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Treatment of facial telangiectasia with a small spot of intense pulsed light: A case series of three patients. J Dermatol. 2014 Jun 14; Authors: Tsunoda K, Takahashi K, Ogino N, Yoshida A, Akasaka T Abstract Intense pulsed light (IPL) technology has long been used in the treatment of facial telangiectasia. While the large spot size of traditional IPL devices offers rapid coverage, it has limitations in terms of visibility and uniform contact with the skin in contoured areas of the face. The novel IPL used in this study had a small spot size (6.35 mm) and shorter wavelength (500-635 nm), allowing the use of high fluence without burning the normal epidermal tissue surrounding the lesion, thus providing better efficacy. Treatment of facial telangiectasia using small-spot IPL is effective with a low risk of dermatological damage, and its uses for medical care are expected to diversify. PMID: 24931642 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24931642?dopt=Abstract = URL to article

Fragility of epidermis and its consequence in dermatology. J Eur Acad Dermatol Venereol. 2014 Jun;28 Suppl 4:1-18 Authors: Stalder JF, Tennstedt D, Deleuran M, Fabbrocini G, de Lucas R, Haftek M, Taieb C, Coustou D, Mandeau A, Fabre B, Hernandez-Pigeon H, Aries MF, Galliano MF, Duplan H, Castex-Rizzi N, Bessou-Touya S, Mengeaud V, Rouvrais C, Schmitt AM, Bottino R, Cottin K, Saint Aroman M Abstract The skin is the largest organ of the body, providing a protective barrier against bacteria, chemicals and physical insults while maintaining homeostasis in the internal environment. Such a barrier function the skin ensures protection against excessive water loss. The skin's immune defence consists of several facets, including immediate, non-specific mechanisms (innate immunity) and delayed, stimulus-specific responses (adaptive immunity), which contribute to fending off a wide range of potentially invasive microorganisms. This article is an overview of all known data about 'fragile skin'. Fragile skin is defined as skin with lower resistance to aggressions. Fragile skin can be classified into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. This article includes the epidemiologic data, pathologic description of fragile skin with pathophysiological bases (mechanical and immunological role of skin barrier) and clinical description of fragile skin in atopic dermatitis, in acne, in rosacea, in psoriasis, in contact dermatitis and other dermatologic pathologies. This article includes also clinical cases and differential diagnosis of fragile skin (reactive skin) in face in adult population. In conclusion, fragile skin is very frequent worldwide and its prevalence varies between 25% and 52% in Caucasian, African and Asian population. PMID: 24931580 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/24931580?dopt=Abstract = URL to article

Related ArticlesNew rhinophyma severity index and mid-term results following shave excision of rhinophyma. Dermatology. 2013;227(1):31-6 Authors: Wetzig T, Averbeck M, Simon JC, Kendler M Abstract BACKGROUND: Rhinophyma is a progressive nasal deformity resulting from hyperplasia of the sebaceous glands and connective tissue, with a negative effect on quality of life. Partial-thickness shave excision has been used for the treatment of rhinophyma, but the mid- and long-term efficacy of the treatment is unknown. OBJECTIVES: We analysed the clinical outcomes of shave excision in patients with rhinophyma in our centre between 2005 and 2009. METHODS: The entire nose was shaved using a scalpel while under tumescent anaesthesia. The clinical assessment was scored using a novel Rhinophyma Severity Index. RESULTS: Thirty-three patients with rhinophyma and shave excision were recruited for the study. A mid-term follow-up examination was possible in 23/33 (69.7%) patients. After a mean follow-up of 37.4 ± 13.2 months, 21 (91.3%) patients showed an improved Rhinophyma Severity Index (3.3 ± 1.1 to 1.7 ± 0.9, p < 0.0001). All patients reported a high level of satisfaction after surgery (excellent or good result). Eleven (47.8%) patients developed rhinophyma recurrence. CONCLUSION: Shave excision under tumescent anaesthesia is an effective treatment for rhinophyma. The treatment is associated with high patient satisfaction and minimal side effects. A possible recurrence of rhinophyma must be addressed, however, while obtaining informed consent. PMID: 24008235 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24008235?dopt=Abstract = URL to article

