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Ocular rosacea: a review. Arq Bras Oftalmol. 2012 Oct;75(5):363-9 Authors: Vieira AC, Höfling-Lima AL, Mannis MJ Abstract Rosacea is a prevalent chronic cutaneous disorder with variable presentation and severity. Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity. The importance of early diagnosis and adequate treatment cannot be overemphasized. There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent. In this review, we describe the pathophysiologic mechanisms proposed in the literature, clinical features, diagnosis and management of ocular rosacea, as well as discuss the need for a diagnostic test for the disease. PMID: 23471336 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23471336?dopt=Abstract = URL to article

Rosacea: symptoms and support. Br J Nurs. 2012 Nov 22-Dec 12;21(21):1252-5 Authors: Van Onselen J Abstract Rosacea is a common skin condition, especially for middle-aged and some older adults. However, it is often wrongly perceived as cosmetic facial redness caused by alcohol. This can be very distressing for rosacea patients, as it is a facial vascular condition with subtypes, varying in severity. Rosacea should be effectively treated, as physical symptoms such as burning, stinging and soreness, as well as facial disfigurement are very distressing and can have a major impact on quality of life. This articles seeks to explain what rosacea is, including a description of sub-types and possible causes and trigger factors. Treatments for different severities of rosacea and the nurse's role in supporting patients will also be discussed. PMID: 23469507 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23469507?dopt=Abstract = URL to article

New-generation radiofrequency technology. Cutis. 2013 Jan;91(1):39-46 Authors: Krueger N, Sadick NS Abstract Radiofrequency (RF) technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety. It is used worldwide for cellulite reduction; acne scar revision; and treatment of hypertrophic scars and keloids, rosacea, and inflammatory acne in all skin types. However, the most common indication for RF technology is the nonablative tightening of tissue to improve skin laxity and reduce wrinkles. Radiofrequency devices are classified as unipolar, bipolar, or multipolar depending on the number of electrodes used. Additional modalities include fractional RF; sublative RF; phase-controlled RF; and combination RF therapies that apply light, massage, or pulsed electromagnetic fields (PEMFs). This article reviews studies and case series on these devices. Radiofrequency technology for aesthetic medicine has seen rapid advancements since it was used for skin tightening in 2003. Future developments will continue to keep RF technology at the forefront of the dermatologist's armamentarium for skin tightening and rejuvenation. PMID: 23461058 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23461058?dopt=Abstract = URL to article

Management of Severe Rhinophyma With Sculpting Surgical Decortication. Aesthetic Plast Surg. 2013 Mar 1; Authors: Husein-Elahmed H, Armijo-Lozano R Abstract Rhinophyma, a progressive, disfiguring disease of the nose, is considered the final stage of acne rosacea. In its early stages, rhinophyma can be managed with medical treatment using isotretinoin or oral antibiotics (metronidazole). However, severe cases usually are refractory to medical approaches. Surgical therapies to treat these severe refractory cases have been described. This report describes a simple, safe, efficient, and cost-effective approach to the treatment of severe rhinophyma using a scalpel and the electroscalpel, instruments readily available in every operating room. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . PMID: 23456145 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23456145?dopt=Abstract = URL to article

Rosacea under the microscope: characteristic histological findings. J Eur Acad Dermatol Venereol. 2013 Mar 4; Authors: Cribier B Abstract Rosacea is a common facial dermatosis that is seldom biopsied; thus, histological aspects have not been well described. Biopsies are generally performed in the presence of atypical symptoms (e.g. granulomas). Differential diagnosis with sarcoidosis, lupus miliaris or lupus erythematosus is another indication for biopsy. There are few published studies addressing the microscopic aspects of rosacea and describing the histological and immunohistochemical features of this disease. While some textbooks consider the microscopic signs of rosacea to be non-diagnostic, experienced dermatopathologists are generally able to make the diagnosis via histology. This article discusses the specific combinations of histological features that are highly suggestive of rosacea. PMID: 23451732 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23451732?dopt=Abstract = URL to article

Unilateral rosacea in a patient with Bell's palsy. J Dermatol. 2013 Feb 27; Authors: Cabete J, Serrão V, Lestre S PMID: 23442008 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23442008?dopt=Abstract = URL to article

