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Inflammation and Keratoconus.

Optom Vis Sci. 2014 Nov 13;

Authors: McMonnies CW

Abstract
Keratoconus (KC) has been traditionally classified as a noninflammatory disease. Barring loss of function, the other classic signs of inflammation (heat, redness, swelling, pain) are not usually obvious or even apparent in KC. This clinical perspective examines the evidence and implications of numerous inflammatory processes that have been recognized in the tears of KC patients as well as some inflammation relevant differences found in the KC cornea. The roles of inflammation in corneal trauma attributed to eye rubbing and/or contact lens wear are examined as is the significance of atopy, allergic disease, dry eye disease, degradative enzyme activity, wound healing, reduced anti-inflammatory capacity, and ultraviolet irradiation. It is possible that any comorbidity that is inflammatory in nature may add synergistically to other forms of KC-related inflammation and exacerbate its pathogenetic processes. For example, some features of inflammation in ocular rosacea and associated corneal thinning and distortion could have some possible relevance to KC. An analogy is drawn with osteoarthritis, which also involves significant inflammatory processes but, like KC, does not meet all the classic criteria for an inflammatory disease. Classifying KC as quasi-inflammatory (inflammatory-related) rather than a noninflammatory disease appears to be more appropriate and may help focus attention on the possibility of developing effective anti-inflammatory therapies for its management.

PMID: 25397925 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25397925?dopt=Abstract = URL to article

Related Articles

Rhinophyma-like granuloma faciale successfully treated with carbon dioxide laser.

Br J Dermatol. 2014 Feb;170(2):474-5

Authors: Bakkour W, Madan V

PMID: 24111815 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/24111815?dopt=Abstract = URL to article

Propranolol, doxycycline and combination therapy for the treatment of rosacea.

J Dermatol. 2014 Nov 12;

Authors: Park JM, Mun JH, Song M, Kim HS, Kim BS, Kim MB, Ko HC

Abstract
Doxycycline is the standard systemic treatment for rosacea. Recently, there have been a few reports on β-adrenergic blockers such as nadolol, carvedilol and propranolol for suppressing flushing reactions in rosacea. To our knowledge, there are no comparative studies of propranolol and doxycycline, and combination therapy using both. The aim of this study was to investigate and compare the efficacy and safety of monotherapy of propranolol, doxycycline and combination therapy. A total of 78 patients who visited Pusan National University Hospital and were diagnosed with rosacea were included in this study. Among them, 28 patients were in the propranolol group, 22 the doxycycline group and 28 the combination group. We investigated the patient global assessment (PGA), investigator global assessment (IGA), assessment of rosacea clinical score (ARCS) and adverse effects. Improvement in PGA and IGA scores from baseline was noted in all groups, and the combination therapy was found to be the most effective during the entire period, but this was statistically insignificant. The reduction rate of ARCS during the treatment period was also highest in the combination group (57.4%), followed by the doxycycline group (52.2%) and the propranolol group (51.0%). Three patients in the combination group had mild and transient gastrointestinal disturbances but there was no significant difference from the other groups. We conclude that the combination therapy of doxycycline and propranolol is effective and safe treatment for rosacea and successful for reducing both flushing and papulation in particular.

PMID: 25389041 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25389041?dopt=Abstract = URL to article

Cutaneous Paraneoplastic Granulomatous Eruptions Secondary to Metastatic Carcinoid Tumour.

Br J Dermatol. 2014 Nov 11;

Authors: Cohen JM, Nambudiri VE, Kulke MH, Todd DJ, Murphy GF, LeBoeuf NR

Abstract
Cutaneous granulomatous eruptions comprise a rare subset of paraneoplastic dermatitides most commonly associated with haematologic malignancies. The pathogenesis of these eruptions remains poorly understood. Carcinoid tumours are uncommon neuroendocrine neoplasms that most often arise in the gastrointestinal tract and produce excess serotonin leading to diarrhoea and flushing. Metastases can result in elevated systemic neuroendocrine mediator levels causing carcinoid syndrome, with cutaneous manifestations including flushing, rosacea, pellagra, and rarely sclerodermatous changes (1). This article is protected by copyright. All rights reserved.

PMID: 25388104 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25388104?dopt=Abstract = URL to article

Crusted demodicosis in an immunocompetent pediatric patient.

