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  1. Related Articles Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics. J Clin Med. 2020 Jan 09;9(1): Authors: Woo YR, Lee SH, Cho SH, Lee JD, Kim HS Abstract Systemic antibiotics are extensively used to control the papules and pustules of rosacea. Hence, it is crucial to understand their impact on the rosacea skin microbiota which is thought to be perturbed. The purpose of this study was to compare the makeup and diversity of the skin microbiota in rosacea before and after taking oral antibiotics. We also compared the skin microbiota at baseline according to age and rosacea severity. A longitudinal cohort study was performed on 12 rosacea patients with papules/pustules and no recent use of oral and topical antimicrobials/retinoids. Patients were prescribed oral doxycycline, 100 mg, twice daily for six weeks. Skin areas on the cheek and nose were sampled for 16S ribosomal RNA gene sequencing at baseline, and after six weeks of doxycycline treatment. Eleven females and one male aged 20-79 (median 51) with a median Investigator's Global Assessment score of 3 (moderate) were enrolled. At baseline, Staphylococcus epidermidis was the most dominant species followed by Cutibacterium acnes (formerly Propionibacterium acnes). In the 60 Over-age group, the prevalence of Cutibacterium acnes was lower than that of the 60 & Under-age group. Rosacea severity increased with age and was associated with a decrease in the relative abundance of Cutibacterium acnes and an increase of Snodgrassella alvi. Across all subjects, antibiotic treatment reduced clinical rosacea grades and was associated with an increase in the relative abundance of Weissella confusa (P = 0.008, 95% CI 0.13% to 0.61%). Bacterial diversity (alpha diversity) was not significantly altered by antibiotics treatment. Principal coordinates analysis showed mild clustering of samples by patient (ANOSIM, Analysis of Similarity, R = 0.119, P = 0.16) and scant clustering with treatment (ANOSIM, R = 0.002; P = 0.5). In conclusion, we believe that rosacea has a unique age-dependent characteristic (i.e., severity). Although we were not able to pinpoint a causative microbiota, our study provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics. PMID: 31936625 [PubMed] {url} = URL to article
  2. Related Articles Huge rhinophyma in a complicated patient successfully treated with CO2 laser. Dermatol Ther. 2019 05;32(3):e12850 Authors: Tortorella R, Mori E, Rovesti M, Casanova D, D'Astolto R, Scrivani S, Bertolani M, Zucchi A, Feliciani C PMID: 30714265 [PubMed - indexed for MEDLINE] {url} = URL to article
  3. Related Articles Topical 10% Tranexamic acid for erythematotelangiectatic steriod induced rosacea. J Am Acad Dermatol. 2020 Jan 10;: Authors: Jakhar D, Kaur I, Misri R PMID: 31931084 [PubMed - as supplied by publisher] {url} = URL to article
  4. Related Articles Dermoscopy of idiopathic facial aseptic granuloma: report of 2 cases. Clin Exp Dermatol. 2020 Jan 10;: Authors: Salerni G, Peralta R, Bertaina C, Gorosito M, Fernández-Bussy R Abstract Idiopathic facial aseptic granuloma (IFAG) is an uncommon childhood condition, characterized by one or more asymptomatic erythematous-violaceous nodules, usually located on the cheeks and eyelid [1]. IFAG heals spontaneously usually without scarring after a few months to a year. The pathogenesis of this disease is unclear; the most current hypothesis is that represents a form of paediatric rosacea [2]. PMID: 31919863 [PubMed - as supplied by publisher] {url} = URL to article
  5. Hydroxychloroquine is a novel therapeutic approach for rosacea. Int Immunopharmacol. 2020 Jan 06;79:106178 Authors: Li J, Yuan X, Tang Y, Wang B, Deng Z, Huang Y, Liu F, Zhao Z, Zhang Y Abstract Rosacea is a chronic inflammatory disease in face. Hydroxychloroquine (HCQ), an anti-malaria drug, was reported to have anti-inflammation activities. However, the role of HCQ on rosacea remains unclear. In this study, we revealed the potential molecular mechanism by which HCQ improved rosacea in rosacea-like mice and mast cells (MCs). Moreover, the effects of HCQ treatment for rosacea patients were investigated. In this study, we found HCQ ameliorated the rosacea-like phenotype and MCs infiltration. The elevated pro-inflammatory factors and mast cell protease were significantly inhibited by HCQ treatment in rosacea-like mice. In vitro, HCQ suppresses LL37-induced MCs activation in vitro, including the release of inflammatory factors, chemotaxis, degranulation and calcium influx. Moreover, HCQ attenuated LL37-mediated MCs activation partly via inhibiting KCa3.1-mediated calcium signaling. Thus, these evidences suggest HCQ ameliorated rosacea-like dermatitis may be by regulating immune response of MCs. Finally, the 8-week HCQ treatment exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment. PMID: 31918061 [PubMed - as supplied by publisher] {url} = URL to article