Childhood Granulomatous Periorificial Dermatitis with a Good Response to Oral Metronidazole. Pediatr Dermatol. 2013 Feb 26; Authors: Rodriguez-Caruncho C, Bielsa I, Fernandez-Figueras MT, Ferrándiz C Abstract Childhood granulomatous periorificial dermatitis (CGPD) is a condition included in the spectrum of rosacea and perioral dermatitis that affects prepubescent children. It is characterized by papular eruptions located around the mouth, nose, and eyes that histopathologically show a granulomatous pattern. We report a 9-year-old girl with CGPD who required treatment with an oral antibiotic. Oral metronidazole was administered because of its known efficacy in adult rosacea and its safety in children. The patient responded well to this therapy, showing resolution of the lesions. PMID: 23437890 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23437890?dopt=Abstract = URL to article

Non-invasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy Reply from authors. Br J Dermatol. 2013 Feb 20; Authors: Sattler EC, Maier T, Hoffmann VS, Ruzicka T, Berking C Abstract we thank Lacey et al. for their interesting and very welcome thoughts concerning our article on the usefulness of confocal laser scanning microscopy (CLSM) in the quantification of demodex mites and for their excellent pictures of Demodex mites seen under the light microscope after extraction using the standardized skin surface biopsy (SSSB) method. As a center specialized in acne and rosacea we are also using SSSB routinely as the standard method for demodex quantification and have gathered ample experience within the past decades. We agree that mainly Demodex folliculorum is detected with both SSSB and especially with CLSM (with a penetration depths limited to about 200-300 μm), since Demodex folliculorum is usually located at the upper part of the infundibulum of the hair follicle, while Demodex brevis is usually seen at the lower portion close to the sebaceous glands. PMID: 23421742 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23421742?dopt=Abstract = URL to article

Demodex quantification methods: Limitations of Confocal Laser Scanning Microscopy (CLSM). Br J Dermatol. 2013 Feb 16; Authors: Lacey N, Forton FM, Powell FC Abstract We read with interest the recent paper by Sattler et al.,(1) describing the quantification of Demodex mites by confocal laser scanning microscopy (CLSM). Their work is interesting but we feel there are limitations to the use of this method to accurately detect absolute numbers of mites in human skin. Because the role of Demodex in normal or diseased skin is unknown,(2) their possible role in modulation of immune reactivity of the follicle(3) and an association between the degree of mite infestation and the development of rosacea,(4-6) accurate reproducible in vivo methods of quantifying mites is becoming increasingly important. PMID: 23414055 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23414055?dopt=Abstract = URL to article

Successful Long-term Use of Oral Isotretinoin for the Management of Morbihan Disease: A Case Series Report and Review of the Literature. Arch Dermatol. 2012 Dec 1;148(12):1395-8 Authors: Smith LA, Cohen DE Abstract BACKGROUND Morbihan disease (MD) is characterized by persistent erythema and solid edema of the upper two-thirds of the face. It is generally regarded as a late-stage complication of rosacea, although its etiology is poorly understood. The standard therapeutic management includes systemic anti-inflammatory medications; however, the clinical response, if any, is often unsatisfactory. We review the current challenges and a promising new option for the treatment of MD. OBSERVATIONS Five cases of MD were treated with long-term (>6 months; mean, 16 months) oral isotretinoin, with documented nonrecurrence. The mean sustained daily dose was 60 mg/d (range, 40-80 mg/d), and the mean cumulative dose was approximately 285 mg/kg (range, 170-491 mg/kg). The total treatment period ranged from 10 to 24 months, with a mean disease-free follow-up period of 9 months (range, 1-24 months). A substantial clinical improvement was not noted until 6 months of treatment in all 5 cases. CONCLUSIONS We report 5 cases of MD that were successfully treated with long-term oral isotretinoin, with lasting results. Further research is required to better understand the pathogenesis of MD and isotretinoin's mechanism of action in this condition. PMID: 23403940 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23403940?dopt=Abstract = URL to article