Case Rep Dermatol Med. 2014;2014:458046

Authors: Guerrero-González GA, Herz-Ruelas ME, Gómez-Flores M, Ocampo-Candiani J

Abstract
Demodicosis refers to the infestation by Demodex spp., a saprophytic mite of the pilosebaceous unit. Demodex proliferation can result in a number of cutaneous disorders including pustular folliculitis, pityriasis folliculorum, papulopustular, and granulomatous rosacea, among others. We report the case of a 7-year-old female presenting with pruritic grayish crusted lesions over her nose and cheeks, along with facial erythema, papules, and pustules. The father referred chronic use of topical steroids. A potassium hydroxide mount of a pustule scraping revealed several D. folliculorum mites. Oral ivermectin (200 μg/kg, single dose) plus topical permethrin 5% lotion applied for 3 consecutive nights were administered. Oral ivermectin was repeated every week and oral erythromycin plus topical metronidazole cream was added. The facial lesions greatly improved within the following 3 months. While infestation of the pilosebaceous unit by Demodex folliculorum mites is common, only few individuals present symptoms. Demodicosis can present as pruritic papules, pustules, plaques, and granulomatous facial lesions. To our knowledge, this is the first reported case of facial crusted demodicosis in an immunocompetent child. The development of symptoms in this patient could be secondary to local immunosuppression caused by the chronic use of topical steroids.

PMID: 25371830 [PubMed]

http://www.ncbi.nlm.nih.gov/pubmed/25371830?dopt=Abstract = URL to article

Preliminary open-label clinical evaluation of the soothing and reepithelialization properties of a novel topical formulation for rosacea.

Clin Cosmet Investig Dermatol. 2014;7:275-83

Authors: Sparavigna A, Tenconi B, De Ponti I

Abstract
BACKGROUND: Rosacea is a common, incurable skin barrier disorder characterized by relapses and remissions.
PURPOSE: To evaluate the efficacy of Farmaka Rosacea Cream (FRC), a novel topical formulation for rosacea.
METHODS: This single-center, open-label pilot study comprised a single-dose substudy in 20 healthy subjects and a long-term, repeat-dose substudy in 22 subjects with rosacea. The 2-hour, controlled, single-dose substudy assessed the soothing and reepithelialization properties of FRC after stripping-induced erythema based on the erythema index, transepidermal water loss, skin hydration, and clinical assessments of erythema. In the long-term substudy, subjects applied FRC twice daily for 8 weeks. Clinical assessments included vascular and pigmentary homogeneity and erythema and hemoglobin indices. Subjects completed questionnaires to assess FRC efficacy and cosmetic acceptability.
RESULTS: Greater reductions were seen in FRC-treated areas compared with untreated areas for the erythema index (-16% versus -8%; P<0.001) and mean transepidermal water loss (-35.8% versus -10.1%; P<0.001) 30 minutes after stripping. Significant improvements over untreated areas were maintained 2 hours after stripping. Skin hydration and clinical erythema assessments also indicated that FRC soothed rosacea symptoms and promoted skin reepithelialization. Erythema and hemoglobin indices were significantly reduced from baseline after 4 and 8 weeks of treatment. Clinically assessed parameters were significantly improved following FRC application. Subjects assessed FRC positively.
CONCLUSION: Improvement of rosacea symptoms was noted with FRC application. The main film-forming ingredients of FRC (trehalose, cholesterol, ceramide, and fatty acids), combined with other soothing and calming ingredients and ultraviolet filters, could explain its efficacy.

PMID: 25368529 [PubMed]

http://www.ncbi.nlm.nih.gov/pubmed/25368529?dopt=Abstract = URL to article

More info on FRC

Comparison of Reflectance Confocal Microscopy and Standardized skin surface biopsy for three different lesions in a pityriasis folliculorum patient.

Br J Dermatol. 2014 Oct 31;

Authors: Yuan C, Wang XM, Guichard A, Lihoreau T, Sophie MM, Lamia K, Ardigò M, Humbert P

Abstract
Pityriasis folliculorum(1) (PF) is a human demodicosis proposed as "primary", caused by the proliferation of Demodex folliculorum (D):(2) it consists of very small, discrete and regularly dispersed follicular scales, involving sebaceous hair follicles, often without visible inflammation. Patients can complain about pruritus, dry, sensitive, irregular or rough skin.(1) Forton et al(3) report that PF is the most frequent demodicosis (54%) compared with papulopustular rosacea, and has a higher demodex density (Dd) (D=61/cm(2) , n=45) tested by "Standardized skin surface biopsy (SSSB)". However, Reflectance Confocal Microscopy (RCM) now shows promising results.(4) This article is protected by copyright. All rights reserved.

