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Update on the management of rosacea. Clin Cosmet Investig Dermatol. 2015;8:159-77 Authors: Weinkle AP, Doktor V, Emer J Abstract Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies. PMID: 25897253 [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/25897253?dopt=Abstract = URL to article

Related ArticlesThe pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea. Australas J Dermatol. 2015 Apr 20; Authors: Maeda A, Ishiguro N, Kawashima M Abstract The cause of perioral dermatitis is still unknown. We previously reported that rod-shaped bacteria (RB) containing intracellular granules were detected in cases of perioral dermatitis at a high incidence. The aim of this study was to study further the role of RB in perioral dermatitis. Altogether 10 patients with perioral dermatitis and eight patients with perioral corticosteroid-induced rosacea, who were referred to our department from 2009 to 2014, were examined for the presence of RB, using the tape-stripping toluidine blue method. RB were detected on the surfaces of the roots of vellus hairs from lesions in nine of the 10 patients with perioral dermatitis. In contrast, RB were not detected in any of the eight patients with perioral corticosteroid-induced rosacea. No RB were found in the perioral areas of other types of facial dermatitis, including atopic dermatitis and seboerrheic dermatitis or in 16 healthy controls. We treated four of the patients with perioral dermatitis with minocycline hydrochloride and five with cefcapene pivoxil hydrochloride hydrate. Three of the patients with perioral dermatitis who were treated with minocycline hydrochloride were cured in 3 to 8 weeks, while the five patients treated with cefcapene pivoxil hydrochloride hydrate were cured in 2 to 9 weeks. These results strongly suggest that RB (possible fusobacteria) play an important role in perioral dermatitis and that this is probably a distinct clinical entity from corticosteroid-induced rosacea. Cefcapene pivoxil hydrochloride hydrate seems to be an effective treatment for perioral dermatitis associated with RB. PMID: 25894304 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25894304?dopt=Abstract = URL to article

Related ArticlesRosacea: Part II. Topical and systemic therapies in the treatment of rosacea. J Am Acad Dermatol. 2015 May;72(5):761-770 Authors: Two AM, Wu W, Gallo RL, Hata TR Abstract Although rosacea's impact on physical health is limited, it has profound effects on a person's psychological well-being. Therefore, treating rosacea can greatly affect a person's quality of life. Patient education regarding trigger avoidance and skin care techniques such as moisturizing and sun protection are important non-pharmacologic first steps in treating rosacea. Pharmacologic interventions range from topical to systemic medications, with the ideal medication choice dependent on the symptoms and severity of each individual patient. Despite this variety of therapeutic options, none of these therapies are completely curative, and therefore further research into the pathophysiology of rosacea is required in order to create more targeted and efficacious treatment options. PMID: 25890456 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25890456?dopt=Abstract = URL to article

Related ArticlesRosacea: Part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015 May;72(5):749-758 Authors: Two AM, Wu W, Gallo RL, Hata TR Abstract Rosacea is a chronic inflammatory skin condition that affects approximately 16 million Americans. Four distinct subtypes of rosacea have been recognized, with transient and nontransient facial flushing, telangiectasia, and inflammatory papules and pustules being among the more commonly recognized features. Although the exact pathogenesis of rosacea is unknown, dysregulation of the innate immune system, overgrowth of commensal skin organisms, and aberrant neurovascular signaling may all have a role in promoting the clinical features of rosacea. PMID: 25890455 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25890455?dopt=Abstract = URL to article

