional 72,922 disease-free days (200 years) over a 3-year period compared with metronidazole 0.75% cream BID, leading to a lower cost per disease-free day for ivermectin 1% cream QD ($4.54) compared with metronidazole 0.75% cream BID ($4.85). Ivermectin 1% cream QD was associated with lower total costs and greater clinical benefit compared with azelaic acid 15% gel BID at year 3 and dominated this treatment. After 3 years, ivermectin 1% cream QD was associated with the lowest health care costs ($62,767 compared with $73,284 for metronidazole 0.75% cream BID and $77,208 for azelaic acid 15% gel BID), reflecting a 15% reduction in physician visit costs, when compared with metronidazole 0.75% cream BID, and almost a 20% reduction, when compared with azelaic acid 15% gel BID. The univariate sensitivity analyses indicated that the results are sensitive to the time horizon selected: the longer the time horizon, the more beneficial the results for ivermectin 1% cream QD relative to the comparators, although even at 1 year, ivermectin 1% cream QD dominated azelaic acid 15% gel BID. The PSA suggested that ivermectin 1% cream QD was the most likely treatment to be cost-effective at a willingness-to-pay threshold of $15,000 and above. CONCLUSIONS: Ivermectin 1% cream QD had favorable incremental cost-effectiveness when compared with metronidazole 0.75% cream BID and dominated azelaic acid 15% gel BID in the treatment of papulopustular rosacea in the United States. Therefore, ivermectin 1% cream QD may be a good first-line treatment for papulopustular rosacea, providing additional clinical benefit at no or low additional cost. DISCLOSURES: This study was sponsored by Galderma Laboratories. The sponsor was involved in the design of the model structure but not in the collection of the data used to populate the model. Manuscript preparation was also funded by Galderma. Taieb is an investigator and advisor for Galderma. Gold is an investigator for Galderma. Feldman is a consultant and speaker for Galderma and has received grants from Galderma. Dansk and Bertranou received a research grant from Galderma to conduct this study. Dansk and Bertranou contributed to the design of the model structure, the sourcing and inputting of the data, and the interpretation of the results. Taieb, Feldman, and Gold contributed to the interpretation of the results. All authors reviewed draft versions of the manuscript and gave permission for the submission of the final version. PMID: 27231793 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles In vivo confocal microscopy evaluation of ocular and cutaneous alterations in patients with rosacea. Br J Ophthalmol. 2016 May 24; Authors: Liang H, Randon M, Michee S, Tahiri R, Labbe A, Baudouin C Abstract AIMS: The physiopathology of rosacea and the correlation between ocular and cutaneous rosacea remains unclear. This study analysed ocular and cutaneous rosacea with in vivo confocal microscopy (IVCM). METHODS: Thirty-four eyes of 34 patients with confirmed rosacea-associated meibomian gland dysfunction-related evaporative dry eye were enrolled in the study. The ophthalmological investigations included dry eye ocular surface disease index (OSDI), the Schirmer test, tear osmolarity, tear break up time, the Oxford score, infrared meibography for meibomian gland (MG) analysis and IVCM investigation for cornea, MG and skin analysis (cheek, hand). Presences of Demodex in the MG and in the cheek were also investigated. We established scores for quantifying the MG alterations in the MG (IVCM-MG) and cheek (IVCM-Cheek), and scores for Demodex quantification in the MG and cheek (IVCM-MG-Dex and IVCM-Cheek-Dex). RESULTS: IVCM was relevant for analysing the cornea and MG structures and was also suitable for cutaneous analysis. Exposed skin explorations presented the epidermal and dermal layers clearly. In patients with rosacea, the IVCM-MG alteration scores were correlated with IVCM-Cheek (R(2)=0.27 and p=0.0006) and IVCM-MG-Dex was correlated with IVCM-Cheek-Dex (R(2)=0.70 and p<0.0001). However, no correlation was found between the IVCM-MG or IVCM-Cheek and the break up time, Schirmer, Oxford and osmolarity evaluations. CONCLUSIONS: IVCM could be a safe, effective and reliable tool to quantify alterations of the cornea, MG and cheek glands in patients with rosacea combined with quantification of Demodex infections. As a valuable tool for investigating the pathophysiology of the disease, it could be used to assess the effectiveness of therapy. PMID: 27222243 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Evidence suggests rosacea may be linked to Parkinson's and Alzheimer's disease. Nurs Stand. 2016 May 25;30(39):14 Authors: Abstract Patients who have rosacea are at increased risk of developing dementia, particularly Alzheimer's disease. PMID: 27224602 [PubMed - in process] {url} = URL to article

