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Related Articles[Rosacea]. Rev Med Liege. 2015 Apr;70(4):179-85 Authors: Libon F, El Hayderi L, Nikkels-Tassoudji N, Dezfoulian B, Nikkels AF Abstract Rosacea is a common centro-facial dermatosis with a high socio-esthetic impact. Different subtypes are distinguished, classified into grades according to their severity. This classification is essential for therapeutic management. In general, rosacea remains difficult to treat as its pathophysiology is still not entirely understood. Future research is needed for a better understanding of this disease and the development of targeted treatments. PMID: 26054168 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/26054168?dopt=Abstract = URL to article

Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. J Clin Aesthet Dermatol. 2015 May;8(5):19-26 Authors: Del Rosso JQ Abstract Oral antibiotics have been used for the treatment of acne vulgaris for six decades. Among dermatologists, tetracyclines represent at least three-fourths of the oral antibiotics prescribed in clinical practice. Unlike other specialties, antibiotic use in dermatology is predominantly for the treatment of noninfectious disorders, such as acne vulgaris and rosacea, which usually involves prolonged therapy over several weeks to months as compared to short courses used to treat cutaneous infections. At the present time, doxycycline and minocycline are the most commonly prescribed tetracyclines in dermatology, used primarily for treatment of acne vulgaris with a long overall favorable track record of effectiveness and safety. Although both are commonly used, doxycycline may be chosen by clinicians more readily as there is a lower risk of rare yet potentially serious adverse reactions, although doxycycline does warrant preventative measures to reduce the risks of esophagitis and phototoxicity reactions. This article reviews data with a new double-scored small 150mg tablet of doxycycline hyclate that has proven functional scoring, exhibits bioavailability similar to enteric-coated doxycycline, and has been shown to be associated with a low potential for gastrointestinal adverse reactions very comparable to what is achieved with enteric-coated tablets. PMID: 26029331 [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/26029331?dopt=Abstract = URL to article

Perceptions on the Psychological Impact of Facial Erythema Associated with Rosacea: Results of International Survey. Dermatol Ther (Heidelb). 2015 May 29; Authors: Dirschka T, Micali G, Papadopoulos L, Tan J, Layton A, Moore S Abstract INTRODUCTION: Rosacea (including facial erythema) has a negative impact on psychological and emotional health. This survey aimed to assess the impact of facial erythema on subconscious perceptions and the initial reactions of others and how this affects attitudes in different settings. The survey also measured the impact of facial erythema on a person's emotional and psychological wellbeing. METHODS: A total of 6831 participants from eight countries completed online computer-assisted web interviewing psychological assessments based on the implicit association test. Traditional questionnaires provided data on the impact of facial erythema and perceptions of people with rosacea from other participants. RESULTS: Facial erythema was strongly associated with poor health and negative personality traits with participants reporting negative impacts of rosacea emotionally, socially and in the workplace. Nearly 80% reported difficulty in controlling facial erythema but those with physician-diagnosed rosacea had significantly improved control versus those with undiagnosed rosacea (39% vs 20%, p < 0.05). CONCLUSIONS: People with facial erythema have to manage their own psychological barriers to cope with the disease and deal with the prejudice and negative first impressions of others. Formal diagnosis, advice and treatment from a healthcare professional improve rosacea control. FUNDING: Galderma. PMID: 26022994 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/26022994?dopt=Abstract = URL to article

The treatment of rosacea with topical ivermectin. Drugs Today (Barc). 2015 Apr;51(4):243-250 Authors: Ali ST, Alinia H, Feldman SR Abstract The treatment of rosacea is challenging because several pathophysiologic processes may be involved, including neurovascular dysregulation and alterations in innate immune status. Demodex mites may play a role in the latter mechanism. Topical ivermectin is a new therapeutic modality which demonstrates antiparasitic and anti-inflammatory properties. This article reviews published evidence related to the efficacy and safety of topical ivermectin. PubMed was utilized to search for key words "topical ivermectin", "ivermectin cream" and "rosacea". Three clinical trials were found that studied topical ivermectin as a treatment option for rosacea. Ivermectin was effective, safe and well tolerated. PMID: 26020066 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/26020066?dopt=Abstract = URL to article