[New possibilities in the treatment of early stages of rosacea]. Georgian Med News. 2013 Jan;(214):23-8 Authors: Tsiskarishvili N, Katsitadze A, Tsiskarishvili Ts Abstract Rosacea is a chronic skin disease of unknown etiology, affecting the central areas of the face skin (cheeks, chin, nose, forehead) and is characterized by periods of remission and exacerbation. Currently, about 10% of the world's population suffered from rosacea. Significant role in the pathogenesis of Rosacea, most researchers reffered to vascular disorders. Pathology of the skin capillaries can be attributed with several factors, which are united by a single result - a persistent vasodilation of the skin vessels and the subsequent blood stasis. Clinically the Rosacea manifested by erythema and telangiectasia. According to Morrison (2012) in the study of the autonomic nervous system (using the vegetative index of Kerdo) the prevalence of parasympathetic tone of the autonomic nervous system has been found in Rosacea patients. The urgency of Rosacea correction in its initial stage of development is primarily due to the state of the skin blood vessels' walls, which has not only the outward manifestation, but also influencing the trophic, morphology and function of the skin in general, the progression of the disease and its transition to a more severe stage, up to rhinophym. Thus, it is advisable to carry out remedial measures in the early stages of Rosacea in order to correct the clinical manifestations of pre-rosacea and prevent development of more severe forms of the disease. Based on foregoing, objective of the study was to investigate the therapeutic efficacy of beta-blockers and drug Rozaliak in treatment of patients with Rosacea. We observed 25 patients (15 women and 10 men) aged 25 to 49 years with erythematous stage of Rrosacea. Depending on the treatment, all patients were divided into 2 groups. 13 patients (8 women and 5 men) were included in the control group who received a full comprehensive treatment complex, including short courses of antibiotics, systemic metronidazole, antihistamines, desensitizing agents, traditional external therapy (Rosamet, 0.75% metronidazole cream). 12 patients (7 women and 5 men) were included in the study group, which additionally, after the main course (up to the revealing of clinical effects), obtained Inderal (10 mg a day for 10-20 minutes before meals) and externally - Rozaliak cream (2 times a day). Patents of this group were under the close supervision of a cardiologist. The period of observation after treatment was 12 months. During this period the relapses in the group of study were not observed, while in the control group - relapses were detected already in the third month of observation. At the same time, a substantial reduction of erythema in patients with rosacea were not revealed. Thus, this study suggests that beta-blockers and Rozaliak are effective choice for the treatment of torpid relapsing forms of Rosacea on erythematous stage of disease, as well as for stable and long-term clinical remission. PMID: 23388530 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23388530?dopt=Abstract = URL to article

Related ArticlesA New Treatment Regimen for Rosacea: OnabotulinumtoxinA. J Drugs Dermatol. 2012 Dec 1;11(12):e76-9 Authors: Dayan SH, Pritzker RN, Arkins JP Abstract Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical !ndings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its bene!t in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and "ushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, in"ammation, and hypersebaceous activity is reviewed. J Drugs Dermatol. 2012;11(12):e76-e79. PMID: 23377526 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23377526?dopt=Abstract = URL to article

Related ArticlesClindamycin phosphate 1.2% and tretinoin 0.025% gel for rosacea: summary of a placebo-controlled, double-blind trial. J Drugs Dermatol. 2012 Dec 1;11(12):1410-4 Authors: Freeman SA, Moon SD, Spencer JM Abstract Rosacea is a common, chronic, and poorly understood dermatological condition characterized by an in"ammatory component composed of papules and pustules and a vascular component composed of "ushing and erythema. Current treatment options include topical, systemic, and light-based methods, each of which focuses on either the in"ammatory or the vascular component. Retinoids are not routinely indicated as treatment because of the common conception that they would be too in"ammatory for the sensitive rosacea patient. However, photodamage may play a role in rosacea and tretinoin is well-known to repair photodamage. Thirty rosacea subjects were enrolled to assess their response to the use of clindamycin phosphate 1.2% and tretinoin 0.025% gel (ZIANA; Medicis Pharmaceutical Corporation, Scottsdale, AZ) for a period of 12 weeks. The results showed a dramatic decrease in pustules and papules without any signi!cant in"ammation or overall intolerance. No improvement in facial redness was achieved. Based on our results, more investigation of topical retinoids for rosacea treatment is prudent. J Drugs Dermatol. 2012;11(12):1410-1414. PMID: 23377509 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23377509?dopt=Abstract = URL to article

