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Vasoconstriction and anti-inflammatory properties of the selective α-adrenergic receptor agonist brimonidine.

J Dermatol Sci. 2014 Apr 16;

Authors: Piwnica D, Rosignoli C, de Ménonville ST, Alvarez T, Schuppli Nollet M, Roye O, Jomard A, Aubert J

Abstract
BACKGROUND: The facial erythema of rosacea is recognized as the most prevalent and most difficult manifestation of rosacea to treat. A recent approach in patients with rosacea has been to reduce this erythema through vasoconstriction of cutaneous blood vessels by selectively targeting α2-adrenergic receptors with brimonidine.
OBJECTIVE: To further investigate the pharmacodynamic profile of brimonidine, its vasoconstrictive effects and its anti-inflammatory properties.
METHODS: The potency for the α1A, α1B, α2A, α2B and α2C receptors of brimonidine was measured, as well as performing a large target profiling study in order to determine the target selectivity profile of brimonidine. The vasoconstrictive effects of brimonidine were measured using ex vivo wire myography and human skin biopsy neuroinflammation models. The anti-inflammatory properties of brimonidine were measured using two in vivo mice ear inflammation models.
RESULTS: Brimonidine was found to be highly selective for the α2A adrenoreceptor (EC50 0.45nM) over the other α-adrenoreceptors. Additionally, the large target profiling study demonstrated the high selectivity of brimonidine with minimal off-target effects. The ex vivo wire myography model showed that brimonidine is a potent vasoconstrictor of human subcutaneous vessels with a diameter of less than 200μm (EC50 0.4nM). The ex vivo human skin biopsy neuroinflammation model demonstrated that brimonidine completely inhibited vasodilation induced by capsaicin. Both in vivo mouse ear inflammation models highlighted that brimonidine inhibited ear edema (up to 76%) when compared to vehicle.
CONCLUSION: The selectivity, vasoconstrictive and anti-inflammatory properties of brimonidine that have been described in these studies are in agreement with the benefits observed with this compound in the treatment of facial erythema in rosacea.

PMID: 24802713 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24802713?dopt=Abstract = URL to article

MIRVASO (brimonidine tartrate) topical gel 0.33%.

Skinmed. 2014 Jan-Feb;12(1):41-3

Authors: Abramovits W, Prato A, Vincent KD, Scheinfeld N, Gupta AK

PMID: 24720083 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/24720083?dopt=Abstract = URL to article

[Case report: unusual clinical presentation of a follicular lymphoma].

Rev Med Suisse. 2014 Apr 2;10(424):744, 746-8

Authors: Sahil M, Prins C, Kaya G, Poffet F, Boehncke WH, Cortés B

Abstract
Follicular lymphoma is an indolent B-cell lymphoma. Fluctuant asymptomatic lymphadenopathies are their usual clinical manifestation. B-cell neoplasms can sometimes involve the skin. In this case, it is important to distinguish a systemic B-cell lymphoma with secondary skin involvement from primary cutaneous lymphoma. Immunohistochemical stainings and staging usually allow to make the difference. Here we report the first case of a systemic follicular lymphoma with secondary cutaneous involvement presented with papular lesions on the face mimicking a rosacea.

PMID: 24772807 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24772807?dopt=Abstract = URL to article

Microbiota of Demodex Mites from Rosacea Patients and Controls.

Microb Pathog. 2014 Apr 23;

Authors: Murillo N, Aubert J, Raoult D

Abstract
Proliferation of Demodex mites is associated with rosacea. Furthermore, Demodex-associated bacteria were suggested to play a role in the pathogenesis of rosacea. We decided to analyze Demodex microbiota. Mites were collected by standardized skin surface biopsies from patients with erythematotelangiectatic, papulopustular rosacea or from control subjects. The microbiota from each mite was characterized by 16S rRNA clone library approach. The 16S rRNA clone library consisted of 367 clones obtained from 73 extracts originating from 5 samples per study group (ETR, PPR or healthy subjects). A total of 86 species were identified with 36 as Demodex-specific microbiota. In the papulopustular group, proportions of Proteobacteria and Firmicutes increased whereas proportion of Actinobacteria decreased. Here, we report preliminary results on the microbiota of Demodex mites based on a molecular approach showing an unexpected diversity. Differences according to the host status need to be confirmed but open new perspectives for diagnostic of rosacea.