Meibomian Glands and Ocular Surface Inflammation. Ocul Surf. 2015 Apr;13(2):133-149 Authors: Suzuki T, Teramukai S, Kinoshita S Abstract The purpose of this review was to systematically analyze publications related to the role of meibomian gland disease in ocular surface inflammation, with special reference to meibomitis as an inflammatory form of meibomian gland dysfunction (MGD). Meibomian gland inflammation is often present with the ocular surface inflammation in conditions such as blepharokeratoconjunctivitis, ocular rosacea, and phlyctenular keratitis, but its contribution is often overlooked, especially in younger subjects. This can result in misdiagnosis, mistreatment, and, sometimes, severe visual impairment. We identified a related disease entity, seen predominantly in young patients, of ocular surface inflammation associated with meibomitis, which we termed meibomitis-related keratoconjunctivitis. Its specific clinical features are similar to those observed in the above-mentioned diseases, and the inflammatory form of MGD was found to be closely involved in the ocular surface inflammation seen in those four diseases, based on our statistical evaluation. The diagnosis and management of meibomitis, an inflammatory form of MGD, is vital for the successful treatment of the induced ocular surface inflammation. We propose that the ocular surface and the adnexal meibomian glands should be considered as one unit, i.e., the "meibomian gland and ocular surface" (MOS), when encountered in the clinical setting. PMID: 25881997 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25881997?dopt=Abstract = URL to article

Multi-drugs resistant acne rosacea in a child affected by Ataxia-Telangiectasia: successful treatment with Isotretinoin. Ital J Pediatr. 2015 Mar 28;41(1):23 Authors: Cantarutti N, Claps A, Angelino G, Chessa L, Callea F, El Hachem M, Diociaiuti A, Finocchi A Abstract Ataxia-Telangiectasia is a rare multisystem autosomal recessive disorder [OMIM 208900], caused by mutations in Ataxia-Telangiectasia Mutated gene. It is characterized by neurological, immunological and cutaneous involvement. Granulomas have been previously reported in Ataxia-Telangiectasia patients, even if acne rosacea has not been described.We report a case of a young Ataxia-Telangiectasia patient with a severe immunological and neurological involvement, who developed granulomatous skin lesions diagnosed by skin biopsy as acne rosacea. Considering the severe clinical picture and the lack of improvement to multiple topic and systemic therapies, treatment with Isotretinoin was started and the skin lesions disappeared after five months. However the therapy was stopped due to drug-hepatotoxicity.Systemic treatment with Isotretinoin should be carefully considered in patient with Ataxia-Telangiectasia for the treatment of multi-drug resistant acne rosacea, however its toxicity may limit long-term use and the risk/benefit ratio of the treatment should be evaluated. PMID: 25881033 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25881033?dopt=Abstract = URL to article

[CAPILLARY FRAGILITY AND SOME HEMOSTATIC PARAMETERS IN PATIENTS WITH ROSACEA]. Georgian Med News. 2015 Mar;(240):33-36 Authors: Tsiskarishvili NV, Katsitadze A, Tsiskarishvili T, Tsiskarishvili NI Abstract The aim of the study was to investigate the association between capillary fragility and some hemostatic parameters, lipid profile in patients with rosacea. 50 patients (30 women and 20 men) aged 35 to 65 years were under observation. Control group consisted of 50 healthy persons, adequate to comparison group by sex and age. To determine the resistance of the capillary, Rumpel-Leede cuff (tourniquet test) was used which consists in determining the formation of petechial hemorrhages on the skin in the area of ​​short-term increase in venous pressure. The hemostatic system was evaluated in terms of prothrombin and thrombin time. Content of fibrinogen and fibrinolytic activity of blood were determined also. The serum lipid profile was studied by means of the following parameters: total cholesterol, triglycerides, HDL (high density lipoprotein), LDL (low density lipoproteins). The survey revealed that in 25 patients the arm cuff test was positive, whereas in the control group, only 2 cases it was weakly positive. Manifestations of hypercoagulation were found in half of patients with a positive cuff test, almost in half of the patients an increased level of fibrinogen and the reduced fibrinolytic activity in blood serum has been revealed. Significant correlation with lipid metabolism have not been identified. Phenomenon of hypercoagulation in rosacea patients on the one hand suggests the existence of processes of microcoagulation, on the other hand the connection with the results of a cuff test can be used to predict the severity of the dermatosis and the possible risk for developing of cardiovascular disease. PMID: 25879556 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25879556?dopt=Abstract = URL to article