[Doxycycline or How to Create New with the Old?] Therapie. 2014 3-4;69(2):129-141 Authors: Shehwaro N, Langlois AL, Gueutin V, Gauthier M, Casenave M, Izzedine H Abstract Tetracyclines are broad-spectrum antibiotics that interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s in the treatment of acne. More recently, their biological actions on inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism were studied. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that degrade components of the extracellular matrix (ECM). MMPs have direct or indirect effects on the vascular endothelium and the vascular relaxation/contraction system. The therapeutic effects of tetracyclines and analogues were studied in rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis and autoimmune diseases autoimmune diseases such as rheumatoid arthritis and scleroderma. In addition, downregulation of MMP using doxycycline could be beneficial in reducing vascular dysfunction mediated by MMPs and progressive damage of the vascular wall. We review the nonantibiotic properties of doxycycline and its potential clinical applications. PMID: 24926631 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24926631?dopt=Abstract = URL to article

Rosacea Fulminans With Extrafacial Lesions in an Elderly Man: Successful Treatment With Subantimicrobial-Dose Doxycycline. J Drugs Dermatol. 2014 Jun 1;13(6):763-765 Authors: Smith LA, Meehan SA, Cohen DE Abstract Rosacea fulminans, previously known as pyoderma faciale, is a rare disease occurring almost exclusively in young women characterized by the sudden eruption of coalescing papules and pustules, and large cystic nodules limited to the face. Patients generally respond well to standard therapy consisting of systemic isotretinoin in combination with topical and systemic corticosteroids. Lesions usually resolve with minimal scarring with appropriate management. We describe an elderly male patient with extrafacial rosacea fulminans successfully treated with daily subantimicrobial (40mg) dose doxycycline (SDD). To our knowledge, this is the first report of rosacea fulminans with extrafacial lesions in an elderly male. We suggest that SDD may be a safe and effective alternative, particularly for those unable to tolerate standard therapy.<BR /><BR /> <EM>J Drugs Dermatol.</EM> 2014;13(6):763-765. PMID: 24918570 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918570?dopt=Abstract = URL to article

Only Skin Deep: Optimism and Public Self-Consciousness Did Not Associate With the Placebo Response in a Dermatology Clinical Trial. J Drugs Dermatol. 2014 Jun 1;13(6):719-722 Authors: Garshick MK, Chang AL, Kimball AB Abstract OBJECTIVE: Although not well-understood, dermatologic diseases studied in clinical trials often demonstrate substantial response to placebo. The study objective is to determine if optimism, public self-consciousness and other personality traits predict response to placebo or active treatment in a dermatology clinical trial.<BR /> METHODS: A questionnaire was mailed to subjects previously enrolled in a two-center rosacea study who had been randomized to either a treatment or placebo gel. The questionnaire included the Revised Life Orientation Test (LOT-R), the Public Self-Consciousness Scale, and questions to assess personality traits.<BR /> RESULTS: Forty-seven subjects out of 83 (57%) returned the questionnaire. There was no statistically significant difference in the LOT-R score in those who responded to placebo versus those who did not (18.08 vs 17.92, <EM>P</EM>= 0.92) nor in those who responded to active treatment versus those who did not (16.27 vs 15.86, <EM>P</EM>= 0.79). There was no statistically significant difference in public-self consciousness among placebo or active treatment responders versus non-responders (11.75 vs 10.67, <EM>P</EM>=0.66; 13.55 vs 14.45, <EM>P</EM>= 0.68). The placebo responders were more likely to report that they were not unusually sensitive to most drugs/medications (X2= 8.33, <EM>P</EM>= 0.004).<BR /> CONCLUSION: Although this pilot study is small, there was no meaningful difference in levels of optimism or public self-consciousness among those who responded to placebo. Placebo responders were more likely to report that they were not sensitive to most drugs/medications, raising the possibility that they are actually less likely to detect when they are on medications.<BR /><BR /> <EM>J Drugs Dermatol.</EM> 2014;13(6):719-722. PMID: 24918563 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918563?dopt=Abstract = URL to article