PMID: 25363861 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25363861?dopt=Abstract = URL to article

Hidradenitis Suppurativa: a pilot study to determine patients capability to self-assess their Hurley stage.

Br J Dermatol. 2014 Oct 29;

Authors: Deckers IE, Mihajlović D, Prens E, Boer J

Abstract
Hidradenitis suppurativa (HS) is a chronic skin disease of the inverse areas of the body such as the axillary, inguinal, genital, and perineal regions. Estimates of the prevalence of HS ranges from 0.33% to 4%. This prevalence is partly based on large questionnaire-based studies. However, with these questionnaires, the severity of the disease could not be determined. In studies on acne, chronic hand dermatitis and rosacea, coloured pictures have been used as a guide to determine disease severity. This article is protected by copyright. All rights reserved.

PMID: 25354349 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25354349?dopt=Abstract = URL to article

Increased expression of cathelicidin by direct activation of protease-activated receptor 2: possible implications on the pathogenesis of rosacea.

Yonsei Med J. 2014 Nov 1;55(6):1648-55

Authors: Kim JY, Kim YJ, Lim BJ, Sohn HJ, Shin D, Oh SH

Abstract
PURPOSE: Recent findings of increased cathelicidin protein and its proteolytic fragments in rosacea suggest a pathogenic role for cathelicidin in this disease. The relationship between cathelicidin and protease-activated receptor 2 (PAR-2) is therefore of interest, as PAR-2, expressed principally in keratinocytes, regulates pro-inflammatory cytokine expression in the skin. The purpose of this study was to determine the relationship between expression of PAR-2 and cathelicidin in rosacea and to test the effect of direct PAR-2 activation on cathelicidin expression in keratinocytes.
MATERIALS AND METHODS: Samples from 40 patients with clinicopathologic diagnosis of rosacea and facial skin tissue samples from 20 patients with no specific findings or milium without inflammation were retrieved. Intensities of immunohistochemical staining for PAR-2 and cathelicidin were compared between normal and rosacea-affected skin tissues. Additionally, correlations between PAR-2 and cathelicidin staining intensities within rosacea patients were analyzed. In cultured keratinocytes, changes in PAR-2, cathelicidin, and vascular endothelial growth factor (VEGF) mRNA and protein were analyzed after treatment with PAR-2 activating peptide (AP).
RESULTS: Cathelicidin expression was significantly higher in rosacea skin tissues than in normal tissues (p<0.001), while PAR-2 expression was not significantly higher in rosacea tissues than in normal skin tissues. A positive correlation between PAR-2 and cathelicidin within rosacea samples was observed (R=0.330, p=0.037). After treatment of PAR-2 AP, both mRNA and protein levels for PAR-2, cathelicidin, and VEGF significantly increased in cultured keratinocytes, compared with PAR-2 control peptide treatment.
CONCLUSION: PAR-2 may participate in the pathogenesis of rosacea through activation of cathelicidin LL-37, a mediator of innate immune responses in the skin.

PMID: 25323904 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/25323904?dopt=Abstract = URL to article

Ophthalmic Rosacea: Case Report in a Child and Treatment Recommendations.

Pediatr Dermatol. 2014 Oct 16;

Authors: Potz-Biedermann C, Mehra T, Deuter C, Zierhut M, Schaller M

Abstract
We report a rare case of rosacea with ocular involvement in a child that remitted with prolonged anti-inflammatory oral tetracycline therapy and provide general expert recommendations. A 14-year-old girl presented with discrete papules and pustules on both cheeks with blepharitis and conjunctivitis. Ophthalmologic examination confirmed bilateral severe blepharitis, as well as a corneal infiltrate in the right eye with additional neovascularization. The diagnosis of rosacea with ocular involvement was made. In addition to the existing antibiotic and anti-inflammatory topical eye therapy, systemic treatment with minocycline 50 mg twice a day was started. After marked improvement, the dose was reduced to 50 mg once a day. After further amelioration, treatment was switched to maintenance therapy with 40 mg of prolonged-release doxycycline. Three years after a 12-month course of anti-inflammatory therapy, the patient remained recurrence free.

PMID: 25323001 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25323001?dopt=Abstract = URL to article

Related Articles

Compounding as a current therapeutic option in dermatology.