PMID: 24768927 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24768927?dopt=Abstract = URL to article

Updated Physician's Guide to the Off-label Uses of Oral Isotretinoin.

J Clin Aesthet Dermatol. 2014 Apr;7(4):22-34

Authors: Nickle SB, Peterson N, Peterson M

Abstract
While oral isotretinoin is renowned for its ability to treat acne vulgaris, many of its off-label uses continue to go underappreciated. Since the last review on the unapproved indications of isotretinoin, relevant publications have surfaced with new recommendations. This article attempts to provide physicians with the latest information regarding successful and unsuccessful use of isotretinoin as an effective treatment for dermatological conditions, such as rosacea, psoriasis, pityriasis rubra pilaris, condyloma acuminatum, granuloma annulare, Darier's disease, systemic cutaneous lupus erythematosus, nonmelanoma skin cancer, and hidradenitis suppurativa. Variations in dosage regimens and isotretinoin viability as an alternative to other standard treatments are also discussed in relation to these conditions.

PMID: 24765227 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24765227?dopt=Abstract = URL to article

Common Dermatologic Conditions.

Med Clin North Am. 2014 May;98(3):445-485

Authors: Vary JC, O'Connor KM

Abstract
This review discusses common dermatologic presentations as they would appear in a primary care office, exploring the differential diagnoses for each. Tips are provided on choosing an appropriate topical drug and vehicle and advising patients on its use. Etiology, differential diagnosis, and treatment options are discussed for the following: alopecias including androgenetic alopecia, female pattern hair loss, alopecia areata, and telogen effluvium; facial rashes including acne vulgaris, acne rosacea, periorificial dermatitis, seborrheic dermatitis, erysipelas/cellulitis, and systemic lupus erythematosus; intertriginous rashes including infections, intertrigo, and inverse psoriasis; and the inflamed leg including cellulitis and erysipelas, stasis dermatitis, and contact dermatitis.

PMID: 24758956 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24758956?dopt=Abstract = URL to article

A multicentre, randomized, placebo-controlled trial establishing the treatment effect of TDT 068, a topical formulation containing drug-free ultra-deformable phospholipid vesicles, on the primary features of erythematotelangiectatic rosacea.

J Eur Acad Dermatol Venereol. 2014 Apr 22;

Authors: Luger T, Peukert N, Rother M

Abstract
BACKGROUND: Rosacea subtype 1 (erythematotelangiectatic) is an inflammatory skin disease with limited treatment options. TDT 068, a topical drug-free gel containing ultra-deformable Sequessome vesicles, is registered for use in inflammatory skin conditions, but has not been investigated in rosacea.
OBJECTIVE: This postmarketing study aimed to substantiate the effects of TDT 068 in rosacea subtype 1.
METHODS: Patients aged 18-85 scoring 6-15/30 for the primary and secondary features of the rosacea standard grading system (RSGS) were enrolled. Following stratification (four females/one male) patients were randomized (2:1) to receive TDT 068 or vehicle gel for 4 weeks. Efficacy was evaluated using the patient-rated rosacea-specific quality of life (R-QOL) instrument and investigator-rated RSGS. Adverse events (AEs) were monitored throughout.
RESULTS: Of the 61 randomized patients, 58 were eligible for the full analysis set per protocol. Baseline characteristics were balanced across the groups. R-QOL symptom construct scores improved slightly from baseline to Week 4 in both groups (-0.04 ± 0.51 TDT 068 vs. -0.22 ± 0.59 vehicle; P = 0.1990). Changes in R-QOL total, function and emotion construct scores at Week 4 were similar with TDT 068 and vehicle, but TDT 068 yielded numerically greater increases in total RSGS scores (-1.55 ± 1.83 vs. -0.75 ± 2.38 vehicle; P = 0.105). Non-transient erythema improved significantly with TDT 068 at Week 4 (-0.34 ± 0.63 vs. -0.05 ± 0.51 vehicle; P = 0.044), with ≥1 grade improvement in 35% of patients (vs. 15% vehicle; P = 0.039). Numerically greater improvements in transient erythema and telangiectasia were also seen with TDT 068. Three treatment-related AEs were reported but no serious AEs occurred.
CONCLUSION: These data, based on investigator assessment, provide evidence for the good tolerability of drug-free TDT 068 as well as modest improvements in the symptoms of erythematotelangiectatic rosacea.