Divergent selection along climatic gradients in a rare central European endemic species, Saxifraga sponhemica. Ann Bot. 2015 Apr 9; Authors: Walisch TJ, Colling G, Bodenseh M, Matthies D Abstract BACKGROUND AND AIMS: The effects of habitat fragmentation on quantitative genetic variation in plant populations are still poorly known. Saxifraga sponhemica is a rare endemic of Central Europe with a disjunct distribution, and a stable and specialized habitat of treeless screes and cliffs. This study therefore used S. sponhemica as a model species to compare quantitative and molecular variation in order to explore (1) the relative importance of drift and selection in shaping the distribution of quantitative genetic variation along climatic gradients; (2) the relationship between plant fitness, quantitative genetic variation, molecular genetic variation and population size; and (3) the relationship between the differentiation of a trait among populations and its evolvability. METHODS: Genetic variation within and among 22 populations from the whole distribution area of S. sponhemica was studied using RAPD (random amplified polymorphic DNA) markers, and climatic variables were obtained for each site. Seeds were collected from each population and germinated, and seedlings were transplanted into a common garden for determination of variation in plant traits. KEY RESULTS: In contrast to previous results from rare plant species, strong evidence was found for divergent selection. Most population trait means of S. sponhemica were significantly related to climate gradients, indicating adaptation. Quantitative genetic differentiation increased with geographical distance, even when neutral molecular divergence was controlled for, and QST exceeded FST for some traits. The evolvability of traits was negatively correlated with the degree of differentiation among populations (QST), i.e. traits under strong selection showed little genetic variation within populations. The evolutionary potential of a population was not related to its size, the performance of the population or its neutral genetic diversity. However, performance in the common garden was lower for plants from populations with reduced molecular genetic variation, suggesting inbreeding depression due to genetic erosion. CONCLUSIONS: The findings suggest that studies of molecular and quantitative genetic variation may provide complementary insights important for the conservation of rare species. The strong differentiation of quantitative traits among populations shows that selection can be an important force for structuring variation in evolutionarily important traits even for rare endemic species restricted to very specific habitats. PMID: 25862244 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25862244?dopt=Abstract = URL to article

Ausgewählte seltene rhinologische Krankheitsbilder Pathogenese - Klinik - Therapie. Laryngorhinootologie. 2015 Mar;94(S 01):S272-S287 Authors: Laudien M Abstract Rare rhinological diseases are a diagnostic challenge. From the primary manifestation until the final diagnosis it may take several months or even up to years in which the disease progress is uncontrolled and the disease insufficiently treated. This results in (irreversible) damage and possibly life-threatening situations. The unexpected course of a (misdiagnosed) disease should lead to further diagnostic considerations and steps to detect the orphan disease at a stage as early as possible. In the present work granulomatous diseases of the nose and sinuses caused by mycobacteria, treponemes, klebsiella, fungi and protozoa as well as vasculitis, sarcoidosis, rosacea, the cocaine-induced midline destruction, the nasal extranodal NK/T-cell lymphoma and cholesterol granuloma are discussed. Furthermore diseases with disorders of mucociliary clearance as the primary ciliary dyskinesia and cystic fibrosis are presented taking into account the current literature. PMID: 25860493 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25860493?dopt=Abstract = URL to article

Ivermectin cream (Soolantra) for rosacea. Med Lett Drugs Ther. 2015 Apr 13;57(1466):51-52 Authors: PMID: 25853662 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25853662?dopt=Abstract = URL to article