Actas Dermosifiliogr. 2013 Nov;104(9):738-56

Authors: Sánchez-Regaña M, Llambí-Mateos F, Salleras-Redonnet M, Iglesias Sancho M, Collgros Totosaus H, Umbert-Millet P

Abstract
Compounding continues to play a key role in the treatment of skin conditions, despite the abundance of products made by the pharmaceutical industry. Right from the earliest days of dermatology, compounding proved very useful in the treatment of diseases for which no specific drugs were available. However, as new products came onto the market, this usefulness was called into question, and doubts over safety, stability, and effectiveness were raised. Today, compounding is regaining the place it once held in routine dermatological practice. We review the advantages and disadvantages of compounding, the most common indications, current legislation in our setting, and the latest developments in active ingredients and vehicles.

PMID: 22818830 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/22818830?dopt=Abstract = URL to article

Cathelicidin peptide LL-37 increases UVB-triggered inflammasome activation: Possible implications for rosacea.

J Dermatol Sci. 2014 Sep 28;

Authors: Salzer S, Kresse S, Hirai Y, Koglin S, Reinholz M, Ruzicka T, Schauber J

Abstract
BACKGROUND: In patients with rosacea, environmental stressors, especially UVB radiation, trigger disease flares that are characterized by inflammation and vascular hyperactivity. An altered innate immune detection and response system, modulated to a large extent by the aberrant production and processing of human cathelicidin LL-37, is thought to play a central role in disease pathogenesis.
OBJECTIVE: To investigate whether the proinflammatory and proangiogenic effects of UV radiation are enhanced in the presence of cathelicidin LL-37.
METHODS: Human skin ex vivo and epidermal keratinocytes in vitro were exposed to UVB irradiation. The proinflammatory effects of UVB exposure in the presence and absence of LL-37 were characterized using immunoblot, transfection, qPCR, and a cell-based second messenger assay. ELISA was used to assess cytokine release and the angiogenic potential of endothelial cells was evaluated using an in vitro angiogenesis assay.
RESULTS: UVB irradiation triggered the inflammasome-mediated processing and release of IL-1β. LL-37 augmented this UV-induced IL-1β secretion by acting on the P2X7 receptor on keratinocytes. P2X7 receptor activation by UVB and LL-37 resulted in an increase in intracellular calcium concentrations, which enhances inflammasome activation and subsequent IL-1β release. Furthermore, IL-1β and LL-37 worked synergistically to increase the angiogenic potential of endothelial cells.
CONCLUSION: Cathelicidin LL-37 modulates the proinflammatory and proangiogenic effects of UV radiation and thereby contributes to enhanced sensitivity to sun exposure in rosacea.

PMID: 25306296 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25306296?dopt=Abstract = URL to article

Alarmin Function of Cathelicidin Antimicrobial Peptide LL37 through IL-36γ Induction in Human Epidermal Keratinocytes.

J Immunol. 2014 Oct 10;

Authors: Li N, Yamasaki K, Saito R, Fukushi-Takahashi S, Shimada-Omori R, Asano M, Aiba S

Abstract
Several dermatoses, including psoriasis, atopic dermatitis, and rosacea, alter the expression of the innate immune effector human cathelicidin antimicrobial peptide (CAMP). To elucidate the roles of aberrant CAMP in dermatoses, we performed cDNA array analysis in CAMP-stimulated human epidermal keratinocytes, the primary cells responding to innate immune stimuli and a major source of CAMP LL37 in skin. Among LL37-inducible genes, IL-1 cluster genes, particularly IL36G, are of interest because we observed coordinate increases in CAMP and IL-36γ in the lesional skin of psoriasis, whereas virtually no CAMP or IL-36γ was observed in nonlesional skin and normal skin. The production and release of IL-36γ were up to 20-30 ng/ml in differentiated keratinocytes cultured in high-calcium media. G-protein inhibitor pertussis toxin and p38 inhibitor suppressed IL-36γ induction by LL37. As an alarmin, LL37 induces chemokines, including CXCL1, CXCL8/IL8, CXCL10/IP-10, and CCL20/MIP3a, and IL-36 (10-100 ng/ml) augments the production of these chemokines by LL37. Pretreatment with small interfering RNA against IL36γ and IL-36R IL36R/IL1RL2 and IL1RAP suppressed LL37-dependent IL8, CXCL1, CXCL10/IP10, and CCL20 production in keratinocytes, suggesting that the alarmin function of LL37 was partially dependent on IL-36γ and its receptors. Counting on CAMP induction in innate stimuli, such as in infection and wounding, IL-36γ induction by cathelicidin would explain the mechanism of initiation of skin inflammation and occasional exacerbations of psoriasis and skin diseases by general infection.