Related ArticlesManagement of rhinophyma with Versajetâ„¢ and ReCell®. Br J Oral Maxillofac Surg. 2013 Dec;51(8):e282-4 Authors: Dunne JA, Saleh DB, Rawlins JM Abstract Operation is the mainstay of treatment for rhinophyma. Numerous techniques for dermaplaning and dermabrasion have been described with typical healing times of roughly 3 weeks. We present a case that combined use of the Versajetâ„¢ (Smith & Nephew, UK) system with ReCell(®) non-cultured autologous skin cells (Avita Medical, UK) to expedite re-epithelialisation. After sculpting with Versajetâ„¢, a 1cm(2) split-thickness skin biopsy specimen was harvested for application of autologous skin. Postoperative pictures at 6 days show well-formed epithelial buds, and at 9 days the nose was fully healed. The application of ReCell(®) hastened healing. This could potentially avoid hypertrophic scars and lessen the number of visits to outpatients for dressing to be changed, rendering it more advantageous than other techniques. PMID: 23510790 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23510790?dopt=Abstract = URL to article

Severe Facial Dermatitis Following Rhinoplasty due to an Unusual Etiopathogenesis: Rosacea. Arch Plast Surg. 2015 May;42(3):362-4 Authors: TaÅŸ S PMID: 26015896 [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/26015896?dopt=Abstract = URL to article

Epidemiology and risk factors of childhood acne in Korea: a cross-sectional community based study. Clin Exp Dermatol. 2015 May 25; Authors: Park SY, Kwon HH, Min S, Yoon JY, Suh DH Abstract BACKGROUND: The epidemiology of acne vulgaris appears to be evolving, with an increasingly earlier onset seen in childhood. Relevant studies have been rarely performed in Asia. AIM: We sought to estimate the prevalence and clinical characteristics of acne among schoolchildren, and its association with treatment-seeking behaviour, body mass index (BMI), nutritional habits and other lifestyle elements. METHODS: A cross-sectional study was conducted with elementary schoolchildren aged 7-12 years. Children were interviewed by self-administered questionnaires, and were subsequently evaluated by dermatologists. RESULTS: Of 693 children enrolled, 36.2% were diagnosed with acne, and the prevalence increased with age. Additionally, clinical characteristics including severity, duration of disease and lesion distribution were significantly different between the lower (aged 7-9 years) and the higher (aged 10-12 years) grades. Subjective features including recognition about acne and treatment-seeking behaviours were also different between the two groups. Overweight or obesity (BMI ≥ 25 kg/m(2) at 18 years of age; OR = 2.7) and consumption of chocolates/sweets (OR = 1.6) were significant risk factors for acne. CONCLUSIONS: In the current study, the prevalence of acne among elementary schoolchildren was high, but only a few children had received treatment. Physicians should be attentive to childhood acne, and educate patients and their parents about the need to treat it. PMID: 26011595 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/26011595?dopt=Abstract = URL to article

Related ArticlesA cutaneous angiosarcoma arising from the rhinophyma. Kulak Burun Bogaz Ihtis Derg. 2013 Nov-Dec;23(6):344-7 Authors: Düzgün S, Pekdemir I, Yılancı S, Balı YY, Sıngın S, Tapan M Abstract In this article, we report a 66-year-old male case of rhinophyma who had a persistent lesion on his nose for two-years. Despite steroid therapy, the lesion continued to grow. Histopathological and immunohistochemical findings were consistent with cutaneous angiosarcoma. Rhinophyma-like features should be considered as an unusual clinical manifestation of cutaneous angiosarcoma. PMID: 24283810 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24283810?dopt=Abstract = URL to article

Major Pathophysiological Correlations of Rosacea: A Complete Clinical Appraisal. Int J Med Sci. 2015;12(5):387-396 Authors: Vemuri RC, Gundamaraju R, Sekaran SD, Manikam R Abstract Background: Rosacea is a characteristic cutaneous disorder with a diverse clinical manifestations ranging from facial vascular hyper-reactivity to sebaceous gland hyperplasia. Many theories on pathophysiology of rosacea were proposed over the past decade, however the pathogenicity is poorly understood. Aim: To review the evidence on different pathophysiological correlations of rosacea. Methods: A literature search was conducted for studies published between 1990 to March 2014. The inclusion criteria was pathophysiology, randomized controlled trials, controlled trials on rosacea. Results: Out of 5141 articles, 14 high quality studies met all the selection criteria. Of 14 articles, 5 are randomized control trials (RCTs), 2 are controlled trial, 3 comparative trials, 2 observational trials, 1 prospective and 1 diagnostic trial. The studies were categorized into two groups: the trigger factors and sub-types & symptoms. Of 7 high quality studies, 4 provided strong evidence that immune responses causing disease triggered by external/internal factors such as sunlight, food and chemical agents, 3 trials provided significant evidence of microorganisms as causative agents. The remaining trials did not provide significant evidences on pathophysiology. Conclusion: Vasculature, chronic inflammatory responses, environmental triggers, food and chemicals ingested and microorganisms either alone or in combination are responsible for rosacea. Many promising drugs are under various phases of clinical trials and interestingly, probiotics could also possibly be used as one of the treatment option. PMID: 26005373 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/26005373?dopt=Abstract = URL to article