Molecular and morphological characterization of inflammatory infiltrate in rosacea reveals activation of Th1/Th17 Pathways. J Invest Dermatol. 2015 Apr 7; Authors: Buhl T, Sulk M, Nowak P, Buddenkotte J, McDonald I, Aubert J, Carlavan I, Déret S, Reiniche P, Rivier M, Voegel JJ, Steinhoff M Abstract Rosacea is a common chronic inflammatory skin disease of unknown etiology. Our knowledge about an involvement of the adaptive immune system is very limited. We performed detailed transcriptome analysis, qRT-PCR, and quantitative immunohistochemistry on facial biopsies of rosacea patients, classified according to their clinical subtype. As controls, we used samples from patients with facial lupus erythematosus and healthy controls. Our study shows significant activation of the immune system in all subtypes of rosacea, characterizing erythematotelangiectatic rosacea (ETR) already as a disease with significant influx of proinflammatory cells. The T cell response is dominated by Th1/Th17-polarized immune cells, as demonstrated by significant upregulation of IFNγ or IL-17, for example. Chemokine expression patterns support a Th1/Th17 polarization profile of the T cell response. Macrophages and mast cells are increased in all three subtypes of rosacea, while neutrophils reach a maximum in papulopustular rosacea. Our studies also provide evidence for activation of plasma cells with significant antibody production already in ETR, followed by a crescendo pattern towards phymatous rosacea. In sum, Th1/Th17 polarized inflammation and macrophage infiltration is an underestimated hallmark in all subtypes of rosacea. Therapies directly targeting the Th1/Th17 pathway are promising candidates in the future treatment of this skin disease.Journal of Investigative Dermatology accepted article preview online, 07 April 2015. doi:10.1038/jid.2015.141. PMID: 25848978 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25848978?dopt=Abstract = URL to article

Idiopathic Facial Aseptic Granuloma: Review of an Evolving Clinical Entity. Pediatr Dermatol. 2015 Apr 6; Authors: Zitelli KB, Sheil AT, Fleck R, Schwentker A, Lucky AW Abstract Idiopathic facial aseptic granuloma (IFAG), originally termed pyodermite froide du visage, describes a generally asymptomatic facial nodule presenting in childhood with clinical resemblance to pyoderma or cystic, granulomatous, or vascular lesions. Clinical understanding is constantly evolving, with recent observations indicating that IFAG may represent a subtype of childhood rosacea. We present a case of IFAG associated with eyelid chalazions in a 19-month-old boy. Although his clinical course paralleled previously reported IFAG cases, we observed a unique ultrasound variation during initial diagnostic examination. Further delineation of clinical, imaging, and histologic properties of IFAG may reveal insights into etiologic associations and ideal management. PMID: 25847574 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25847574?dopt=Abstract = URL to article

Pediatric Periorificial Dermatitis: Clinical Course and Treatment Outcomes in 222 Patients. Pediatr Dermatol. 2015 Apr 6; Authors: Goel NS, Burkhart CN, Morrell DS Abstract BACKGROUND: Periorificial dermatitis (POD) is a rosacea-like papulopustular facial eruption most commonly reported in young adult women. Although POD has been reported in children as young as 6 months of age, there are limited data on the diagnosis and management of POD in pediatric cases. METHODS: All children diagnosed with POD at the Dermatology Clinic at the University of North Carolina at Chapel Hill between June 2002 and March 2014 were included in the current study. Information related to demographics, associated risk factors, treatment prescribed, adverse effects, and response to treatment were obtained from a retrospective analysis of medical records. RESULTS: Of the 222 children identified, 55.4% were female, 62.2% Caucasian, and the average age at presentation to the clinic was 6.6 years. Although the etiology of POD remains uncertain, 29.3% reported a past medical history of atopic dermatitis, 14.9% reported a history of asthma and 58.1% reported a history of steroid use prior to POD onset. Fifty-nine percent were seen at a clinic visit for follow-up at an average of 3.8 months. Treatment often involved combining oral azithromycin with topical metronidazole or sodium sulfacetamide lotion. Of the patients with documented follow-up, 71.8% experienced complete resolution of POD. Recurrence of POD occurred in children dependent on inhaled steroids or nebulizers. Adverse effects were minimally noted, but included pigmentary changes (1.8%), worsening of symptoms (1.8%), gastrointestinal upset (0.9%), irritant dermatitis (0.9%), and xerosis (0.5%). CONCLUSION: This study discusses the clinical diagnosis and management of POD in pediatric cases. PMID: 25847356 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25847356?dopt=Abstract = URL to article