PMID: 25305315 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25305315?dopt=Abstract = URL to article

Skin Microbiome and Skin Disease: The Example of Rosacea.

J Clin Gastroenterol. 2014 November/December;48 Suppl 1, Proceedings From The 7th Probiotics, Prebiotics & New Foods Meeting Held In Rome On September 8-10, 2013:S85-S86

Authors: Picardo M, Ottaviani M

Abstract
The imbalance and/or the perturbation of the microbial populations that colonize the skin and that contribute to its defense may represent one of the causes of the development of noninfectious skin diseases. Atopic dermatitis, psoriasis, acne, and rosacea can be listed among these kinds of pathologies. In particular, considering that microbes have been long addressed as having a role in rosacea, this common dermatosis can be an interesting model to evaluate the correlation between microbiome alterations and the occurrence of clinical manifestations. Different microorganisms have been suggested to have a role in rosacea, but no direct correlation with the incidence of the pathology has been clearly defined. Skin microbiome composition is crucial for the correct skin immune functions and recent findings indicate an abnormal activation of innate immune system associated with the rosacea. The enhanced expression of toll-like receptor 2 in the epidermis of rosacea patients can represent a possible explanation for the amplified inflammatory response to external stimuli observed during the disease. In addition, significantly higher small intestinal bacterial overgrowth prevalence in rosacea subjects has been found and its eradication has been associated with a regression of the skin lesions. In conclusion, both skin and gut microbiome seem to have a role, even if synergistic with other factors, in the pathogenesis of rosacea. A deeper knowledge of human microbiome composition and microbe-host interactions will contribute to clarify the mechanism of development of rosacea and possibly will provide innovative therapeutic approaches.

PMID: 25291137 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25291137?dopt=Abstract = URL to article

Exposure of a corneal epithelial cell line (hTCEpi) to Demodex-associated Bacillus proteins results in an inflammatory response.

Invest Ophthalmol Vis Sci. 2014 Oct 2;

Authors: McMahon F, Gallagher C, O'Reilly N, Clynes M, O'Sullivan F, Kavanagh K

Abstract
Purpose: A role for a bacterium, Bacillus oleronius, originally isolated from a Demodex mite in the induction of ocular rosacea has been proposed. The aim of this work was to characterize the response of a corneal epithelial cell line to Bacillus proteins as this might give an insight into how such proteins contribute to the symptoms of ocular rosacea in vivo. Methods: The effect of exposing Bacillus protein preparation on hTCEpi cells was measured by monitoring changes in cell proliferation and the expression of a number of genes associated with inflammation. The production of inflammatory cytokines was measured and the expression and activity of MMP-9 was quantified. Results: Exposure of corneal epithelial cells (hTCEpi) to 2 or 6 µg/mL Bacillus protein resulted in a dose dependent reduction in cell proliferation. Exposure of cells to 6 µg/mL Bacillus protein did not induce apoptosis but there was an increase in the expression of genes coding for IL-6 (13.8-fold), IL-1β (4.0-fold), IL-8 (11.1-fold) and TNF-α (4.1-fold). Increased expression of genes coding for the defensins, CCL20 (4.5-fold) and S100A7 (6.8-fold) was also observed. Elevated production of IL-6 and IL-8 was evident from cells exposed to 2 and 6 μg/mL Bacillus protein. hTCEpi cells demonstrated increased MMP-9 expression (3.2-fold, p = 0.003) and activity (2.2-fold, p = 0.0186) after 48 hours exposure to 6 µg/mL Bacillus protein preparation. Conclusions: The results suggest that interaction of Demodex-associated Bacillus proteins with the corneal surface could lead to tissue degradation and inflammation possibly leading to corneal scarring.

PMID: 25277231 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25277231?dopt=Abstract = URL to article

Unconventional Use of Intense Pulsed Light.

Biomed Res Int. 2014;2014:618206

Authors: Piccolo D, Di Marcantonio D, Crisman G, Cannarozzo G, Sannino M, Chiricozzi A, Chimenti S

Abstract
According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases), port-wine stain (PWS) (10 cases), disseminated porokeratosis (10 cases), pilonidal cyst (3 cases), seborrheic keratosis (10 cases), hypertrophic scar (5 cases) and keloid scar (5 cases), Becker's nevus (2 cases), hidradenitis suppurativa (2 cases), and sarcoidosis (1 case). Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator's experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

PMID: 25276803 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25276803?dopt=Abstract = URL to article

Health-related Quality of Life in Patients with Cutaneous Rosacea: A Systematic Review.