Cardiovascular comorbidities in patients with rosacea: A nationwide case-control study from Taiwan. J Am Acad Dermatol. 2015 May 22; Authors: Hua TC, Chung PI, Chen YJ, Wu LC, Chen YD, Hwang CY, Chu SY, Chen CC, Lee DD, Chang YT, Liu HN Abstract BACKGROUND: Rosacea is a chronic inflammatory skin disease. Inflammation plays a prominent role in atherosclerosis and its complications. OBJECTIVE: We sought to investigate the associations of rosacea with cardiovascular disease risk factors and cardiovascular diseases from a nationwide population-based database. METHODS: A total of 33,553 patients with rosacea and 67,106 age- and gender-matched control subjects were identified from the National Health Insurance Research Database in Taiwan from 1997 to 2010. Multivariate logistic regressions were performed to compare the odds of comorbidities between the 2 groups. RESULTS: Dyslipidemia (odds ratio 1.41; 95% confidence interval 1.36-1.46), coronary artery disease (odds ratio 1.35, 95% confidence interval 1.29-1.41), and hypertension (odds ratio 1.17, 95% confidence interval 1.12-1.21) were significantly associated with rosacea. Coronary artery disease remained independently associated with rosacea after adjustment for hypertension, diabetes mellitus, and dyslipidemia. Male patients with rosacea had higher risks for all comorbidities than female patients with rosacea. LIMITATIONS: The National Health Insurance Research Database does not contain information regarding rosacea subtypes or disease severity, or laboratory data. CONCLUSION: Patients with rosacea are more likely to have dyslipidemia and hypertension. They are also at increased risk of coronary artery disease after adjustment for cardiovascular disease risk factors. PMID: 26004520 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/26004520?dopt=Abstract = URL to article

Related ArticlesRhinophyma-like hypertrophy of the nose caused by chronic facial pyoderma in a patient with Crohn's disease. J Plast Surg Hand Surg. 2014 Oct;48(5):344-6 Authors: Tsuchiya S, Ichioka S, Tajima S Abstract We present our experience with a 22-year-old man who had Crohn's disease with rhinophyma-like hypertrophy of the nose arising from pyogenic skin disease of the face. The clinical appearance did not precisely match any previously reported skin diseases. PMID: 23834302 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23834302?dopt=Abstract = URL to article

Related ArticlesInterest of confocal laser scanning microscopy for the diagnosis and treatment monitoring of demodicosis. J Eur Acad Dermatol Venereol. 2014 Feb;28(2):255-7 Authors: Harmelin Y, Delaunay P, Erfan N, Tsilika K, Zorzi K, Passeron T, Lacour JP, Bahadoran P PMID: 23659565 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23659565?dopt=Abstract = URL to article

Rhinophyma. Eplasty. 2015;15:ic25 Authors: Laun J, Gopman J, Elston JB, Harrington MA PMID: 25987948 [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/25987948?dopt=Abstract = URL to article

Related ArticlesRhinophyma--a patient case study. J Vis Commun Med. 2013 Dec;36(3-4):128-31 Authors: Shah A, Lakhani R, Panesar J Abstract This is a case report about a 62-year-old gentleman who presented at the Otolaryngology department with a rhinophyma. Rhinophyma is a swelling of the soft tissue of the nose due to sebaceous gland hypertrophy, lymphoedema and fibrosis. Photography of the patient's condition highlights not only the features of the disease but is useful when comparing the contours and shape of the nose after surgical excision. Images of a relatively large rhinophyma are useful not only for their visual but also their educational value. PMID: 24206029 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24206029?dopt=Abstract = URL to article