Related ArticlesLasers and laser-like devices: part two. Australas J Dermatol. 2014 Feb;55(1):1-14 Authors: Sebaratnam DF, Lim AC, Lowe PM, Goodman GJ, Bekhor P, Richards S Abstract Part two of this review series evaluates the use of lasers and laser-like devices in dermatology based on published evidence and the collective experience of the senior authors. Dermatologists can laser-treat a wide range of dermatoses, including vascular, pigmentary, textural, benign proliferative and premalignant conditions. Some of these conditions include vascular malformation, haemangioma, facial telangiectases, café-au-lait macules, naevi of Ota, lentigines, acne scarring, rhytides, rhinophyma and miscellaneous skin lesions. Photodynamic therapy with lasers and intense pulsed light is addressed, with particular reference to actinic keratosis and actinic cheilitis. A treatment algorithm for acne scarring based on scar morphology and severity is comprehensively outlined. Following from part one, the various devices are matched to the corresponding dermatological conditions with representative pictorial case vignettes illustrating likely clinical outcomes as well as limitations and potential complications of the various laser and light therapies. PMID: 24433372 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24433372?dopt=Abstract = URL to article

Evaluation of Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Rosacea. Cornea. 2015 May;34(5):497-499 Authors: Palamar M, Degirmenci C, Ertam I, Yagci A Abstract PURPOSE: To evaluate the dry eye tests and meibography of patients with ocular rosacea. METHODS: Thirty-six eyes of 18 patients with ocular rosacea (group 1) and 38 eyes of 19 healthy individuals (group 2) were enrolled. Besides full-eye examination, corneal and conjunctival fluorescein staining and Oxford scoring, tear film break-up time, Schirmer 1 test, ocular surface disease index score assessment, and evaluation of upper and lower eyelid meibomian glands using infrared captures of an optical coherence tomography (OCT) (Spectralis HRA+OCT; Heidelberg Engineering) device were performed (grade 0: no loss of meibomian glands, grade 1: gland dropout area <1/3 of the total meibomian glands, grade 2: gland dropout area 1/3 to 2/3 of the total meibomian glands, grade 3: gland dropout >2/3 of the total meibomian glands). RESULTS: The mean ages of group 1 and group 2 were 50.2 ± 9.5 (range, 32-65), and 46.3 ± 14.1 years (range, 25-70), respectively (P = 0.225). No significant difference in best-corrected visual acuity and meiboscores of upper eyelids were detected in between groups. Schirmer 1 and tear film break-up time in group 1 were significantly lower than in group 2 (P = 0.005, P < 0.001, respectively). Ocular surface disease index and Oxford scale scores and meiboscores of lower and total (upper + lower) eyelids were significantly higher in group 1 than in group 2 (P = 0.04, P = 0.018, P < 0.001, P = 0.03, respectively). CONCLUSIONS: Ocular rosacea causes dry eye and significant meibomian gland loss that can objectively be demonstrated with meibography. The infrared camera of OCT-that is widely found in many ophthalmology departments-might be used to evaluate meibomian gland dysfunction in these individuals. PMID: 25826323 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25826323?dopt=Abstract = URL to article

Reflectance confocal microscopy for monitoring the density of demodex mites in rosacea patients before and after treatment. Br J Dermatol. 2015 Mar 20; Authors: Sattler EC, Hoffmann VS, Ruzicka T, Maier T, Berking C Abstract BACKGROUND: Demodex mites seem to serve as pathogenic trigger in many Demodex-associated diseases like rosacea. In facial skin of rosacea patients significantly higher numbers of Demodex mites have been shown compared to healthy controls. Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo non-invasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM. MATERIAL AND METHODS: In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5x5 mm(2) and 8x8 mm(2) were scanned and the total number of mites per follicle and per area as well as of the follicles per area were counted. RESULTS: In all patients Demodex folliculorum could be detectedand quantified using RCM.. RCM showed significant differences pre- and post-treatment (p-value =0.0053 for 5x5 mm(2) and 0.0003 for 8x8 mm(2) ): The mean number of mites per follicle was 0.632 (range 0.157 - 2.276) per 8x8 mm(2) area and 0.704 (range 0.106 - 2.200) per 5x5 mm(2) area before treatment and 0.405 (range 0.074 - 1.745) and 0.505 (range 0.094 - 1.704), respectively, after treatment. The corresponding mean number of mites was 155.2 (range 45-446) and 86.2 (range 12 - 286), respectively, before treatment and 96.2 (range 18-363) and 58.5 (12-230), respectively, after treatment. CONCLUSION: By RCM a reduction of the density of Demodex mites in facial skin of rosacea patients under therapy, correlating to clinical improvement, can be quantified and monitored non-invasively. Possible reasons for this therapeutic effect are discussed. This article is protected by copyright. All rights reserved. PMID: 25801631 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25801631?dopt=Abstract = URL to article