Acta Derm Venereol. 2014 Oct 1;

Authors: van der Linden MM, van Rappard DC, Daams JG, Sprangers MA, Spuls PI, de Korte J

Abstract
Health-related quality of life (HRQoL) of rosacea patients is a relevant outcome measure in research and clinical practice. A review of the literature was systematically carried out regarding levels of HRQoL of patients with rosacea, including associations between HRQoL scores, demographic and clinical characteristics. Searches were performed in Cochrane, PubMed, EMBASE, PsycINFO, CINAHL and LILACS. HRQoL studies in patients with cutaneous rosacea, using validated HRQoL instruments, published between 1991 and 2014, were included. Data extraction was performed independently by 2 authors. Study design, demographics, clinical characteristics and HRQoL scores were summarized per HRQoL questionnaire. Associations between HRQoL, demographic and clinical characteristics were explored. Out of 984 references, 12 studies were included. Three HRQoL instruments were used: Short Form-36 (SF-36), Dermatology Life Questionnaire Index (DLQI) and Rosacea Quality of Life Index (RosaQoL). Because of the heterogeneity of the included studies, data synthesis was hardly feasible. All studies reported a negative impact on HRQoL, which appeared to be associated with disease severity and age. Results regarding the association with sex and subtype were mixed. With regard to the clinical relevance of HRQoL scores of rosacea patients, it seems that rosacea has a small to moderate effect on HRQoL.

PMID: 25270577 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25270577?dopt=Abstract = URL to article

Lactic acid sting test does not differentiate between facial and generalized skin functional impairment in sensitive skin in atopic dermatitis and rosacea.

J Dermatol Sci. 2014 Sep 16;

Authors: Darlenski R, Kazandjieva J, Fluhr JW, Maurer M, Tsankov N

PMID: 25266652 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25266652?dopt=Abstract = URL to article

Related Articles

Treatment of superficial vascular lesions with the KTP 532-nm laser: experience with 647 patients.

Lasers Med Sci. 2014 Jan;29(1):267-71

Authors: Becher GL, Cameron H, Moseley H

Abstract
Superficial vascular lesions are a common dermatological diagnosis but are often difficult to treat. Numerous lasers (especially the dye laser) and intense pulsed light sources have been used, but there have been very few reports on the effectiveness of the potassium-titanyl phosphate (KTP) laser. We have extensive experience of this modality at our institution, and the purpose of this survey is to report on the safety and efficacy of the KTP laser. Using an in-house database, we retrospectively collected data from patients who had undergone treatment with the KTP laser for superficial vascular lesions. Patients of Fitzpatrick skin type I-IV were included. Exclusion criteria were Fitzpatrick skin type V, patients with obvious suntan and those on potentially phototoxic medications or minocycline therapy. Diagnoses included discrete or matted telangiectasia, strawberry naevus, spider angioma, rosaceal erythema, rosaceal telangiectasia, telangiectatic naevus, angioma, combined rosaceal erythema/telangiectasia, port-wine stain, venous lake haemangioma and hereditary haemorrhagic telangiectasia. Patients underwent an initial test treatment and further treatment at 6-week intervals as required. Clinical photographs were taken pre- and post-treatment, and outcome was graded by patient and physician. Adverse effects were recorded including scarring, hypo- or hyperpigmentation, marked swelling, blistering, scabbing and bruising. Six hundred forty-seven patients with 13 diagnoses on 9 different body sites were recorded. Four hundred eighty-six were female, and the median age was 39.5 years. Of the lesions treated, 33.7 % (n = 218) were discrete telangiectases and 31.8 % (n = 206) were spider angiomas. A 92.7 % of lesions were on the face. Four hundred thirteen (77.6 %) patients who had outcomes recorded at 6 weeks were graded as "clearance" or "marked improvement". Only 38 (5.8 %) patients experienced adverse effects, all of which were minor; the main adverse effect was swelling. Unlike the dye laser, there was only one case of bruising out of 647 patients. This is the largest survey of patients to have undergone KTP laser treatment reported in the literature. Our results show that the KTP laser is a safe and effective modality for the treatment of superficial vascular lesions.

PMID: 24401943 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/24401943?dopt=Abstract = URL to article

Utility of sentinel flaps in assessing facial allograft rejection.