Related ArticlesAcne & rosacea: thinking outside the box. J Drugs Dermatol. 2012 Dec 1;11(12):1400 Authors: Shalita AR, Bowe WP PMID: 23377506 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23377506?dopt=Abstract = URL to article

Related ArticlesSkin microbiota: overview and role in the skin diseases acne vulgaris and rosacea. Future Microbiol. 2013 Feb;8:209-22 Authors: Murillo N, Raoult D Abstract As the first barrier to environmental exposures, human skin has developed an integrated immune system to protect the inner body from chemical, physical or microbial insults. Microorganisms inhabiting superficial skin layers are known as skin microbiota and include bacteria, viruses, archaea and fungi. The microbiota composition is crucial in the instruction and support of the skin's immune system. Changes in microbiota can be due to individual, environmental or behavioral factors, such as age, climate, hygiene or antibiotic consumption, which can cause dysbiosis. The contribution of skin microbiota to disease development is known in atopic dermatitis, where there is an increase in Staphylococcus aureus. Culture-independent studies have enabled more accurate descriptions of this complex interplay. Microbial imbalance is associated with the development of various diseases. This review focuses on microbial imbalances in acne vulgaris and rosacea. PMID: 23374126 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23374126?dopt=Abstract = URL to article

Related ArticlesRosacea: Pathophysiology and Management Principles. Facial Plast Surg Clin North Am. 2013 Feb;21(1):127-136 Authors: Chauhan N, Ellis DA Abstract This article presents an overview of the pathophysiology, epidemiology, and clinical presentations of rosacea. It also presents the therapeutic spectrum for effective management of this challenging and often confusing clinical entity. PMID: 23369595 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23369595?dopt=Abstract = URL to article

[Meibomian gland dysfunction--review]. Klin Oczna. 2012;114(2):147-52 Authors: Nowińska A, Wylegała E, Tarnawska D, Janiszewska D, Dobrowolskia D Abstract Meibomian gland dysfunction is a common ocular disorder affecting from 39 to 50% of population. Despite that, so far a pathophysiology path of the disease remains unknown, moreover there is no distinct border between physiology and the disease. There has been no clear diagnostic criteria. The purpose of this review was to combine a current knowledge of Meibomian gland anatomy, Meibomian gland dysfunction epidemiology, as well as presenting current definition, nomenclature, classification and diagnostic criteria. The importance of diagnosis associated with conditions such as aqueous tear deficiency, seborrheic dermatitis, and rosacea is emphasized. The available treatment methods are discussed. Meibomian gland dysfunction, blepharitis, dry eye syndrome. PMID: 23346806 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23346806?dopt=Abstract = URL to article

Green tea in dermatology. Skinmed. 2012 Nov-Dec;10(6):352-5 Authors: Pazyar N, Feily A, Kazerouni A Abstract The purpose of this brief review is to summarize all in vitro, in vivo, and controlled clinical trials on green tea preparations and their uses in dermatology. An extensive literature search was carried out to identify in vivo and in vitro studies as well as clinical trials. Twenty studies were assessed and the results suggest that oral administration of green tea can be effective in the scavenging of free radicals, cancer prevention, hair loss, and skin aging plus protection against the adverse effects associated with psoralen-UV-A therapy. Topical application of green tea extract should be potentially effective for atopic dermatitis, acne vulgaris, rosacea, androgenetic alopecia, hirsutism, keloids, genital warts, cutaneous leishmaniasis, and candidiosis. There are promising results with the use of green tea for several dermatologic conditions; however, the efficacy of oral and topical green tea has not always been confirmed. PMID: 23346663 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23346663?dopt=Abstract = URL to article