Assessment of rosacea severity: A review of evaluation methods used in clinical trials. J Am Acad Dermatol. 2015 Mar 19; Authors: Hopkinson D, Moradi Tuchayi S, Alinia H, Feldman SR Abstract BACKGROUND: Novel rosacea treatments are needed. Assessment methodologies for clinical trials of rosacea treatments are not standardized and are relatively inadequate. To determine the efficacy of new treatments, a valid and reliable assessment methodology is needed. OBJECTIVE: We sought to determine the assessment methodologies used in clinical trials for rosacea treatments, to demonstrate the need for a valid and reliable assessment tool, and to describe the relevant properties of such a tool. METHODS: PubMed and MEDLINE were searched for clinical trials of rosacea treatments since January 1, 1985. RESULTS: In all, 32 clinical trials met inclusion criteria. Assessment methodologies were highly variable, and standardized assessment methodologies were used in only 3 studies. The various manifestations of rosacea were assessed inconsistently. LIMITATIONS: Eighteen articles could not be included as a result of lack of access to the full text. CONCLUSIONS: The diverse methodologies make the assessment of novel treatments and comparison of treatments difficult. A valid and reliable assessment tool is needed to properly assess novel treatments to improve the management of rosacea. PMID: 25799418 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25799418?dopt=Abstract = URL to article

Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging. JAMA Dermatol. 2015 Mar 23; Authors: Helfrich YR, Maier LE, Cui Y, Fisher GJ, Chubb H, Fligiel S, Sachs D, Varani J, Voorhees J Abstract Importance: Facial erythema and telangiectasia are commonly associated with the erythematotelangiectatic subtype of rosacea (ETR). It is important for clinicians to recognize that these findings can also be associated with a subtype of photoaging, which we term telangiectatic photoaging (TP). Objective: To demonstrate that ETR and TP are distinct dermatologic disorders. Design: A case-control observational study comparing clinical, histologic, and gene expression features of 26 participants with ETR, 20 with TP, and 11 age- and sex-matched controls in the Program for Clinical Research in Dermatology at University of Michigan. Main Outcomes and Measures: Findings of clinical history and examination, light and electron microscopy, immunohistochemical analyses, and real-time quantitative reverse-transcriptase polymerase chain reaction gene expression. Results: Transient erythema was greater in the ETR group (38% graded moderate to severe) than in the TP (0%; P < .001) and control groups (0%; P = .002). Nontransient erythema was also greater in the ETR group (50% graded moderate to severe) than in the TP (25%; P = .03) and control groups (0%; P < .001). Participants with ETR tended to have erythema and telangiectasia primarily on the central face (79%), whereas those with TP tended to have more lateral involvement (57%; P < .001). Those with ETR had significantly less clinical evidence of photodamage (0% graded 6-8 on a photonumeric scale) than those with TP (40% graded 6-8; P = .01). Histologically, there was less evidence of photodamage in ETR than in TP, which had wispy collagen and solar elastosis surrounding blood vessels. Immunohistologic analysis demonstrated greater geometric mean immunostained area by mast cell tryptase staining in ETR samples (0.018%) than in TP (0.004%; P = .01) or control samples (0.001%; P < .001) but no increase in mast cell number, indicative of greater mast cell degranulation. Gene expression of matrix metalloproteinase-3 was 4-fold greater in ETR samples than in TP samples (P = .004) and 5-fold higher than in control samples (P = .004). Gene expression of the neuropeptides calcitonin gene-related peptide (CGRP-α) and substance P was significantly increased in ETR compared with TP (9-fold [P < .001] and 5-fold [P = .002], respectively) and control samples (10-fold [P < .001] and 28-fold [P < .001], respectively). Conclusions and Relevance: Telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less MMP-mediated matrix remodeling than ETR. These data demonstrate that TP is a distinct clinical entity from ETR that can be distinguished on the basis of clinical, histologic, and gene expression findings. PMID: 25798811 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25798811?dopt=Abstract = URL to article