PMID: 24754379 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24754379?dopt=Abstract = URL to article

[Angioprotectors in the treatment of rosacea].

Georgian Med News. 2014 Mar;(228):51-4

Authors: Tsiskarishvili N, Katsitadze A, Tsiskarishvili Ts, Tchitanava L, Tsiskarishvili N

Abstract
Rosacea - a common chronic inflammatory dermatosis (3-10% of all dermatoses) primarily affecting the skin of face. Numerous methods for the treatment of rosacea are defined by the diversity of etiologic and pathogenic factors of dermatosis, its stage and clinical form. But a significant role in its development, most researchers relate to vascular disturbances. It is suggested that vascular changes in this disease are the product of two interrelated pathological processes: the disturbances in integrity and tone of the vascular wall and disorganization of perivascular connective tissue. The results of these processes are formation of a stable dilatation of skin blood vessels clinically manifested by erythema and telangiectasia. Based on foregoing, The aim of this study was evaluation of therapeutic efficacy of Rutin Forte in complex treatment and prevention of rosacea. 30 patients with an erythematous stage of rosacea were under observation (20 women and10 men) aged 25 to 50 years. The first group (15 patients) was treated by the standard procedure (Antibiotics, systemic metronidazole, antihistamines, traditional external therapy). Patients of the second group (15 people) additionally received a Rutin Forte containing long-acting vitamin C, zinc and selenium. The drug was administered at a dose of 2 capsule per day. Duration of treatment - 2 to 3 months. Observation period after treatment were 12 months. During this period we revealed a significant reduction of erythema, recurrence of disease in the second group of patients was not observed, but in the group of comparison recurrences were detected on 3rd month of follow up and the degree of erythema reduction was significantly less. Thus, the study revealed that Rutin Forte is an effective means for the treatment and prevention of the torpid relapsing forms of rosacea on erythematous stage of dermatosis.

PMID: 24743122 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24743122?dopt=Abstract = URL to article

Characterizing the Relationship Between Free Drug Samples and Prescription Patterns for Acne Vulgaris and Rosacea.

JAMA Dermatol. 2014 Apr 16;

Authors: Hurley MP, Stafford RS, Lane AT

Abstract
IMPORTANCE Describing the relationship between the availability of free prescription drug samples and dermatologists' prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician's office. OBJECTIVES To investigate the relationships between free drug samples and dermatologists' local and national prescribing patterns and between the availability of free drug samples and prescription costs. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of acne vulgaris or rosacea in 2010. MAIN OUTCOMES AND MEASURES National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples. RESULTS On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated (r = 0.92) with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples). CONCLUSIONS AND RELEVANCE Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs.

PMID: 24740450 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24740450?dopt=Abstract = URL to article

Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea.

Cutis. 2014 Mar;93(3):134-8

Authors: Del Rosso JQ, Thiboutot D, Gallo R, Webster G, Tanghetti E, Eichenfield LF, Stein-Gold L, Berson D, Zaenglein A

Abstract
The last article in this 5-part series provides a final overview of consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. Optimal management of rosacea requires careful assessment of the patient's clinical features with integration of therapies that adequately treat the presenting signs and symptoms. The treatment consensus recommendations from the AARS are based on 2 major common clinical presentations of rosacea: (1) centrofacial erythema with papulopustular lesions, and (2) centrofacial erythema without papulopustular lesions. The recommendations provided here serve to guide clinicians in their clinical practice.