  6. Related Articles The importance of good photography in clinical trials and in the clinic. Br J Dermatol. 2019 05;180(5):978 Authors: Tanghetti E PMID: 31025752 [PubMed - indexed for MEDLINE] {url} = URL to article
  7. A Multicenter, Randomized, Double-Masked, Parallel Group, Vehicle-Controlled Phase 2b Study to evaluate the safety and efficacy of 1% and 3% topical Minocycline Gel in patients with Papulopustular Rosacea. Br J Dermatol. 2020 Jan 06;: Authors: Webster G, Draelos ZD, Graber E, Lee MS, Dhawan S, Salman M, Magrath GN Abstract BACKGROUND: Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti-inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions. OBJECTIVE: To assess the safety and efficacy of once-daily Minocycline Gel 1% and 3% in subjects with papulopustular rosacea. METHODS: This was a prospective, double-blinded study conducted at 26 sites in the United States. Subjects with papulopustular rosacea and between 12 and 40 inflammatory lesions were randomized to either 1% minocycline, 3% minocycline, or vehicle. The study product was applied to the face at bedtime for 12 weeks. The primary endpoints was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on the investigator global assessments (IGA). RESULTS: 270 subjects were randomized. The baseline mean lesion count was 24.6, 25.1, and 24.3 in the 1% minocycline, 3% minocycline, and vehicle groups, respectively. At week 12, mean inflammatory lesion count had decreased by 12.64 (1% minocycline), 13.09 (3% minocycline), and 7.92 (vehicle). The minocycline treatment arms significantly decreased inflammatory lesions when compared to vehicle (p=0.01, 95% CI -7.930 to -0.871 for 1% minocycline and p=0.007, 95% CI -8.319 to -1.310 for 3% minocycline). The proportion of subjects achieving IGA success was 38.9% in the 1% minocycline group (p=0.34, OR 1.396 and OR 95% CI 0.708 to 2.751 vs. vehicle), 46.2% in the 3% minocycline group (p=0.04, OR 2.028 and OR 95% CI 1.040 to 3.952 vs. vehicle), and 30.8% in the vehicle group. CONCLUSION: 1% and 3% topical minocycline gel appears safe and tolerable. 1% and 3% topical minocycline gel significantly decreased inflammatory lesion counts and a significantly larger proportion of subjects achieved IGA success at week 12 in the 3% topical minocycline group. These findings support further evaluation of minocycline gel for the treatment of inflammatory lesions associated with papulopustular rosacea. PMID: 31907924 [PubMed - as supplied by publisher] {url} = URL to article
  8. Related Articles Morbihan Syndrome Successfully Treated with Omalizumab. Acta Derm Venereol. 2019 Jun 01;99(7):677-678 Authors: Kafi P, Edén I, Swartling C PMID: 30848286 [PubMed - indexed for MEDLINE] {url} = URL to article
  9. Related Articles Bardolph's rosacea: skin disorders that define personality in Shakespeare's plays. Clin Dermatol. 2019 Sep - Oct;37(5):600-603 Authors: Hassan S, Mohammed TO, Hoenig LJ Abstract Several popular Shakespearean characters are dramatically portrayed on stage with striking physical appearances caused by medical and dermatologic disorders. Shakespeare's colorful portrayal of their maladies not only helps to entertain audiences but also serves to define the characters' personalities and behavior. Shakespeare himself emphasizes this point in his play Richard III, in which the notorious English king states that his evil nature is a direct result of his hideous spinal deformity. This contribution discusses four other famous Shakespearean characters: Bardolph, who appears to be suffering from rosacea; the Witches of Macbeth, who have beards; Juliet, who has green sickness (chlorosis); and Falstaff, who is morbidly obese. In all of these cases, their skin disorders and medical maladies serve to highlight their underlying nature. PMID: 31896414 [PubMed - in process] {url} = URL to article
  10. Related Articles Rhinophyma: when Red Nose Day is no laughing matter. Br J Gen Pract. 2019 Mar;69(680):137 Authors: Liu A, Al-Lami A, Kapoor K PMID: 30819745 [PubMed - indexed for MEDLINE] {url} = URL to article