Erythematotelangiectatic Rosacea and Telangiectatic Photoaging: Same, Separate, and/or Sequential? JAMA Dermatol. 2015 Mar 23; Authors: Wilkin JK PMID: 25798736 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25798736?dopt=Abstract = URL to article

Dermatitis medicamentosa: severe rebound erythema secondary to topical brimonidine in rosacea. Dermatol Online J. 2015;21(3) Authors: Werner K, Kobayashi TT Abstract BACKGROUND: Rebound erythema secondary to use of topical brimonidine in the setting of rosacea is an important, possibly significantly distressing potential side effect that may be under-reported; there is little photo-documentation in the literature to date. This article documents such a case. OBSERVATIONS: A 28-year-old woman (Fitzpatrick II) with a long-standing history of untreated rosacea presented for initiation of treatment of what was noted to be primarily erythematotelangiectatic rosacea and was offered Mirvaso for daily use. Initial improvement was followed by progressive worsening of baseline erythema several hours following treatment, only improved with subsequent applications of additional Mirvaso. The patient's symptoms were improved upon discontinuing use of Mirvaso. CONCLUSIONS: There are few cases documented of rebound erythema secondary to use of Mirvaso to date. Further reporting might prompt further long term investigation for this topical medication for further delineation of its role in treatment of rosacea. What is proposed is a phenomenon similar to that of rhinitis medicamentosa with upregulation of alph-adrenergic receptors, suggesting the name "dermatitis medicamentosa" for this phenomenon. PMID: 25780983 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25780983?dopt=Abstract = URL to article

Recall Dermatitis to Metronidazole. J Cutan Med Surg. 2015 Mar 13; Authors: Mussani F, Skotnicki S Abstract BACKGROUND AND OBJECTIVE: Recall dermatitis is an uncommon entity that has been noted with patch testing, repeat exposures to a medication or allergen, and the concurrent use of ultraviolet radiation and certain medications. Recall dermatitis from primary cutaneous exposure and subsequent oral exposure are rare, and the etiology remains unknown. CONCLUSION: We report a case of recall dermatitis with a drug eruption secondary to metronidazole. Therapy with this medication was initially topical for rosacea and subsequently oral for a gastrointestinal infection. This case draws attention to the use of metronidazole and the risk of recall dermatitis. PMID: 25775652 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25775652?dopt=Abstract = URL to article

Prevalence of Rosacea in Community Settings. J Cutan Med Surg. 2015 Mar 11; Authors: Moustafa F, Hopkinson D, Huang KE, Feldman S Abstract BACKGROUND: The prevalence of rosacea is poorly characterized. Because selection bias may affect prevalence estimates, there is a need to characterize the prevalence of rosacea outside the clinic setting. OBJECTIVE: To assess the prevalence of rosacea in community settings. METHODS: A clinical research fellow and a medical student stood in public places (a mall, the Department of Motor Vehicles, a grocery store) and examined consecutive individuals who passed by ≤ 2 yards away. They tallied demographic and descriptive data on the subject and included the subject in one of three categories: clearly rosacea, possible rosacea, and definitely no rosacea. Subanalyses by perceived gender, age, race, and rosacea subtype were also performed. Comparisons between groups were made using the Fisher exact test. RESULTS: Considering the prevalence of rosacea among all observed individuals in the community setting, 5.4% (95% CI 3.6-7.8) of individuals had "possible" rosacea and 6% (95% CI 4.1-8.5) of individuals had "definite" rosacea. Older, white individuals with fairer skin types (Fitzpatrick skin types I, II, and III) were more likely to have rosacea. There was no gender predisposition. LIMITATIONS: Distance from subjects made it difficult to assess patients with mild rosacea or a few telangiectasias, as well as ocular rosacea. The study could not assess those individuals who were too embarrassed by their rosacea to be in the public settings observed. Additionally, some subjects may have applied significant makeup in an effort to conceal their rosacea, making assessment difficult. CONCLUSIONS: Based on direct observation of individuals in community settings, rosacea is more common than previously reported in the United States. PMID: 25775639 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25775639?dopt=Abstract = URL to article