PMID: 24738094 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24738094?dopt=Abstract = URL to article

Regulation of kallikrein-related peptidases in the skin - from physiology to diseases to therapeutic options.

Thromb Haemost. 2013 Sep;110(3):442-9

Authors: Fischer J, Meyer-Hoffert U

Abstract
Kallikrein-related peptidases (KLKs) constitute a family of 15 highly conserved serine proteases, which show a tissue-specific expression profile. This made them valuable tumour expression markers. It became evident that KLKs are involved in many physiological processes like semen liquefaction and skin desquamation. More recently, we have learnt that they are involved in many pathophysiological conditions and diseases making them promising target of therapeutic intervention. Therefore, regulation of KLKs raised the interest of numerous reports. Herein, we summarise the current knowledge on KLKs regulation with an emphasis on skin-relevant KLKs regulation processes. Regulation of KLKs takes place on the level of transcription, on protease activation and on protease inactivation. A variety of protease inhibitors has been described to interact with KLKs including the irreversible serine protease inhibitors (SERPINs) and the reversible serine protease inhibitors of Kazal-type (SPINKs). In an attempt to integrate current knowledge, we propose that KLK regulation has credentials as targets for therapeutic intervention.

PMID: 23446429 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/23446429?dopt=Abstract = URL to article

In vitro/in vivo characterization of nanoemulsion formulation of metronidazole with improved skin targeting and anti-rosacea properties.

Eur J Pharm Biopharm. 2014 Apr 2;

Authors: Yu M, Ma H, Lei M, Li N, Tan F

Abstract
Topical skin treatment was limited due to the lack of suitable delivery system with significant cutaneous localization and systemic safety. The aim of this study was to develop and optimize a nanoemulsion (NE) to enhance targeting localization of metronidazole (MTZ) in skin layers. In vitro studies were used to optimize NE formulations, a series of experiments were carried in vitro and in vivo to validate the therapeutic efficacy of MTZ-loaded optimal NE. NE type selection and D-optimal design study were applied to optimize NE formulation with maximum skin retention and minimum skin penetration. Three formulation variables: Oil X1 (Labrafil), Smix X2 (a mixture of Cremophor EL/Tetraethylene glycol, 2:1 w/w) and water X3 were included in D-design. The system was assessed for skin retention Y1, cumulative MTZ amount after 24 h Y2 and droplet size Y3. Following optimization, the values of formulation components (X1, X2 and X3) were 4.13%, 16.42% and 79.45%, respectively. The optimized NE was assessed for viscosity, droplet size, morphological study and in vitro permeation in pig skin. Distributions of MTZ were validated by confocal laser scanning microscopy (CLSM). Active agent of NE transferred into deeper skin and localized in epidermal/dermal layers after 24 h, which showed significant advantages of the optimal NE over Gel. The skin targeting localization and minimal systemic escape of optimal NE was further proved by in vivo study on rat skin. Current in vitro-in vivo correlation (IVIVC) enabled the prediction of pharmacokinetic profile of MTZ from in vitro permeation results. Further, the in vivo anti-rosacea efficacy of optimal formulation was investigated by pharmacodynamics study on mice ear.

PMID: 24704200 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24704200?dopt=Abstract = URL to article

Face-to-face with anti-inflammatory therapy for rosacea.

Exp Dermatol. 2014 Mar 29;

Authors: Salzer S, Ruzicka T, Schauber J

Abstract
In the past, our understanding of rosacea has been inadequate and limited to descriptions of factors that exacerbate and improve the disease. While the pathophysiology of rosacea is complex and multifactorial, cathelicidin peptides have emerged as key players in the pathogenesis of this common dermatological disorder. This article correlates recent findings in abnormal cathelicidin production and proteolytic processing in rosacea with therapeutic actions of current treatment options and, in this way, highlights potential points of intervention for the development of efficient therapeutic alternatives. This article is protected by copyright. All rights reserved.

PMID: 24684602 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24684602?dopt=Abstract = URL to article

Diagnosis of dry eye disease and emerging technologies.