  11. Related Articles A case of pediatric rosacea-Skin and ocular involvement. Clin Case Rep. 2019 Dec;7(12):2414-2416 Authors: Ooi XT, Tan KB, Chandran N Abstract Childhood rosacea presents a diagnostic difficulty due to the lack of diagnostic criteria and potential mimics. Ocular involvement is a frequent complication of rosacea in children and may appear before cutaneous findings. It is important for clinicians to be aware of these and to screen patients appropriately in order for timely treatment to be instituted. PMID: 31893071 [PubMed] {url} = URL to article
  12. Anthocyanin-Functionalized Contact Lens Sensors for Ocular pH Monitoring. ACS Omega. 2019 Dec 24;4(26):21792-21798 Authors: Riaz RS, Elsherif M, Moreddu R, Rashid I, Hassan MU, Yetisen AK, Butt H Abstract Anthocyanins are bioactive compounds naturally found in a variety of leaves, fruits, and vegetables. Anthocyanin pigments undergo a modification in their chemical structure when exposed to different concentrations of hydrogen ions, and they were extensively studied to be used as active elements in biocompatible pH sensors. The ocular pH is a significant parameter to assess the ocular physiology in cases of postocular surgery, keratoconjunctivitis, and ocular rosacea. Contact lenses have the potential to be used as medical diagnostic devices for in situ continuous monitoring of the ocular physiology. Here, anthocyanin-functionalized contact lenses were developed as wearable sensors to monitor the ocular pH. Anthocyanin pigments were extracted from Brassica oleracea and used to functionalize the polymeric matrices of commercial soft contact lenses by soaking and drop-casting processes. Contact lenses responded to the physiological ocular pH of 6.5, 7.0, and 7.5, exhibiting a systematic color shift from pink (pH 6.5) to purple (pH 7.0) and blue (pH 7.5). The functionalization of contact lens sensors was evaluated as a function of the dye concentration. Quantitative values were obtained by comparing the RGB triplets of the colors obtained with the naturally extracted dye and with delphinidin chloride dye in 0.0 to 1.5 mmol L-1 aqueous solution. The functionalization of contact lenses was studied as a function of the soaking time, resulting in best results when soaking for 24 h. The dye leakage from the contact lenses in deionized water was evaluated, and a negligible leakage after 18 h was observed. Poly-2-hydroxy ethylmethacrylate contact lenses were fabricated and cross-linked with anthocyanin dye, resulting in a slight color shift upon pH changes from 6.5 to 7.4. Contact lens pH sensors may be used to continuously monitor the ocular pH at point-of-care settings. PMID: 31891056 [PubMed] {url} = URL to article
  13. Related Articles Microdebrider-Assisted Rhinophyma Excision. Case Rep Otolaryngol. 2019;2019:4915416 Authors: Abushaala A, Stavrakas M, Khalil H Abstract Rhinophyma represents a progressive deformity of the nose which leads to cosmetic disfigurement and has a significant impact on the patient's quality of life. This pathological entity originates from hyperplasia of sebaceous gland tissue, connective tissue, and vessels of the nose and is associated with rosacea and more specifically, stage III rosacea. Surgical treatment is the method of choice. We present five cases of rhinophyma that we treated with microdebrider-assisted excision. The procedure was divided in two main steps: scalpel excision of the main bulk of the rhinophyma and then further contouring with the microdebrider. All patients had weekly follow-up for the first four weeks, and then three-monthly. All patients had uneventful recovery and satisfactory cosmetic outcomes. No postoperative infections or other complications were reported in our case series. The use of the microdebrider reduces the operating time, preserves the islands of skin regeneration, and allows finer manipulations than the standard scalpel techniques. Microdebrider-assisted rhinophyma excision is a safe approach, with good aesthetic results. Larger series of patients need to be examined in order to establish the value of the method. PMID: 31885991 [PubMed] {url} = URL to article
  14. Related Articles Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Int J Dermatol. 2019 Dec 27;: Authors: Marson JW, Baldwin HE Abstract Rosacea is a chronic inflammatory disorder of the central face with multiple overlapping presentations. Recent advancements are reshaping our understanding of rosacea from both a pathophysiologic perspective and clinical approach to therapy, introducing novel agents that have improved patient outcomes and reduced morbidity. In this article, we aim to outline the advancements in understanding, diagnosing, and managing rosacea and to familiarize physicians with the literature, thereby allowing us to better practice safe and effective medicine. PMID: 31880327 [PubMed - as supplied by publisher] {url} = URL to article