Erythematotelangiectactic rosacea following occupational ultraviolet radiation injury. Photodermatol Photoimmunol Photomed. 2015 Mar 13; Authors: Heelan K, McAleer MA, Murphy M, Bourke JF Abstract Rosacea is a common chronic inflammatory skin disease predominantly affecting the central facial skin.(1) Traditional classification divides rosacea into 4 main subtypes; erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea (PhR), and ocular rosacea. This article is protected by copyright. All rights reserved. PMID: 25772068 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25772068?dopt=Abstract = URL to article

Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea. Dermatology. 2015 Mar 3; Authors: Park KY, Hyun MY, Jeong SY, Kim BJ, Kim MN, Hong CK Abstract BACKGROUND: Persistent erythema and severe rosacea flushing can cause significant physical discomfort and emotional stress to patients. Currently, no satisfactory treatments are available. METHODS: We report two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injections. RESULTS: Good cosmetic results were achieved for both patients. The side effects during and after treatment were mild pain and localized bruising; these symptoms resolved within several days without further treatment. CONCLUSION: Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population. © 2015 S. Karger AG, Basel. PMID: 25765295 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25765295?dopt=Abstract = URL to article

Risk Factors for Dry Eye Syndrome: A Retrospective Case-Control Study. Optom Vis Sci. 2015 Mar 10; Authors: Yang WJ, Yang YN, Cao J, Man ZH, Yuan J, Xiao X, Xing YQ Abstract PURPOSE: To investigate the independent risk factors of dry eye syndrome (DES) in Chinese. METHODS: A hospital-based age- and sex-matched population was enrolled with a case-control ratio of 1:2, with 789 DES case patients and 1119 healthy family members. Both groups underwent standard ophthalmologic examinations, including slit-lamp evaluation of the anterior segment, measurement of tear film breakup time, Schirmer test, and corneal fluorescein staining. Data on demographic characteristics and lifestyle habits were collected using a questionnaire. Dry eye syndrome risk factors were identified by univariate and multivariate logistic regression analyses. RESULTS: The following independent risk factors showed significant association with DES: diabetes (odds ratio [OR], 1.408; 95% confidence interval [CI], 1.031 to 1.924), hepatitis C (OR, 3.326; 95% CI, 1.632 to 6.776); connective tissue disease (OR, 2.157; 95% CI, 1.679 to 2.771), benign prostatic hyperplasia (OR, 3.892; 95% CI, 2.476 to 6.116), rosacea (OR, 3.747; 95% CI, 1.972 to 7.120), posttraumatic stress disorder (OR, 1.449; 95% CI, 1.043 to 2.013), hematopoietic stem cell transplantation (OR, 7.269; 95% CI, 2.312 to 22.849), head and neck radiotherapy (OR, 8.776; 95% CI, 3.096 to 24.873), postmenopausal estrogen therapy (OR, 1.912; 95% CI, 1.160 to 3.151), antihistamines (OR, 2.040; 95% CI, 1.516 to 2.746), antidepressants (OR, 1.982; 95% CI, 1.077 to 3.647), contact lenses (OR, 2.366; 95% CI, 1.266 to 4.423), and video display terminal exposure for more than 6 h/d (OR, 2.275; 95% CI, 1.451 to 3.568). Potentially protective factors against DES were vitamin supplements (OR, 0.716; 95% CI, 0.528 to 0.972) and Ω-3 fatty acid-rich diet (OR, 0.514; 95% CI, 0.332 to 0.796). CONCLUSION: Several known risk factors of DES are applicable to Chinese, and some distinctive dietary factors may be protective in this population.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. PMID: 25756335 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/25756335?dopt=Abstract = URL to article