Improvement in Facial Erythema Within 30 Minutes of Initial Application of Brimonidine Tartrate in Patients With Rosacea. J Drugs Dermatol. 2014 Jun 1;13(6):699-704 Authors: Jackson JM, Fowler J, Moore A, Jarratt M, Jones T, Meadows K, Steinhoff M, Rudisill D, Leoni M Abstract BACKGROUND: Brimonidine tartrate (BT) 0.5% gel demonstrated significantly greater efficacy versus vehicle gel once-daily for the treatment of moderate to severe erythema of rosacea.<BR /> OBJECTIVES: To assess the 30-minute speed of onset of topical BT 0.5% gel in reducing facial erythema in Phase III studies as measured by subject and clinician assessments of erythema.<BR /> METHODS: Two Phase III, randomized, controlled studies with identical design in which subjects with moderate erythema of rosacea (study A: n=260; study B: n=293) were randomized 1:1 to apply topical BT 0.5% or vehicle gel once-daily for 4 weeks. Evaluations included severity of erythema based on Clinician's Erythema Assessment (CEA) and Patient's Self-Assessment (PSA) prior to study drug application and at 30 minutes after application on days 1, 15, and 29.<BR /> RESULTS: 97.7% and 96.6% of subjects reported normal study completion for studies A and B, respectively. The percentage of subjects achieving a 1-grade improvement in both CEA and PSA was significantly increased at 30 minutes post-dosing with BT 0.5% gel compared to vehicle gel on visit days (day 1: 27.9 vs 6.9%, <em>P</em>&lt;0.001; day 15: 55.9 vs 21.1%, <em>P</em>&lt;0.001; Day 29: 58.3 vs 32.0%, <em>P</em>&lt;0.001 for BT 0.5% gel vs vehicle) in study A. Similar results were shown for study B.<BR /> CONCLUSIONS: Once-daily topical BT gel 0.5% is not only efficacious at reducing facial erythema but also exhibits response within 30 minutes of application in a significant number of patients throughout both Phase III studies.<BR /><BR /> <EM>J Drugs Dermatol.</EM> 2014;13(6):699-704. PMID: 24918560 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918560?dopt=Abstract = URL to article

The Quality of Life Impact of Acne and Rosacea Compared to Other Major Medical Conditions. J Drugs Dermatol. 2014 Jun 1;13(6):692-697 Authors: Cresce ND, Davis SA, Huang WW, Feldman SR Abstract BACKGROUND: Acne and rosacea cause significant negative impact on quality of life. There is limited information comparing the health-related quality of life (HRQL) impact associated with acne and rosacea to other patient populations.<BR /> PURPOSE: We review available literature to assess the HRQL impact of acne and rosacea and compare them with major medical conditions.<BR /> METHODS: A PubMed search identified studies that utilized the Short Form 36 (SF-36), the Dermatology Life Quality Index (DLQI), and the willingness-to-pay (WTP) metric to assess the HRQL impact of acne and rosacea. These data were compared to HRQL values for other diseases.<BR /> RESULTS: The HRQL impact of acne is similar to asthma, epilepsy, diabetes, back pain, arthritis, and coronary heart disease using SF-36 data. DLQI scores for acne ranged from 2 to 17.7 and for rosacea ranged from 4.3 to 17.3; the DLQI scores for psoriasis ranged from 1.7 to 18.2. WTP data identified ranged widely for both acne and rosacea.<BR /> LIMITATIONS: There was limited broadly generalizable data for acne and rosacea.<BR /> CONCLUSIONS: Acne and rosacea impact HRQL to a similar degree as other major medical conditions by indirect comparison to psoriasis, a skin condition causing significant disability, and by direct comparison for acne. In the setting of limited health care resources, allocation should be grounded in the evidence that acne and rosacea are not trivial in their effects.<BR /><BR /> <EM>J Drugs Dermatol.</EM> 2014;13(6):692-697. PMID: 24918559 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918559?dopt=Abstract = URL to article