  15. Related Articles Demodex Infestation in Patients with Rosacea Turkiye Parazitol Derg. 2019 Dec 23;43(4):194-197 Authors: Türkmen D, Türkoğlu G Abstract Objective: Although the etiology of rosacea is not known exactly, it is thought as a multifactorial disease. Demodex spp. are asymptomatic saprophytic ectoparasites living in hair follicles and sebaceous glands. The aim of this study was to investigate the frequency of Demodex spp. in patients with rosacea and compare with the control group by using superficial skin biopsy method. Methods: Seventy seven patients with rosacea and 31 control patients were included in the study. In patients, for the determination of density of Demodex spp., non-invasive standard superficial skin biopsy method was applied. Detection of ≥5/cm2 Demodex spp. was considered positive. Results: The mean age of the patients was 44.5±14.6 years and the mean age of the control group was 48.2±14.9 years. Of the patients, 55.1% had erythema-telangiectatic type, 43.5% had papulopustular type, and 3.9% had fimatous type lesions. Demodex infestation was positive in 33.8% of the patients with rosacea and this rate was 9.7% in the control group. Difference was statistically significant. There was no significant difference in Demodex spp. positivity in terms of gender in patients with rosacea. Conclusion: The importance of Demodex infestation in patients with rosacea has been increasing in recent years. Considering some studies conducted in our country, we think that the investigation of Demodex spp. in patients who are considered to have rosacea will be beneficial in the terms of early diagnosis and treatment. PMID: 31865655 [PubMed - in process] {url} = URL to article
  16. Related Articles Is rosacea a systemic disease? Clin Dermatol. 2019 Nov - Dec;37(6):629-635 Authors: Wollina U Abstract Rosacea is a chronic inflammatory facial disease occurring world-wide. The incidence of rosacea is increasing with age, with the clinical course being characterized by relapses. The pathogenesis of rosacea is not completely understood, but neurovascular and immunologic mechanisms are involved. Rosacea has a number of known extrinsic triggers that should be avoided, such as sun exposure, heat and cold, alcoholic beverages, and spicy food. Of greater importance is the observation that rosacea may develop as a manifestation of systemic diseases with a significant morbidity and even mortality. Obesity, Helicobacter pylori infection, smoking, and inflammatory bowel disease bear a significant risk for the development of rosacea. Metabolic, psychiatric, and neurologic disorders and certain types of cancer show a significant association with rosacea. The possible link to cardiovascular events is debatable. There are extrafacial and extracutaneous manifestations of rosacea, such as the red scalp syndrome, ocular rosacea, and migraine. Rosacea should be considered a systemic disease. PMID: 31864441 [PubMed - in process] {url} = URL to article
  17. Related Articles Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis. Dermatol Ther. 2019 Dec 20;:e13203 Authors: Husein-ElAhmed H, Steinhoff M Abstract Rosacea is a chronic inflammatory dermatosis involving certain facial areas. The multifactorial nature of this condition makes the management challenging. In addition, rosacea affects negatively to patients' quality of life (QoL). Despite the multiple articles supporting its use for papulopustular rosacea (PPR), there is a shortage of high-quality evidence researches comparing the efficacy of ivermectin cream (IVM) 1% with other available topical choices. Besides, the well-documented impaired of self-esteem and stigmatization of rosacea patients make essential to address which treatment can provide the greatest psychological, physical and social benefit. The objective of this work is to critically review and appraise the efficacy of topical IVM 1% in PPR and the impact in patients' QoL against other options. We carried out a search of literature from PubMed, MEDLINE, EMBASE, Cochrane and clinicaltrials.gov using the following descriptors: "rosacea" AND "ivermectin". Efficacy was assessed with the Investigator Global Assessment (IGA), and the impact on QoL was based on the DLQI score Six studies from 4 published articles were included. The meta-analysis estimated that more participants achieved "success" (IGA≤1) and "complete clearance" (IGA = 0) with IVM 1%. The overall effect estimate for IGA≤1 was: 1.56 [1.23-1.97], while for IGA = 0 it was: 1.72 [1.40-2.11]. The rate of participants achieving lower DLQI score, and thus, better QoL was higher with IVM 1%. The overall effect estimate was: 1.71 [1.34-2.18] at week 16# and 1.64 [1.38-1.94] at week 52#. This meta-analysis gives strong evidence that IVM 1% cream is the most effective topical treatment above other alternatives and it satisfies the impairment of social and working life with a sustained better QoL. Further studies confirming and extending this period of remission are warranted, as well as researches investigating the potential use of this agent in combination with other agents. This article is protected by copyright. All rights reserved. PMID: 31863543 [PubMed - as supplied by publisher] {url} = URL to article