Clin Ophthalmol. 2014;8:581-590

Authors: Zeev MS, Miller DD, Latkany R

Abstract
Dry eye is one of the most commonly encountered problems in ophthalmology. Signs can include punctate epithelial erosions, hyperemia, low tear lakes, rapid tear break-up time, and meibomian gland disease. Current methods of diagnosis include a slit-lamp examination with and without different stains, including fluorescein, rose bengal, and lissamine green. Other methods are the Schirmer test, tear function index, tear break-up time, and functional visual acuity. Emerging technologies include meniscometry, optical coherence tomography, tear film stability analysis, interferometry, tear osmolarity, the tear film normalization test, ocular surface thermography, and tear biomarkers. Patient-specific considerations involve relevant history of autoimmune disease, refractive surgery or use of oral medications, and allergies or rosacea. Other patient considerations include clinical examination for lid margin disease and presence of lagophthalmos or blink abnormalities. Given a complex presentation and a variety of signs and symptoms, it would be beneficial if there was an inexpensive, readily available, and reproducible diagnostic test for dry eye.

PMID: 24672224 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24672224?dopt=Abstract = URL to article

[The Prevalence of Demodex sp. in Patients Admitted to the Parasitology Laboratory of the Dursun OdabaÅŸ Medical Center in Yüzüncü Yıl University, Van].

Turkiye Parazitol Derg. 2014;38(1):9-11

Authors: Cengiz ZT, Yılmaz H, Ozkol HU, Ekici A, Odemiş N

Abstract
Objective: The aim of the study was to determine the prevalence of Demodex sp. in patients referred fom the Dermatology Outpatient Clinic to the Parasitology Laboratory, Dursun OdabaÅŸ Medical Center of the Yüzüncü Yıl University. Methods: The study was conducted between May 2012-May 2013. The samples were taken from 67 patients using the standard skin surface biopsy method. Results: Demodex sp. mites were identified in 47.4% of 38 women, and in 48.3% of 29 male patients. These mites were detected in 15.8% of 19 patients who were 35 years old and younger, and in 60.4% of 48 patients who were 36 years old and older. Overall, 47.8% (32 patients) of 67 patients were found positive for demodicosis. It was determined that 53.1% of Demodex sp. positive patients had eritemato telangiectatic rosacea, 21.9% had papulo-pustular type rosacea, 18.8% had papules, 3.1% had erythematous pustules, and 3.1% had erythematous squamous plaques. There was a statistically significant difference between the Demodex sp. positivity and age groups (p=0.001). Conclusion: It was concluded that dermatologists should also take into consideration the possible presence of Demodex sp. mites in patients with skin symptoms such as erythema, telangiectasia, papules and pustules, and apply the appropriate treatment for these parasites. (Turkiye Parazitol Derg 2014; 38: 9-11).

PMID: 24659694 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24659694?dopt=Abstract = URL to article

Effect of Tetracyclines on the Development of Vascular Disease in Veterans with Acne or Rosacea-A Retrospective Cohort Study.

J Invest Dermatol. 2014 Mar 21;

Authors: Dosal J, Rodriguez G, Pezon C, Li H, Keri J

PMID: 24658505 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24658505?dopt=Abstract = URL to article

Comparative analysis of rosacea and cutaneous lupus erythematosus: Histopathologic features, T-cell subsets, and plasmacytoid dendritic cells.

J Am Acad Dermatol. 2014 Mar 19;