Randomized, Phase 2, Dose-Ranging Study in the Treatment of Rosacea With Encapsulated Benzoyl Peroxide Gel. J Drugs Dermatol. 2014 Jun 1;13(6):685-688 Authors: Leyden JJ Abstract OBJECTIVE: Compare the safety and efficacy of 1% and 5% silica encapsulated benzoyl peroxide (E-BPO) in patients with papulopustular rosacea.<BR /> DESIGN: Multi-centered randomized, double blind, vehicle controlled parallel group, 12 week treatment in 92 patients with papulopustular rosacea. Primary endpoints were dichotomized IGA with success defined as clear/near clear and reduction in inflammatory lesions.<BR /> PATIENTS: 92 patients: 74% graded as moderate IGA, 14% severe and 12% mild. The mean inflammatory lesion count was 24.<BR /> INTERVENTION: Once daily treatment for 12 weeks with vehicle, 1% or 5% E-BPO.<BR /> RESULTS: 1% and 5% E-BPO were superior to vehicle in reducing papulopustular lesions <EM>P</EM>=0.01 and <em>P</em>=0.02. 5% E-BPO was superior to vehicle for IGA <em>P</em>=0.0013.<BR /><BR /> <EM>J Drugs Dermatol.</EM> 2014;13(6):685-688. PMID: 24918558 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918558?dopt=Abstract = URL to article

The Changing Face of Challenges in the Management of Acne and Rosacea. J Drugs Dermatol. 2014 Jun 1;13(6):649 Authors: Del Rosso JQ Abstract . PMID: 24918551 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24918551?dopt=Abstract = URL to article

Related ArticlesBrimonidine effective but may lead to significant rebound erythema. J Am Acad Dermatol. 2014 May;70(5):e109-10 Authors: Ilkovitch D, Pomerantz RG PMID: 24742853 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24742853?dopt=Abstract = URL to article

Demodex - An Old Pathogen or a New One? Adv Clin Exp Med. 2014 March-April;23(2):295-298 Authors: Rusiecka-ZióÅ‚kowska J, Nokiel M, Fleischer M Abstract Demodex was first identified over 150 years ago, but only recently has it attracted wider interest as a contributor to chronic diseases such as acne rosacea or marginal blepharitis. Demodex is commonly found in the human population, in skin sebaceous glands or follicles. The frequency of Demodex infection increases with age, as it is mainly diagnosed after the age of seventy; however, it can sometimes be found in children and teenagers. Demodex is supposed to contribute to the development of marginal blepharitis or acne rosacea, but the pathogenic mechanisms have not yet been explained in detail. These diseases are chronic and the long-term treatment effects are not satisfactory. This paper presents the characteristics of Demodex as well as its prevalence in the pathogenesis of eye and skin diseases, and describes the diagnostics and treatment of these disorders. PMID: 24913122 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24913122?dopt=Abstract = URL to article

Medically Reversible Limbal Stem Cell Disease: Clinical Features and Management Strategies. Ophthalmology. 2014 Jun 4; Authors: Kim BY, Riaz KM, Bakhtiari P, Chan CC, Welder JD, Holland EJ, Basti S, Djalilian AR Abstract PURPOSE: To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-two eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with 3 months or more of follow-up. METHODS: Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, causes, location and duration of disease, and medical inventions were analyzed. MAIN OUTCOME MEASURES: Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity. RESULTS: Causes of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes), and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy, or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%). The corneal epithelial phenotype returned to normal with only conservative measures, including lubrication and discontinuing contact lens wear in 4 patients (4 eyes), whereas in 11 patients (18 eyes), additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, punctal occlusion, or a combination thereof. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P < 0.0184). CONCLUSIONS: Disturbances to the LSC function, niche, or both may be reversible with medical therapy. These cases, which represent a subset of patients with LSC deficiency, may be considered to have LSC niche dysfunction. PMID: 24908203 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24908203?dopt=Abstract = URL to article