  18. Related Articles Erythematous Crusted Papules on Face Arising in an Immunocompromised Child With Chemotherapy-Induced Acral Erythema. Clin Pediatr (Phila). 2019 04;58(4):478-481 Authors: Paci KM, Wink R, Blatt J, Morrell DS, Googe PB, McShane DB PMID: 30674201 [PubMed - indexed for MEDLINE] {url} = URL to article
  19. Related Articles Ros-NET: A deep convolutional neural network for automatic identification of rosacea lesions. Skin Res Technol. 2019 Dec 17;: Authors: Binol H, Plotner A, Sopkovich J, Kaffenberger B, Niazi MKK, Gurcan MN Abstract BACKGROUND: Rosacea is one of the most common cutaneous disorder characterized primarily by facial flushing, erythema, papules, pustules, telangiectases, and nasal swelling. Diagnosis of rosacea is principally done by a physical examination and a consistent patient history. However, qualitative human assessment is often subjective and suffers from a relatively high intra- and inter-observer variability in evaluating patient outcomes. MATERIALS AND METHODS: To overcome these problems, we propose a quantitative and reproducible computer-aided diagnosis system, Ros-NET, which integrates information from different image scales and resolutions in order to identify rosacea lesions. This involves adaption of Inception-ResNet-v2 and ResNet-101 to extract rosacea features from facial images. Additionally, we propose to refine the detection results by means of facial-landmarks-based zones (ie, anthropometric landmarks) as regions of interest (ROI), which focus on typical areas of rosacea occurrence on a face. RESULTS: Using a leave-one-patient-out cross-validation scheme, the weighted average Dice coefficients, in percentages, across all patients (N = 41) with 256 × 256 image patches are 89.8 ± 2.6% and 87.8 ± 2.4% with Inception-ResNet-v2 and ResNet-101, respectively. CONCLUSION: The findings from this study support that pre-trained networks trained via transfer learning can be beneficial in identifying rosacea lesions. Our future work will involve expanding the work to a larger database of cases with varying degrees of disease characteristics. PMID: 31849118 [PubMed - as supplied by publisher] {url} = URL to article
  20. Related Articles Botulin Toxin Use in Rosacea and Facial Flushing Treatment. Open Access Maced J Med Sci. 2019 Sep 30;7(18):2985-2987 Authors: Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T Abstract Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed. PMID: 31850105 [PubMed] {url} = URL to article
  21. Related Articles Rosacea Flare - Up after Photodynamic Therapy (PDT) for Field Cancerization and a Review on Adverse Events with PDT in General. Open Access Maced J Med Sci. 2019 Sep 30;7(18):2998-3001 Authors: Wollina U, Bitel A, Vojvodic A, Lotti T Abstract BACKGROUND: Actinic keratoses (AKs) are precancerous epidermal lesions induced by chronic exposure to ultraviolet light. Several topical and surgical treatments are available. For field cancerization, photodynamic therapy (PDT) is a very effective noninvasive treatment with excellent outcome and cosmesis. The management of treatment-associated adverse events, however, is crucial to achieve the treatment aims and to ensure patients adherence to PDT. CASE REPORT: We report on adverse events and their management related to PDT. We conducted literature research on PUBMED (R). Also, we present a case of an uncommon adverse event-PDT-induced rosacea flare-up on scalp and eyes. The patient was treated successfully by submicrobial slow-release doxycycline orally. Conclusions: PDT is an excellent treatment option for multiple AKs such as in bald scalp field cancerization. The management of adverse events during and after PDT is an essential part of a successful treatment plan. PMID: 31850108 [PubMed] {url} = URL to article