Authors: Brown TT, Choi EY, Thomas DG, Hristov AC, Chan MP

Abstract
BACKGROUND: Distinction of rosacea and cutaneous lupus erythematosus (LE) can be challenging because of significant clinical and histologic overlap. A controlled study comparing these conditions is lacking.
OBJECTIVE: We compared the histologic features, T-cell subsets, and plasmacytoid dendritic cells in rosacea and LE.
METHODS: Biopsy specimens of rosacea (n = 27) and facial LE (n = 30) were retrospectively reviewed and reacted with Alcian blue and periodic acid-Schiff stains, and CD4, CD8, CD25, and CD123 immunostains.
RESULTS: LE demonstrates a lower CD4:CD8 ratio (1.74 vs 2.80, P = .0064), fewer CD4(+)CD25(+) regulatory T cells (13% vs 31%, P < .0001), and more CD123(+) plasmacytoid dendritic cells (18% vs 6%, P = .0137) than rosacea. The plasmacytoid dendritic cells in LE are more likely to form clusters (P = .0137) and comprise at least 20% of the infiltrate (P = .0340). Also associated with LE are follicular plugging (P = .0039), perineural lymphocytic infiltrate (P = .0211), abundant mucin deposition (P = .0031), and conspicuous basement membrane thickening (P = .0073), whereas Demodex infestation (P = .0064) and sebaceous hyperplasia (P = .0029) are significantly associated with rosacea.
LIMITATIONS: Although statistically significant, the immunophenotypic differences are rather small and limited for routine use.
CONCLUSION: The infiltrates in rosacea and LE differ immunophenotypically, and may aid in their distinction in addition to conventional histologic examination.

PMID: 24656728 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24656728?dopt=Abstract = URL to article

Nicotinamide and the skin.

Australas J Dermatol. 2014 Mar 17;

Authors: Chen AC, Damian DL

Abstract
Nicotinamide, an amide form of vitamin B3, boosts cellular energy and regulates poly-ADP-ribose-polymerase 1, an enzyme with important roles in DNA repair and the expression of inflammatory cytokines. Nicotinamide shows promise for the treatment of a wide range of dermatological conditions, including autoimmune blistering disorders, acne, rosacea, ageing skin and atopic dermatitis. In particular, recent studies have also shown it to be a potential agent for reducing actinic keratoses and preventing skin cancers.

PMID: 24635573 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24635573?dopt=Abstract = URL to article

Reliability of solar keratosis clinical diagnosis: A prospective study.

Australas J Dermatol. 2014 Mar 17;

Authors: Buinauskaite E, Makstiene J, Buinauskiene J, Valiukeviciene S

Abstract
Usually solar keratoses (SK) are diagnosed clinically. However other diseases may clinically present as erythematous macules, papules or patches on sun-exposed areas; therefore the histopathology remains the gold standard diagnostic tool. Our study, which assessed the efficacy of photodynamic therapy (PDT), showed that one in 20 clinically diagnosed SK lesions grade I-II identified by board-certified dermatologists were rosacea and only one in 40 were malignant lesions. These findings should be considered by clinicians who treat clinically diagnosed grade I-II SK without response to treatment or diagnose the recurrence of SK after PDT.

PMID: 24635483 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24635483?dopt=Abstract = URL to article

What's new in acne? An analysis of systematic reviews published in 2011-2012.

Clin Exp Dermatol. 2014 Apr;39(3):273-8

Authors: Bhate K, Williams HC

Abstract
This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self-esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non-cutaneous events and once-daily application of 0.02-0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non-inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non-ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow-up period are required.

PMID: 24635060 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24635060?dopt=Abstract = URL to article

Azithromycin: Mechanisms of Action and Their Relevance for Clinical Applications.

Pharmacol Ther. 2014 Mar 10;

Authors: Parnham MJ, Haber VE, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R