Demodex folliculorum: its association with oily skin surface rather than rosacea lesions. Int J Dermatol. 2014 Jun 5; Authors: Porta Guardia CA Abstract BACKGROUND: Despite the predilection of Demodex folliculorum (DF) for human sebum, observational studies addressing a relationship between this agent and rosacea paid no attention to the effect of a potentially acting confounder, the oily nature of the skin. OBJECTIVES: To analyze whether a relationship exists between the presence of the mite in rosacea and oily cutis. MATERIALS AND METHODS: An observational study on 63 rosacea cases and 61 healthy controls, both discriminated according to their predominance of oily or dry cutis, was carried out to investigate demodectic density by the skin surface biopsy. RESULTS: While comparisons on the density of DF revealed no differences between patients and controls (Mann-Whitney U-test, P = 0.35), persons with an oily cutis had increased amounts of this mite on the skin surface (Mann-Whitney U-test, P < 0.05), irrespective of whether they had rosacea or not. CONCLUSIONS: The association between DF and oily skin rather than rosacea lesions gives no support for this agent being implied in disease pathogenesis. PMID: 24898344 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24898344?dopt=Abstract = URL to article

Related ArticlesSurgical management of rhinophyma: a case report and review of literature. Conn Med. 2014 Mar;78(3):159-60 Authors: Ferneini EM, Banki M, Paletta F, Ferneini CM Abstract As surgeons, we are often faced with treating many dermatologic and facial lesions. We present a case ofrhinophyma as well as review the medical and surgical management of such a condition. PMID: 24772833 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24772833?dopt=Abstract = URL to article

Related ArticlesBiopsies of facial dermatoses made simple. Arch Pathol Lab Med. 2014 Apr;138(4):550-2 Authors: Al-Mohammedi F, Crawford RI, Martinka M Abstract CONTEXT: Biopsy of the face is rarely done for inflammatory skin diseases, unless the entire process is confined to the face. OBJECTIVE: We hypothesized that facial dermatitis has a differential diagnosis that is more limited than the differential diagnosis of inflammatory skin diseases that affect other parts of the body. To our knowledge, the classification of inflammatory skin diseases occurring on the face has never been conducted before in the English literature. DESIGN: The most-recent 100 facial biopsies of inflammatory skin conditions were retrieved from our files, and the cases were categorized into the main inflammatory skin patterns. RESULTS: Forty-seven cases (47%) were categorized as interface dermatitis, 2 cases (2%) as psoriasiform dermatitis, 11 cases (11%) as spongiotic dermatitis, 16 cases (16%) as diffuse and nodular dermatitis, 8 cases (8%) as perivascular dermatitis, 14 cases (14%) as folliculitis and perifolliculitis, 1 case (1%) as panniculitis, and 1 case (1%) as fibrosing dermatitis. The number of diagnostic entities represented within each of these patterns was small. CONCLUSIONS: We believe that facial dermatitis should have its own more-circumscribed differential diagnosis. From a practical viewpoint, many of the inflammatory skin diseases that affect other parts of the body should be excluded from the differential diagnosis after the tissue is determined to be from a facial skin biopsy, and others should not be considered unless the biopsy is from the face. PMID: 24678686 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/24678686?dopt=Abstract = URL to article