Histopathology of Rhinophyma - a clinical-histopathologic correlation. J Cutan Pathol. 2015 May 6; Authors: Schüürmann M, Wetzig T, Wickenhauser C, Ziepert M, Kreuz M, Ziemer M Abstract BACKGROUND: Whereas early rhinophyma is histopathologically thought to resemble fully developed rosacea, a fibromatous variant has previously been described for severe rhinophyma. In terms of clinical characteristics, recently a new Rhinophyma Severity Index (RHISI) was introduced. METHODS: We studied 24 patients who had been treated with wide shave excisions for rhinophyma. Specimens were stained with hematoxylin-eosin, periodic acid-Schiff reaction and a panel of immunohistochemical stains and observed for any correlation between clinical severity and histopathologic features as well as for predictive markers of clinical recurrence. RESULTS: There were no significant histopathologic differences between the groups reflecting the different clinical expressions. From a histopathologic perspective, clinically severe forms did not demonstrate with exclusive fibrotic changes. Further, there was no histopathologic marker predicting the clinical course or possible recurrence of the disease after surgical treatment. Only the clinical pre-operative RHISI score correlated with the postoperative outcome, with a high pre-operative RHISI being a risk factor for recurrence. CONCLUSION: Histopathologic features do not correlate with the clinical expression of rhinophyma. An exclusively 'fibrotic' rhinophyma form does not appear to exist and could possibly be the result of sampling error based on small biopsies studied. PMID: 25950712 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25950712?dopt=Abstract = URL to article

Treatment of a double-giant Rhinophyma with electrocautery and Versajet hydrosurgery system. Ann Ital Chir. 2015;86 Authors: Novati FC, Franchi A, Roggio T, Ramella V, Arnež ZM Abstract Rhinophyma is a disfiguring condition etiologically related to rosacea and due to hypertrophy of the sebaceous glands of the nose. It leads to a progressive thickening of the skin up to the development, in some cases, of severe deformities that result in significant functional deficits and serious cosmetic damage. We report a case of giant rhinophyma consisting of 2 large masses that interfered with feeding and respiration of the patient, and we describe the surgical treatment by resection with electrosurgery and razor-thin saline jet (Versajet Hydrosurgery System). This combined approach is simple and effective for the treatment of severe cases of rhinophyma. KEY WORDS: Rhinophyma, Nasal deformity, Versajet hydrosurgery system. PMID: 25945469 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25945469?dopt=Abstract = URL to article

Five-Year Trend in the Number of Dermatologic Clinical Drug Trials Registered on ClinicalTrials.gov. J Drugs Dermatol. 2015 May 1;14(5):497-500 Authors: Patel SS, Huang KE, Fleischer AB, Feldman SR Abstract BACKGROUND: There is a reported global decrease in the number of clinical trials conducted in recent years. We aimed to determine if this declining trend can be extrapolated to dermatologic clinical trials. <br/> METHODS: We conducted a query of ClinicalTrials.gov for dermatologic clinical trials from 2009 to 2013 for 6 common skin conditions: <i>acne, psoriasis, rosacea, eczema</i> and <i>atopic dermatitis, actinic keratosis,</i> and <i>skin cancer.</i> Results were sorted by condition and number of study subjects. This study did not involve any participants apart from the researchers. <br/> RESULTS: Although there is an increasing trend in the number of trials performed annually, the results were not significant (<em>P</em>=.08). The average number of patients per study has not significantly changed (<em>P</em>=.12), but there was a significant increase in the number of large studies (201+ subjects) conducted over time (<em>P</em>=.002). Although there was significant variation based on dermatologic condition studied (global statistic P=.01), only skin cancer demonstrated a significant change in the number of studies registered annually (&beta;=10.6 studies/year, <em>P</em>=.04). <br/> CONCLUSIONS AND RELEVANCE: The sky does not appear to be falling, at least not yet, with regard to continued development of treatments for patients with skin disease. <br /><br /> <em>J Drugs Dermatol.</em> 2015;14(5):497-500. PMID: 25942669 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25942669?dopt=Abstract = URL to article