[New insights in the pathogenesis and treatment of rosacea]. Duodecim. 2012;128(22):2327-35 Authors: Palatsi R, Kelhälä HL, Hägg P Abstract The production of cathelicidin, an antimicrobial peptide is strongly increased in rosacea. Cathelicidin activates innate immunity, inflammation and angiogenesis. Cutaneous proteases produce inflammatory fragments of cathelicidin. UV-B irradiation and microbial components increase vitamin D3 and TLR2 expression in keratinocytes leading to an increase of cathelicidin production. Retinoids and doxycycline inhibit inflammation, proteases, angiogenesis and TLR2 expression. A multicenter study 2010 proved that isotretinoin with a dose of 0,3 mg/kg/d for 12 weeks and doxycycline with the dose of 100 mg/d for 14 days followed with 50 mg/d were equally effective. Doxycycline 40 mg/d is also effective in milder cases. PMID: 23342479 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23342479?dopt=Abstract = URL to article

[A histological and immunohistological study of vascular and inflammatory changes in rosacea]. Ann Dermatol Venereol. 2013 Jan;140(1):21-9 Authors: Perrigouard C, Peltre B, Cribier B Abstract BACKGROUND: Rosacea has a number of pathophysiological components, chief of which are vascular abnormalities and inflammation. The morphology of the dilated vessels in rosacea may indicate an increase in the number and size of lymphatic vessels. We carried out a histological and an immunohistological study to quantify these abnormalities in rosacea and compared them with those seen in lupus erythematosus. MATERIALS AND METHODS: We reviewed all cases of rosacea analysed over a 4-year period. Ultimately, we only included 86 cases in which the diagnosis could be confirmed by a dermatologist based upon histopathological correlation and follow-up. All biopsies were reviewed for histopathological features, and 25 of these were compared with 25 facial biopsies in documented cases of lupus erythematosus, using standard staining followed by immunohistochemical analysis with anti-CD3, CD4, CD8 and CD20 (lymphocytic) antibodies, anti-CD68 (histiocytic) antibodies, anti-CD31 (endothelial cell) antibodies and anti-D2-40 (podoplanin, a marker for lymphatic endothelial cells) antibodies. RESULTS: In 88% of cases of rosacea, large superficial dermal vessels of geometrical or bizarre configuration were noted, and turgescent cells and dermal edema were frequently seen. Over 75% of cases involved Demodex, including erythemato-telangiectatic subtypes. The rosacea included a mean 15vessels/mm(2), eight of which expressed D2-40; six were greater than 30μm in diameter (mean: 103μm; maximum: 400μm), with only two of these being D2-40+. The lupus erythematosus biopsies exhibited a mean 15 vessels/mm(2), nine of which expressed D2-40; four measured over 30μm in diameter (mean: 59μm; maximum: 100μm), of which two were D2-40+. The vessels measuring over 100μm were only seen in rosacea, and notable actinic elastosis was associated in 80% of these cases. No Demodex was seen in the lupus cases. The lymphocytic infiltration consisted mainly of CD4+ T cells in both groups, but was chiefly sub-epidermal in lupus, occasionally masking the small vessels of the superficial dermis. DISCUSSION: Rosacea is characterised by large, dilated, anfractuous capillaries, which are both larger and more numerous than in lupus, although there is no difference in dermal vascular density between the two diseases. Contrary to what their form may suggest, these dilated vessels are not lymphatic. D2-40+ vessels (lymphatic), which are flatter, are found in both lupus and rosacea. The association of large telangiectasias with actinic elastosis may indicate a causative role of exposure to UV radiation. These vessels likely exhibit increased permeability, resulting in dermal edema. Inflammation is consistently present, even in the early forms, strongly suggesting a dual inflammatory and vascular mechanism. PMID: 23328356 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23328356?dopt=Abstract = URL to article

Nasal Tip Cutaneous Metastases Secondary to Lung Carcinoma: Three Case Reports and a Review of the Literature. Acta Derm Venereol. 2013 Jan 10; Authors: Chun SM, Kim YC, Lee JB, Kim SJ, Lee SC, Won YH, Yun SJ Abstract Cutaneous metastatic carcinoma of the nose is a rare presentation associated with lung cancer. We report here 3 cases of cutaneous metastatic carcinoma of the nose that originated from lung cancer. Two men, age 61 and 76 years, with lung cancers were referred for evaluation of a tumour on the tip of the nose. The third patient, a 57-year-old man, had developed a rosacea-like tumour on the tip of the nose; although he had no history of internal cancer, whole-body positron-emission tomography-computed tomography revealed a primary lung cancer. Skin biopsies of all 3 cases showed metastatic squamous cell carcinoma, and all primary lung cancers were squamous cell carcinomas. Only 3 patients are described here, and further reports are needed to substantiate this interesting phenomenon. When an elderly patient presents to dermatology with a tumour on the nose with or without known internal cancer, it is necessary to approach the diagnosis with caution. PMID: 23303432 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23303432?dopt=Abstract = URL to article