Related ArticlesIn vivo and in vitro analysis of low level light therapy: a useful therapeutic approach for sensitive skin. Lasers Med Sci. 2013 Nov;28(6):1573-9 Authors: Choi M, Kim JE, Cho KH, Lee JH Abstract Sensitive skin is a relatively common dermatologic condition and no optimal treatments have been established so far. Low-level laser/light therapy (LLLT) has been used for its biostimulative effect in various clinical settings. The purpose of this study was to investigate whether low-level laser/light therapy can improve sensitive skin clinically and to evaluate the effects of LLLT on skin in vitro. Twenty-eight patients complaining of sensitive skin were treated with low-level polarized light, and clinical results were evaluated using subjective and objective method. To investigate possible working mechanism of LLLT on skin, cultured human keratinocytes pretreated with nontoxic concentration of sodium lauryl sulfate (SLS) were used. Cytokines released from irritated keratinocytes after LLLT were analyzed. All patients showed subjective and objective improvement after treatment. No adverse effects were reported. The average number of LLLT sessions required to achieve clinical improvement was 9.9, and cumulative dose of LLLT was 71.3 J/cm(2) on the average. Erythema index decreased significantly after LLLT treatment (p = 0.017). In vitro assay showed that LLLT significantly reduced the release of VEGF from SLS-pretreated keratinocytes (p = 0.021). Our results suggest that LLLT could be a useful and safe treatment modality for sensitive skin, and modification of inflammatory cytokines released from irritated keratinocytes may be considered as one of plausible mechanisms in sensitive skin treated with LLLT. PMID: 23397274 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23397274?dopt=Abstract = URL to article

Current drug therapies for rosacea: a chronic vascular and inflammatory skin disease. J Manag Care Pharm. 2014 Jun;20(6):623-9 Authors: Feldman SR, Huang WW, Huynh TT Abstract BACKGROUND: Rosacea is a chronic skin disorder that presents with abnormal vascular and inflammatory conditions. Clinical manifestations include flushing, facial erythema, inflammatory papules and pustules, telangiectasias, edema, and watery or irritated eyes. OBJECTIVE: To discuss the evolving pathophysiology of rosacea, factors involved in promoting the chronic vascular and inflammatory abnormalities seen in rosacea, and the available drug therapies for the condition. DISCUSSION: Chronic inflammation and vascular changes are believed to be underlying factors in the pathophysiology of rosacea. Aberrant cathelicidin expression, elevated kallikrein 5 (KLK5) proteolytic activity, and altered toll-like receptor 2 (TLR2) expression have been reported in rosacea skin leading to the production of proinflammatory cytokines. Until recently, drug therapies only targeted the inflammatory lesions (papules and pustules) and transient erythema associated with these inflammatory lesions of rosacea. Brimonidine tartrate gel 0.5% was recently approved for the treatment of persistent (nontransient) facial erythema of rosacea, acting primarily on the cutaneous vascular component of the disease. CONCLUSION: Rosacea is a chronic vascular and inflammatory skin disease. Understanding the role of factors that trigger the onset of rosacea symptoms and exacerbate the condition is crucial in treating this skin disease. PMID: 24856600 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/24856600?dopt=Abstract = URL to article

Related ArticlesRosettes: optical effects and not dermoscopic patterns related to skin neoplasms. Australas J Dermatol. 2013 Nov;54(4):271-2 Authors: Rubegni P, Tataranno DR, Nami N, Fimiani M PMID: 23841852 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23841852?dopt=Abstract = URL to article

Decreased serum paraoxonase and arylesterase activities in patients with rosacea. J Eur Acad Dermatol Venereol. 2014 May 22; Authors: Takci Z, Bilgili SG, Karadag AS, Kucukoglu ME, Selek S, Aslan M Abstract BACKGROUND: Recent evidence suggests that oxidative stress may be an important phenomenon in the pathophysiology of rosacea. Paraoxonase-1 (PON1) is an antioxidant enzyme with three activities: paraoxonase, arylesterase and dyazoxonase. In this study, we evaluated serum paraoxonase and arylesterase activities, and serum lipid hydroperoxide (LOOH) levels in patients with rosacea in comparison to healthy controls. MATERIAL AND METHOD: The study included 39 rosacea patients and healthy controls, consisting of 40 age- and sex-matched healthy volunteers. Serum paraoxonase and arylesterase activities were measured using paraoxon and phenylacetate substrates. Serum LOOH levels were measured with the ferrous ion oxidation-xylenol orange assay. RESULTS: In rosacea group mean serum paraoxonase and arylesterase activities were 74.54 ± 38.30 U L(-1) and 141.29 ± 22.27 kU L(-1) respectively, which were significantly lower than controls (P = 0.010, 0.005; respectively). Mean serum LOOH level of rosacea group was 8.17 ± 1.91 μmol L(-1) which was significantly higher than controls (P = 0.009). There were no statistically significant differences between the clinical subtypes of the disease, menopause situation or ocular involvement with the respect to the serum paraoxonase and arylesterase activities and LOOH levels (all; P > 0.05). CONCLUSIONS: Serum PON1 enzyme activities have decreased significantly in rosacea. These findings support that decreased PON1 activity and increased oxidative stress may play a role in the pathogenesis of rosacea. Further studies are needed to elucidate the role of PON1 activity in the pathophysiology of rosacea. PMID: 24854673 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24854673?dopt=Abstract = URL to article