Plast Reconstr Surg. 2014 Sep 24;

Authors: Kueckelhaus M, Fischer S, Lian CG, Bueno EM, Marty FM, Tullius SG, Pribaz JJ, Murphy GF, Pomahac B

Abstract
BACKGROUND:: Skin biopsies are critical for histological evaluation of rejection and proper treatment after facial allotransplantation (FAT). Many facial allografts provide only limited skin area and frequent biopsies may additionally compromise aesthetic outcome. Sentinel flaps (SFs), recovered as free fasciocutanous radial forearm flaps, have been employed for remote site rejection monitoring. They maintain their axial blood supply similar to facial allografts. The correlation between FAT and SF in cases of rejection is presented.
METHODS:: We analyzed the experience of the Boston team's employment of 4 SFs. Rejection was evaluated and the results compared for each time point. The SFs where used as functional flap whenever possible.
RESULTS:: The results show a reliable correlation between biopsies taken from the facial allograft (FA) and SF. During severe rejection episodes in 100% of the biopsy pairs both sites displayed a similar grade of rejection. In one case the clinical findings suggested rejection in the FA but were unraveled as Rosacea, since clinically there was no rejection displayed in the SF.
CONCLUSIONS:: The SF shows a reliable correlation to the FA in cases of severe rejection and therefore provides a valuable tool for rejection monitoring in FAT. Advantages of SF employment include the avoidance of further surgical procedures to the primary VCA, additional utilization of the SF to repair damaged non-facial sites, and its utility as both a clinical and histopathological barometer of rejection and predictor of the potential existence of facial dermatitis unrelated to rejection.Level of evidence: III.

PMID: 25255116 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25255116?dopt=Abstract = URL to article

In vivo confocal microscopy as a novel and reliable tool for the diagnosis of Demodex eyelid infestation.

Br J Ophthalmol. 2014 Sep 24;

Authors: Randon M, Liang H, El Hamdaoui M, Tahiri R, Batellier L, Denoyer A, Labbé A, Baudouin C

Abstract
AIMS: Demodex mites are implicated in several ocular surface diseases such as blepharitis, ocular rosacea and dry eye syndrome. Demodex eyelid infestation is classically diagnosed by analysing depilated eyelashes under the light microscope. The use of in vivo confocal microscopy (IVCM) could be an easy way to improve its diagnosis. The ability of IVCM to identify Demodex was evaluated and compared with the classic depilation method.
METHODS: Eight healthy subjects, 22 patients with dry eye syndrome without anterior blepharitis and 18 patients with anterior blepharitis were examined using lower eyelid IVCM (lash follicles and meibomian glands (MGs)). Twenty-five of the 48 subjects underwent both an IVCM examination and classic depilation to compare the two methods. Ex vivo Demodex obtained from lash depilation were also analysed using the confocal microscope.
RESULTS: IVCM found 100% of the mite infestations among patients with anterior blepharitis, 60% among dry eye patients without blepharitis and 12% in healthy subjects, whereas the depilation technique found 100%, 50% and 0%, respectively. Demodex brevis and Demodex larvae inside the lash follicles were better detected by IVCM. In symptomatic patients, the Demodex infestation was often associated with MG dysfunction, which was better characterised using IVCM in symptomatic patients (60% and 40% of meibomianitis and gland fibrosis, respectively).
CONCLUSIONS: IVCM is an efficient and reliable tool for the diagnosis of eyelid mite infestation and may also provide an evaluation of MGs.

PMID: 25253768 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25253768?dopt=Abstract = URL to article

Unusual features of rosacea in saudi females with dark skin.

Ochsner J. 2014;14(3):321-7

Authors: Al Balbeesi AO, Halawani MR

Abstract
BACKGROUND: Data on the clinical presentation of rosacea among darker-skinned ethnic groups is scarce. This article presents the clinical spectrum of rosacea in Saudi female patients with differences highlighted according to skin types.
METHODS: Female patients diagnosed with rosacea at the dermatology clinic in King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, between February 2010 and May 2011 were studied prospectively. Data collected included demographics, duration of the disease, personal history of any atopic disorder, aggravating factors, cutaneous and ocular symptoms, the presence of migraine, Helicobacter pylori infection, skin phototypes, and the clinical types and severity of rosacea.
RESULTS: FIFTY PATIENTS CONSENTED TO JOIN THE STUDY: 20 (40%) were patients with skin type 4, 9 (18%) had skin type 5, and 21 (42%) had skin type 6. The cheeks, glabella, and chin were involved in 26 (52%) patients. Extrafacial lesions affecting chest, back, and ears were identified in 7 patients (14%). Severe erythematotelangiectatic rosacea was diagnosed in 21 patients (42%): skin type 4 comprised 50%, higher than the incidences for skin type 5 (22%) and skin type 6 (42.9%). The severe papulopustular subtype of rosacea was noted in 7 patients (14.0%), affecting 20% with skin type 4 and 14% with skin type 6. Severity of the erythematotelangiectatic or papulopustular subtypes of rosacea was not significantly associated with skin type (P=0.5691 and P=0.7740, respectively).
CONCLUSION: This study addresses the growing interest in skin diseases in dark-skinned individuals. Rosacea is one of the skin disorders that had always been described for fair-skinned populations, but our results indicate that darker-skinned individuals also can be affected by rosacea and the clinical presentation is similar to that seen in patients with fair skin.