Skin diseases of the nose. Am J Rhinol Allergy. 2016 May;30(3):83-90 Authors: Yigider AP, Kayhan FT, Yigit O, Kavak A, Cingi C Abstract OBJECTIVES: The goal of this study was to review the main lesion types of the nasal skin and appropriate treatment strategies rather than to present a comprehensive list of all diseases that affect the skin that can involve the nose. METHODS: We reviewed the main nasal skin lesion types and available treatment strategies. Nasal skin lesions were classified as benign, premalignant, or malignant. RESULTS: Benign lesions of the nose include nonmalignant tumoral lesions (i.e., freckles, comedo, adenoma sebaceum [Pringle disease], hydrocystoma, fibrous papules, sebaceous hyperplasia, and rhinophyma), autoimmune and inflammatory conditions (i.e., pemphigus, sarcoidosis, systemic lupus erythematosus, facial eosinophilic granuloma, rosacea, herpes zoster infection, leishmaniasis, and leprosy), and vascular lesions (i.e., telangiectasis, hemangioma, and spider nevus). Premalignant lesions are actinic keratosis and keratoacanthoma; and malignant tumors are melanoma, basal cell carcinoma, and squamous cell carcinoma. Regardless of whether or not they are malignant, all facial lesions can yield significant cosmetic discomfort that should be evaluated carefully before commencing any curative or corrective intervention. In general, benign lesions are treated with dermabrasive modalities, such as trichloroacetic acid, phenol, salicylate, and laser ablation. Electrocautery, cryosurgery, and surgical excision are also used, although these methods may result in scar formation, which can sometimes be more problematic than the original lesion itself. CONCLUSION: Any disease that affects the skin, especially those diseases that are triggered by ultraviolet exposure, can involve the face and nose. Cosmetic defects due both to the lesion itself and the intervention must be discussed with the patient, preferably in the presence of a first-degree relative, before commencement of treatment. As a result of heterogeneity of skin lesions of the nose, appropriate education of general practitioners as well as otorhinolaryngologists is mandatory. PMID: 27216341 [PubMed - in process] {url} = URL to article

Related Articles Primary Care of Adult Women: Common Dermatologic Conditions. Obstet Gynecol Clin North Am. 2016 Jun;43(2):181-200 Authors: Ruiz de Luzuriaga AM, Mhlaba J, Roman C Abstract Dermatologic disease often presents in the primary care setting. Therefore, it is important for the primary care provider to be familiar with the presentation, diagnosis, and treatment of common skin conditions. This article provides an overview of acne, rosacea, melasma, vitiligo, alopecia, nonmelanoma, and melanoma skin cancer, dermatitis, and lichen sclerosus. PMID: 27212088 [PubMed - in process] {url} = URL to article

Related Articles Low-Dose Isotretinoin: An Option for Difficult-to-Treat Papulopustular Rosacea. J Invest Dermatol. 2016 Jun;136(6):1081-3 Authors: van Zuuren EJ, Fedorowicz Z Abstract Rosacea is a chronic disease with a profound impact on quality of life. Although there are a range of treatments for its many manifestations, some cases are difficult to treat. Sbidian et al. show in this double-blind, randomized, placebo-controlled trial that low-dose isotretinoin can be effective in treating difficult-to-treat and frequently relapsing papulopustular rosacea. PMID: 27212646 [PubMed - in process] {url} = URL to article

Related Articles Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg. 2016 May 17; Authors: Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C Abstract Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations. PMID: 27207355 [PubMed - as supplied by publisher] {url} = URL to article