  22. Related Articles Ros-NET: A deep convolutional neural network for automatic identification of rosacea lesions. Skin Res Technol. 2019 Dec 17;: Authors: Binol H, Plotner A, Sopkovich J, Kaffenberger B, Niazi MKK, Gurcan MN Abstract BACKGROUND: Rosacea is one of the most common cutaneous disorder characterized primarily by facial flushing, erythema, papules, pustules, telangiectases, and nasal swelling. Diagnosis of rosacea is principally done by a physical examination and a consistent patient history. However, qualitative human assessment is often subjective and suffers from a relatively high intra- and inter-observer variability in evaluating patient outcomes. MATERIALS AND METHODS: To overcome these problems, we propose a quantitative and reproducible computer-aided diagnosis system, Ros-NET, which integrates information from different image scales and resolutions in order to identify rosacea lesions. This involves adaption of Inception-ResNet-v2 and ResNet-101 to extract rosacea features from facial images. Additionally, we propose to refine the detection results by means of facial-landmarks-based zones (ie, anthropometric landmarks) as regions of interest (ROI), which focus on typical areas of rosacea occurrence on a face. RESULTS: Using a leave-one-patient-out cross-validation scheme, the weighted average Dice coefficients, in percentages, across all patients (N = 41) with 256 × 256 image patches are 89.8 ± 2.6% and 87.8 ± 2.4% with Inception-ResNet-v2 and ResNet-101, respectively. CONCLUSION: The findings from this study support that pre-trained networks trained via transfer learning can be beneficial in identifying rosacea lesions. Our future work will involve expanding the work to a larger database of cases with varying degrees of disease characteristics. PMID: 31849118 [PubMed - as supplied by publisher] {url} = URL to article
  23. Related Articles Botulin Toxin Use in Rosacea and Facial Flushing Treatment. Open Access Maced J Med Sci. 2019 Sep 30;7(18):2985-2987 Authors: Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T Abstract Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed. PMID: 31850105 [PubMed] {url} = URL to article
  24. Related Articles Rosacea Flare - Up after Photodynamic Therapy (PDT) for Field Cancerization and a Review on Adverse Events with PDT in General. Open Access Maced J Med Sci. 2019 Sep 30;7(18):2998-3001 Authors: Wollina U, Bitel A, Vojvodic A, Lotti T Abstract BACKGROUND: Actinic keratoses (AKs) are precancerous epidermal lesions induced by chronic exposure to ultraviolet light. Several topical and surgical treatments are available. For field cancerization, photodynamic therapy (PDT) is a very effective noninvasive treatment with excellent outcome and cosmesis. The management of treatment-associated adverse events, however, is crucial to achieve the treatment aims and to ensure patients adherence to PDT. CASE REPORT: We report on adverse events and their management related to PDT. We conducted literature research on PUBMED (R). Also, we present a case of an uncommon adverse event-PDT-induced rosacea flare-up on scalp and eyes. The patient was treated successfully by submicrobial slow-release doxycycline orally. Conclusions: PDT is an excellent treatment option for multiple AKs such as in bald scalp field cancerization. The management of adverse events during and after PDT is an essential part of a successful treatment plan. PMID: 31850108 [PubMed] {url} = URL to article
  25. Related Articles Dermabrasion for Scars and Wire Loop Electrocautery for Rhinophyma. Facial Plast Surg. 2019 Jun;35(3):267-273 Authors: Hom DB, Harmon J Abstract Dermabrasion and wire loop electrocautery are controlled scalpel-less procedures to remove superficial skin layers to treat dermal surface irregularities. Their postprocedure healing involves healing by secondary intention. The purpose of this paper is to discuss the use of diamond fraise dermabrasion to improve scars and the use of wire loop electrocautery to treat rhinophyma surface irregularities. Both techniques are minimally invasive and low cost, and at the same time, can significantly improve facial skin deformities. An advantage in using wire loop electrocautery for rhinophyma excision is that it is a simple, economic, and very effective technique to sculpt the nose, with minimal intraoperative bleeding. With dermabrasion, pretreatment and postregimens can help improve postprocedure results. Future efforts to modulate the healing from both of these techniques include the potential use of topical growth factors, autologous platelet-rich plasma, or using stem cells to accelerate collagen formation and reepithelization during the postprocedure period. PMID: 31189200 [PubMed - indexed for MEDLINE] {url} = URL to article
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