PMID: 25249796 [PubMed]

http://www.ncbi.nlm.nih.gov/pubmed/25249796?dopt=Abstract = URL to article

Ocular rosacea: an underdiagnosed cause of relapsing conjunctivitis-blepharitis in the elderly.

BMJ Case Rep. 2014;2014

Authors: De Marchi SU, Cecchin E, De Marchi S

Abstract
Red eye and relapsing conjunctivitis-blepharitis are among the most common ocular disease in elderly patients. In these cases the search for causes is difficult and frustrating. We report the case of a 79-year-old woman with a long history of red eye and relapsing conjunctivitis-blepharitis caused by ocular rosacea. In this patient the proper diagnosis was performed after 10 years of ocular disease, and repeated evaluations by general practitioners and clinical specialists, only after the appearance of facial signs of erythematotelangiectatic rosacea. Adequate therapy with oral doxycycline led to the improvement of the clinical picture that previously had shown a poor response to several topical treatments. The possibility of ocular rosacea should be considered in evaluating an elderly patient with persistent red eye and relapsing conjunctivitis-blepharitis. Making the proper diagnosis is crucial because ocular rosacea does not respond as expected to topical therapy and may lead to severe corneal involvement.

PMID: 25239991 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/25239991?dopt=Abstract = URL to article

Laser surgery in rhinophyma.

G Ital Dermatol Venereol. 2014 Sep 18;

Authors: Bassi A, Campolmi P, Dindelli M, Bruscino N, Conti R, Cannarozzo G, Pimpinelli N

Abstract
BACKGROUND: Rhinophyma is a benign, disfiguring disorder, commonly reffered to as the end stage of severe rosacea and characterized by a progressive thickening and hypertrophy of the nasal skin and soft tissues..
OBJECTIVES: To evaluate the efficacy of CO2 laser compared to other laser techniques and surgical methods in the treatment of rhinophyma.
METHODS: 24 rhinophyma patients were treated with CO2 laser in our institution from 2003 to 2013. A 10,600--nm CO2 pulsed laser was used in all patients, with a 6--month, post--treatment follow up.
RESULTS: Six months after the last laser session, all patients showed global improvement of their clinical conditions: 19 (79.1%) high improvement (>75%), 4 (16.7%) moderate improvement (50--75%), and 1 (4.2%) low improvement (<25%)..
CONCLUSIONS: Our study demonstrates that carbon dioxide laser warrants a careful nasal surface ablation, allowing the remodeling of the hypertrophic areas, with an excellent cosmetic result, a very short healing time, and virtually no side effects.

PMID: 25236318 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25236318?dopt=Abstract = URL to article

Extraintestinal manifestations of Helicobacter pylori: A concise review.

World J Gastroenterol. 2014 Sep 14;20(34):11950-11961

Authors: Wong F, Rayner-Hartley E, Byrne MF

Abstract
Helicobacter pylori (H. pylori) infection has been clearly linked to peptic ulcer disease and some gastrointestinal malignancies. Increasing evidence demonstrates possible associations to disease states in other organ systems, known as the extraintestinal manifestations of H. pylori. Different conditions associated with H. pylori infection include those from hematologic, cardiopulmonary, metabolic, neurologic, and dermatologic systems. The aim of this article is to provide a concise review of the evidence that supports or refutes the associations of H. pylori and its proposed extraintestinal manifestations. Based on data from the literature, PUD, mucosal associated lymphoid tumors lymphoma, and gastric adenocarcinoma has well-established links. Current evidence most supports extraintestinal manifestations with H. pylori in immune thrombocytopenic purpura, iron deficiency anemia, urticaria, Parkinson's, migraines and rosacea; however, there is still plausible link with other diseases that requires further research.

PMID: 25232230 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25232230?dopt=Abstract = URL to article