Melkersson-Rosenthal Syndrome with Isolated Unilateral Eyelid Edema: An Immunopathologic Study. Ophthal Plast Reconstr Surg. 2014 May 21; Authors: Chen X, Jakobiec FA, Yadav P, Werdich XQ, Fay A Abstract Lymphedema is caused by defective drainage of the lymphatic system. In Melkersson-Rosenthal syndrome, involvement is predominantly of the lumens with blockage of lymphatic channels by histiocytic-epithelioid cell clusters accompanied by dermal granulomas and lymphocytes. It is a localized, painless, nonitching, and nonpitting form of lymphedema. Besides the eyelids, the disease can cause lip edema, facial palsy, and/or fissured tongue. It is rare and has received little attention in the ophthalmic literature, either in its complete triadic form, or more frequently, in its monosymptomatic forms. Pathogenesis is not well understood, and there is no effective therapy. The authors describe a case of Melkesson-Rosenthal syndrome in a 45-year-old Hispanic man with isolated unilateral upper eyelid edema. Histopathological and immunohistochemical evaluations of an eyelid biopsy specimen revealed intravascular and extravascular clusters of histiocytic-epithelioid cells that were CD68/163-positive. Variable numbers of mostly T-lymphocytes were found in the epidermis, dermis, and orbicularis muscle and by virtue of the associated granulomas established the diagnosis of Melkersson-Rosenthal syndrome. CD4 helper and CD8 suppressor T-lymphocytes were equally represented. CD20 B-lymphocytes were exceedingly sparse. Conspicuous CD1a-positive Langerhans' cells were present in the epidermis, sometimes formed subepithelial loose aggregates and were also incorporated in the granulomas. The differential diagnosis includes the far more common condition of acne rosacea. Management of Melkersson-Rosenthal syndrome, and of angioedema in general, is reviewed. PMID: 24853119 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24853119?dopt=Abstract = URL to article

Related ArticlesMast Cells are Key Mediators of Cathelicidin Initiated Skin Inflammation in Rosacea. J Invest Dermatol. 2014 May 20; Authors: Muto Y, Wang Z, Vanderberghe M, Two A, Gallo RL, Di Nardo A Abstract Rosacea is a chronic inflammatory skin disease whose pathophysiological mechanism is still unclear. However, it is known that mast cell (MC) numbers is increased in the dermis of rosacea patients. MC proteases not only recruit other immune cells, which amplify the inflammatory response, but also cause vasodilation and angiogenesis. MCs are also one of the primary sources of cathelicidin LL-37 (Cath LL-37), an antimicrobial peptide that has been shown to be an enabler of rosacea pathogenesis. Here, we demonstrate that MCs are key mediators of cathelicidin initiated skin inflammation. Following Cath LL-37 injection into the dermis, MC deficient B6.Cg-Kit(W-sh)/HNihrJaeBsmJ (KitW-sh) mice did not develop rosacea-like features. Conversely, chymase (P<0.001), tryptase and Mmp9 (P<0.01) mRNA levels were significantly higher in C57BL/6 Wild Type (WT) mice. Treating WT mice with a MC stabilizer significantly decreased the expressions of Mmp9 and Cxcl2 (P<0.01). Our data was confirmed on Erythematotelangiectatic rosacea subjects that showed a decrease in MMP activity (P<0.05), after eight weeks of topical cromolyn treatment. We conclude that MCs play a central role in the development of inflammation subsequent to Cath LL-37 activation and that down regulation of activated MCs may be a therapy for rosacea treatment.Journal of Investigative Dermatology accepted article preview online, 20 May 2014; doi:10.1038/jid.2014.222. PMID: 24844861 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24844861?dopt=Abstract = URL to article