Reply re: "Molecular Biologic Assessment of Cutaneous Specimens of Ocular Rosacea". Ophthal Plast Reconstr Surg. 2013 Jan;29(1):73-4 Authors: Wladis EJ, Iglesias BV, Adam AP, Gosselin EJ PMID: 23299817 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23299817?dopt=Abstract = URL to article

Re: "molecular biologic assessment of cutaneous specimens of ocular rosacea". Ophthal Plast Reconstr Surg. 2013 Jan;29(1):73 Authors: Tawfik HA PMID: 23299816 [PubMed - in process] http://www.ncbi.nlm.nih.gov/PubMed/23299816?dopt=Abstract = URL to article

Optimizing Cosmesis with Conservative Surgical Excision in a Giant Rhinophyma. Aesthetic Plast Surg. 2013 Jan 8; Authors: Lazzeri D, Agostini T, Spinelli G Abstract Rhinophyma is considered the end stage in the development of rosacea, with a clinical aspect characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasia. Although the treatment of rhinophyma typically has an aesthetic purpose, in some cases it also can help with nasal obstruction and eating difficulties caused by rhinophyma beyond the abnormal physical appearance that can cause social seclusion. Very few giant rhinophymas have been reported in the literature. In most cases full-thickness excision of the rhinophymatous tissue down to perichondrium and periosteum of the nasal osteocartilaginous framework followed by coverage of the residual defect with a full-thickness skin graft or local flap has been described in patients affected by giant rhinophyma. The poor results of this approach encouraged us to manage conservatively a very severe form of rhinophyma. We describe the case of a 62-year-old man who presented with a 12-year history of a progressively growing mass on the nose and with a history of nasal obstruction and eating difficulties. We advocate a careful tangential excision of the rhinophymatous tissue which allows the residual deep pilosebaceous appendages to reepithelialize as a safe method and provides a good cosmetic result with minimal scarring. To our knowledge this is the first case of a giant rhinophyma treated with conservative excision followed by secondary healing. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . PMID: 23296764 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23296764?dopt=Abstract = URL to article

Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis. 2013 Jan 4; Authors: Salem DA, El-Shazly A, Nabih N, El-Bayoumy Y, Saleh S Abstract OBJECTIVE: To evaluate the efficacy of ivermectin and combined ivermectin-metronidazole therapy in the treatment of ocular and skin lesions of Demodex folliculorum. METHODS: One hundred twenty patients with skin lesions and anterior blepharitis, whose infestation was treatment-resistant and who had a Demodex count >5 mites/cm(2) for skin lesions or ≥3 mites at the root of each eyelash, were recruited. The treatment regimens were ivermectin and ivermectin-metronidazole combined therapy. We enrolled 15 patients from each of four groups for each treatment regimen. Demodex was detected by standardized skin surface biopsy for skin lesions. Three eyelashes from each affected lower eyelid were epilated and examined. The study subjects were followed-up once a week for four visits. RESULTS: There was a difference in the mite count between the subgroups taking ivermectin and combined therapy during all follow-up visits. At the last visit, in the combined therapy subgroup, 1.7% of patients showed no clinical improvement, 26.7% showed a marked clinical improvement, and 71.6% showed complete remission. In those on the ivermectin regimen, 27 patients had a mite count >5 mites/cm(2), 21.7% showed no clinical improvement, 33.3% showed a marked improvement, and 45% showed complete remission. CONCLUSIONS: Combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in anterior blepharitis. On the other hand, the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions. PMID: 23294870 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/PubMed/23294870?dopt=Abstract = URL to article