Abstract
Azithromycin is a macrolide antibiotic which inhibits bacterial protein synthesis, quorum-sensing and reduces the formation of biofilm. Accumulating effectively in cells, particularly phagocytes, it is delivered in high concentrations to sites of infection, as reflected in rapid plasma clearance and extensive tissue distribution. Azithromycin is indicated for respiratory, urogenital, dermal and other bacterial infections, and exerts immunomodulatory effects in chronic inflammatory disorders, including diffuse panbronchiolitis, post-transplant bronchiolitis and rosacea. Modulation of host responses facilitates its long-term therapeutic benefit in cystic fibrosis, non-cystic fibrosis bronchiectasis, exacerbations of chronic obstructive pulmonary disease (COPD) and non-eosinophilic asthma. Initial, stimulatory effects of azithromycin on immune and epithelial cells, involving interactions with phospholipids and Erk1/2, are followed by later modulation of transcription factors AP-1, NFκB, inflammatory cytokine and mucin release. Delayed inhibitory effects on cell function and high lysosomal accumulation accompany disruption of protein and intracellular lipid transport, regulation of surface receptor expression, of macrophage phenotype and autophagy. These later changes underlie many immunomodulatory effects of azithromycin, contributing to resolution of acute infections and reduction of exacerbations in chronic airway diseases. A sub-group of post-transplant bronchiolitis patients appears to be sensitive to azithromycin, as may be patients with severe sepsis. Other promising indications include chronic prostatitis and periodontitis, but weak activity in malaria is unlikely to prove crucial. Long-term administration of azithromycin must be balanced against the potential for increased bacterial resistance. Azithromycin has a very good record of safety, but recent reports indicate rare cases of cardiac torsades des pointes in patients at risk.

PMID: 24631273 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24631273?dopt=Abstract = URL to article

Cutaneous manifestations of the subtypes of polycystic ovary syndrome in Korean patients.

J Eur Acad Dermatol Venereol. 2014 Mar 14;

Authors: Hong JS, Kwon HH, Park SY, Jung JY, Yoon JY, Min S, Choi YM, Suh DH

Abstract
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women of childbearing-age. Although PCOS has common dermatological manifestations, including hirsutism, acne and androgenetic alopecia, little is known about the dermatological characteristics of PCOS patients in Asia.
OBJECTIVE: The goal of this study is to elucidate the dermatological characteristics and metabolic and hormonal parameters of Korean PCOS patients classified by the three ASRM/ESHERE criteria.
METHODS: We investigated 40 untreated PCOS patients who were newly diagnosed in the Department of Obstetrics & Gynecology of Seoul National University Hospital. Patients were classified according to the presence of irregular menstruation (IM), polycystic ovary morphology (PCOM) and hyperandrogenism (HA). Acne specific questionnaire, physical examination, and blood sampling were thoroughly conducted.
RESULTS: Twenty four patients (60.0%) met the criteria for the IM/HA/PCOM group and sixteen (40.0%) belonged to the IM/PCOM group. Acne was the most commonly observed dermatological manifestation (95.0%) followed by hirsutism (60.0%), seoborrhea (47.5%), acanthosis nigricans (20.0%) and androgenetic alopecia (12.5%). Hirsutism was more frequently observed in the IM/HA/PCOM group; the prevalence of other cutaneous manifestations did not differ significantly. Acne was most often observed on the face and most acne lesions were distributed on the forehead and cheek. Serum dehydroepiandrosterone sulphate level was higher in IM/HA/PCOM group, while serum cholesterol and high density lipoprotein concentrations were higher in the IM/PCOM group.
CONCLUSION: We described several dermatological manifestations and serum hormonal and metabolic parameters in Korean PCOS patients. Cutaneous manifestations might be the first signs of PCOS; therefore, dermatologists should be more aware of cutaneous manifestations of various ethnicities.

PMID: 24628922 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/24628922?dopt=Abstract = URL to article

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Rebound erythema and burning sensation from a new topical brimonidine tartrate gel 0.33%.

J Am Acad Dermatol. 2014 Feb;70(2):e37-8

Authors: Routt ET, Levitt JO

PMID: 24438976 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/24438976?dopt=Abstract = URL to article

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Electro-rhinosculpture for the surgical management of rhinophyma.

Ann R Coll Surg Engl. 2014 Jan;96(1):81

Authors: Wheble GA, Ahmed F, Pandya AN

PMID: 24417844 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/24417844?dopt=Abstract = URL to article

Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 4: a status report on physical modalities and devices.

Cutis. 2014 Feb;93(2):71-6

Authors: Tanghetti E, Del Rosso JQ, Thiboutot D, Gallo R, Webster G, Eichenfield LF, Stein-Gold L, Berson D, Zaenglein A

Abstract
The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.

PMID: 24605343 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/24605343?dopt=Abstract = URL to article