Facial Dystonias and Rosacea: Is There an Association? Orbit. 2014 May 15;:1-4 Authors: Khan TT, Donaldson J, Hesse RJ Abstract Abstract Purpose: Benign essential blepharospasm (BEB) and hemifacial spasm (HFS) belong to a spectrum of focal movement disorders that cause involuntary, spasmodic contractions of the eyelid and facial muscles. In our clinical experience, we have observed an increased prevalence of rosacea in patients who present with BEB and HFS. We investigate our clinical findings with a review of disease pathophysiology and treatment. Methods: Retrospective study approved by the Ochsner Institutional Review Board and literature review. A total of 140 charts dated from 1990 to 2013 were reviewed, including 87 patients with BEB and 53 patients with HFS. Rosacea, BEB, and HFS were defined by standard diagnostic criteria. Results: Within our BEB and HFS patient cohort, approximately 15% of patients presented with rosacea, compared to the general American population prevalence rate of 1.34% (p < 0.001). Of the 140 patients reviewed, a total of 21 patients (13 with BEB and 8 with HFS) exhibited rosacea (p = 0.995). Conclusions: Dry eye and tear instability often co-exist in patients with facial dystonias and rosacea, which may provide the initial drive towards tonic eyelid contractions and simultaneously exacerbate rosacea. Studies suggest that neurogenic inflammation and altered vasoregulation jointly contribute to the pathogenesis of rosacea. From our preliminary observations, we suggest the possibility of shared immune-inflammatory pathways involved in both facial dystonias and rosacea. Identification of common inflammatory mediators involved in both disease processes may facilitate a more targeted approach in drug treatment. Further biochemical analysis will likely be necessary to elucidate this potential association. PMID: 24831933 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24831933?dopt=Abstract = URL to article

Treatment of symptoms of erythemato-telangiectatic rosacea with topical potassium azeloyl diglycinate and hydroxypropyl chitosan: results of a sponsor-free, multicenter, open study. J Dermatolog Treat. 2014 May 15;:1-10 Authors: Veraldi S, Raia DD, Schianchi R, De Micheli P, Barbareschi M Abstract Abstract Thirty-seven adult Caucasian patients (9 males and 28 females), with erythemato-telangiectatic rosacea accompanied by stinging and burning sensation, were treated with a cream containing 5% potassium azeloyl diglycinate and 1% hydroxypropyl chitosan. All patients were previously treated at other centers with topical azelaic acid and/or metronidazole. The cream was applied twice daily for 12 weeks. Objective of the study was the evaluation of the soothing effect of the cream: stinging and burning sensation were measured by means of a 4-point scale (0=absent; 1=mild; 2=moderate and 3=severe). All patients were clinically evaluated every 4 weeks. Thirty out of 37patients (81.1%) were considered evaluable. Before the beginning of the study, the total score of stinging and burning sensation was 66 (mean: 2.2 points/patient); at the end of the study, it was 37 points (-29) (mean: 1.2 points/patient), with a reduction of 56.1%. No side effects were reported or observed. This study shows that the fixed combination potassium azeloyl diglycinate - hydroxypropyl chitosan is effective in reducing stinging and burning sensation in patients with erythemato-telangiectatic rosacea. PMID: 24831156 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24831156?dopt=Abstract = URL to article

Related ArticlesRosacea fulminans. Indian J Dermatol Venereol Leprol. 2014 May-Jun;80(3):272-4 Authors: Koh HY, Ng SK, Tan WP PMID: 24823417 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/24823417?dopt=Abstract = URL to article