Recombinant Erythroid Differentiation Regulator 1 (Erdr1) Inhibits Both Inflammation and Angiogenesis in a Mouse Model of Rosacea. Exp Dermatol. 2015 May 2; Authors: Kim M, Kim KE, Jung HY, Jo H, Jeong SW, Lee J, Kim CH, Kim H, Cho D, Park HJ Abstract The erythroid differentiation regulator 1 (Erdr1), which is a novel and highly conserved factor, was recently reported to be negatively regulated by IL-18 and to play a crucial role as an antimetastatic factor. IL-18 is a proinflammatory cytokine that functions as an angiogenic mediator in inflammation. Rosacea is a chronic inflammatory skin disorder that is characterized by abnormal inflammation and vascular hyperactivity of the facial skin. To determine whether Erdr1 contributes to the regulation of the chronic inflammatory process in the development of rosacea, an immunohistochemical analysis was performed in healthy donors and patients with rosacea. In this study, we showed that Erdr1 was downregulated, whereas IL-18 was upregulated, in patients with rosacea, which led us to question the role of Erdr1 in this disorder. Moreover, a rosacea-like BALB/c mouse model was used to determine the role of Erdr1 in rosacea in vivo. LL-37 injection induced typical rosacea features, including erythema, telangiectasia, and inflammation. Treatment with recombinant Erdr1 (rErdr1) resulted in a significant reduction of erythema, inflammatory cell infiltration (including CD4(+) and CD8(+) T cells), and microvessel density with vascular endothelial growth factor (VEGF). Taken together, our findings suggest that rErdr1 may be involved in attenuating the inflammation and angiogenesis associated with the pathogenesis of rosacea. Thus, these results provide new insight into the mechanism involved in this condition, and indicate that rErdr1 could be a potential target for therapeutic intervention of rosacea. This article is protected by copyright. All rights reserved. PMID: 25940661 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25940661?dopt=Abstract = URL to article

Effect of a hyperosmotic agent on epithelial disruptions during laser in situ keratomileusis. J Cataract Refract Surg. 2015 Apr 29; Authors: Holzman A, LoVerde L Abstract PURPOSE: To evaluate the incidence of epithelial disruptions during primary laser in situ keratomileusis (LASIK) with the use of a preoperative hyperosmotic treatment comprising sodium chloride 5% ophthalmic ointment (Muro-128) and to identify the incidence of epithelial disruptions in various demographic populations. SETTING: TLC Laser Eye Center, McLean, Virginia, USA. DESIGN: Comparative case series. METHODS: Using a matched-pair design, hyperosmotic treatment was randomized to 1 eye of patients having bilateral LASIK. The primary outcome measure, epithelial integrity, was assessed in each eye. Epithelial integrity was evaluated in groups defined by characteristics that included age, sex, ethnicity, skin type, presence or absence of rosacea, eye color, and hair color. RESULTS: The study evaluated 496 eyes of 248 patients. The preoperative hyperosmotic treatment was associated with significantly less corneal epithelial disruption, as indicated by an epithelial integrity score. Compared with control eyes, the rate of corneal epithelial disruptions in the population of treated eyes decreased by 40% (relative risk, 0.60; 95% confidence interval [CI], 0.38-0.95). Among the characteristics studied, age was the best predictor of corneal epithelial disruptions; every 1-year increase in age was associated with a 9.0% increase in the risk for corneal epithelial disruptions (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). Eyes of patients older than 34 years had a 4.4 times greater odds of being associated with epithelial disturbances than eyes of patients 34 years or younger. CONCLUSIONS: The preoperative use of hyperosmotic agents can reduce the risk for intraoperative epithelial disruptions during LASIK. An increase in epithelial disruptions was associated with increasing age. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. PMID: 25935340 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25935340?dopt=Abstract = URL to article

European trends in the frequency of original research in acne vulgaris, rosacea, dermatitis, psoriasis, skin cancer, and skin infections, 1970-2010. Dermatol Online J. 2015;21(4) Authors: Choi YM, Garcha JK, Wu JJ Abstract We analyzed trends in the frequency of original publications into common dermatologic topics in two premier European journals, the British Journal of Dermatology and the Journal of the European Academy of Dermatology and Venereology. Most notably, we found that psoriasis publications peaked around the mid-to-late 1980's as well as demonstrated an upward trend since the 21st century. Skin cancer research witnessed a gradual increase in the frequency of publications since 1970. These findings were consistent with a prior study analyzing trends in two American dermatology journals. We attempted to analyze these results from a historical perspective as well as provide an outlook on the future of research into these common dermatologic topics. PMID: 25933084 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25933084?dopt=Abstract = URL to article

Keratoconus: an inflammatory disorder? Eye (Lond). 2015 May 1; Authors: Galvis V, Sherwin T, Tello A, Merayo J, Barrera R, Acera A Abstract Keratoconus has been classically defined as a progressive, non-inflammatory condition, which produces a thinning and steepening of the cornea. Its pathophysiological mechanisms have been investigated for a long time. Both genetic and environmental factors have been associated with the disease. Recent studies have shown a significant role of proteolytic enzymes, cytokines, and free radicals; therefore, although keratoconus does not meet all the classic criteria for an inflammatory disease, the lack of inflammation has been questioned. The majority of studies in the tears of patients with keratoconus have found increased levels of interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), and matrix metalloproteinase (MMP)-9. Eye rubbing, a proven risk factor for keratoconus, has been also shown recently to increase the tear levels of MMP-13, IL-6, and TNF-α. In the tear fluid of patients with ocular rosacea, IL-1α and MMP-9 have been reported to be significantly elevated, and cases of inferior corneal thinning, resembling keratoconus, have been reported. We performed a literature review of published biochemical changes in keratoconus that would support that this could be, at least in part, an inflammatory condition.Eye advance online publication, 1 May 2015; doi:10.1038/eye.2015.63. PMID: 25931166 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25931166?dopt=Abstract = URL to article

Interventions for rosacea. Cochrane Database Syst Rev. 2015 Apr 28;4:CD003262 Authors: van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L Abstract BACKGROUND: Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. OBJECTIVES: To assess the efficacy and safety of treatments for rosacea. SEARCH METHODS: We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. MAIN RESULTS: We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed adverse events, although often only limited data were provided. In most comparisons there were no statistically significant differences in number of adverse events, most were mild and transient. Physician assessments including investigators' global assessments, lesion counts and erythema were evaluated in three-quarters of the studies, but time needed for improvement and duration of remission were incompletely or not reported.The quality of the body of evidence was rated moderate to high for most outcomes, but for some outcomes low to very low.Data for several outcomes could only be pooled for topical metronidazole and azelaic acid. Both were shown to be more effective than placebo in papulopustular rosacea (moderate quality evidence for metronidazole and high for azelaic acid). Pooled data from physician assessments in three trials demonstrated that metronidazole was more effective compared to placebo (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.29 to 3.02). Four trials provided data on participants' assessments, illustrating that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30 to 1.63). The results from three studies were contradictory on which of these two treatments was most effective.Two studies showed a statistically significant and clinically important improvement in favour of topical ivermectin when compared to placebo (high quality evidence). Participants' assessments in these studies showed a RR of 1.78 (95% CI 1.50 to 2.11) and RR of 1.92 (95% CI 1.59 to 2.32),which were supported by physicians' assessments. Topical ivermectin appeared to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study, for improving quality of life and participant and physician assessed outcomes (high quality evidence for these outcomes).Topical brimonidine in two studies was more effective than vehicle in reducing erythema in rosacea at all time points over 12 hours (high quality evidence). At three hours the participants' assessments had a RR of 2.21 (95% CI 1.52 to 3.22) and RR of 2.00 (95% CI 1.33 to 3.01) in favour of brimonidine. Physicians' assessments confirmed these data. There was no rebound or worsening of erythema after treatment cessation.Topical clindamycin phosphate combined with tretinoin was not considered to be effective compared to placebo (moderate quality evidence).Topical ciclosporin ophthalmic emulsion demonstrated effectiveness and improved quality of life for people with ocular rosacea (low quality evidence).Of the comparisons assessing oral treatments for papulopustular rosacea there was moderate quality evidence that tetracycline was effective but this was based on two old studies of short duration. Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99) (high quality evidence). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doxycycline, but there was evidence of fewer adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54) (low quality evidence). There was very low quality evidence from one study (assessed at high risk of bias) that doxycycline 100 mg was as effective as azithromycin. Low dose minocycline (45 mg) was effective for papulopustular rosacea (low quality evidence).Oral tetracycline was compared with topical metronidazole in four studies and showed no statistically significant difference between the two treatments for any outcome (low to moderate quality evidence).Low dose isotretinoin was considered by both the participants (RR 1.23, 95% CI 1.05 to 1.43) and physicians (RR 1.18, 95% CI 1.03 to 1.36) to be slightly more effective than doxycycline 50-100 mg (high quality evidence).Pulsed dye laser was more effective than yttrium-aluminium-garnet (Nd:YAG) laser based on one study, and it appeared to be as effective as intense pulsed light therapy (both low quality evidence). AUTHORS' CONCLUSIONS: There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea. Time needed to response and response duration should be addressed more completely, with more rigorous reporting of adverse events. Further studies on treatment of ocular rosacea are warranted. PMID: 25919144 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25919144?dopt=Abstract = URL to article

Demodex mite, rosacea and skin melanoma; coincidence or association? Turkiye Parazitol Derg. 2015 Mar;39(1):41-6 Authors: Talghini S, Fouladi DF, Babaeinejad S, Shenasi R, Samani SM Abstract OBJECTIVE: To examine the possible associations between Demodex folliculorum and a number of skin diseases. METHODS: Standardized skin surface biopsy samples were obtained from the cheeks of 144 patients with histopathologically proven basal cell carcinoma (BCC, n=27), squamous cell carcinoma (SCC, n=28), melanoma (n=23), discoid lupus erythematosus (DLE, n=32), and rosacea (n=34). Thirty-four sex- and age-matched healthy volunteers served as controls. Mite density (per cm2) and infestation (density≥5) were compared between the controls and patients. RESULTS: Mite infestation rates (%) did not differ significantly between the controls (20.6) and patients with BCC (22.2, p=0.88), SCC (17.9, p=0.79), melanoma (4.3, p=0.08), and DLE (21.9, p=0.90). Compared with the controls, the mite infestation rate was significantly higher in patients with rosacea (47.1, p=0.02, odds ratio: 3.43, 95% confidence interval: 1.18-9.99). The mean mite density did not differ significantly between the controls (4.11±2.17) and patients with BCC (5.34±2.35, p=0.75), SCC (3.57±2.01, p=0.38), and DLE (3.56±1.34, p=0.83), whereas it was significantly higher in patients with rosacea (8.78±3.58, p=0.02) and lower in patients with melanoma (1.89±0.69, p=0.02). CONCLUSIONS: D. folliculorum may be associated with rosacea and melanoma but not with BCC, SCC, or DLE. PMID: 25917583 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/25917583?dopt=Abstract = URL to article

Related ArticlesRhinophyma-like venous malformation of the nose. Br J Dermatol. 2014 Jul;171(1):195-7 Authors: Kayabasoglu G, Kaymaz R, Yilmaz MS, Altundag A, Dilek FH PMID: 24593157 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24593157?dopt=Abstract = URL to article

Patient-reported outcomes after discontinuation of long-term topical corticosteroid treatment for atopic dermatitis: a targeted cross-sectional survey. Drug Healthc Patient Saf. 2015;7:57-62 Authors: Takahashi-Ando N, Jones MA, Fujisawa S, Hama R Abstract BACKGROUND: Topical corticosteroid (TCS) treatment is widely prescribed for atopic dermatitis (AD). However, TCS treatment is associated with tachyphylaxis, and discontinuation after long-term use may cause exacerbation of symptoms. Some AD patients are reluctant to use TCS. OBJECTIVE: To evaluate patient-reported short- and long-term outcomes after discontinuation of TCS treatment for AD. METHODS: Questionnaires were distributed to adult AD patients (n=1,812) of doctors who did not recommend TCS as first-line therapy for patients who preferred to avoid TCS. Data collected included current TCS use, duration of TCS use, past discontinuation of TCS use, exacerbation of symptoms after discontinuation of TCS use, and limitations to daily activities because of AD. RESULTS: Of 918 respondents, 97.7% had used TCS, of whom 92.3% had experienced discontinuation of TCS use. After discontinuation, 63.9% experienced their most severe AD symptoms ever. The severity of exacerbation of symptoms was significantly correlated with the length of TCS use (P<0.001). Although most respondents who experienced severe exacerbation after TCS discontinuation were not current TCS users, they generally had fewer current limitations to activities than when AD symptoms were at their worst. CONCLUSION: Adult Japanese AD patients who experience severe exacerbation of symptoms immediately after discontinuation of TCS use generally improve over time. We suggest caution regarding long-term TCS treatment in AD patients. PMID: 25897263 [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/25897263?dopt=Abstract = URL to article