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    • Erbium-doped Yttrium Aluminium Garnet (Er:YAG) Laser Resurfacing Restores Normal Function and Cosmesis in Patients with Severe Rhinophyma. J Clin Aesthet Dermatol. 2019 Jul;12(7):28-33 Authors: Mathis J, Ibrahim SF Abstract Background: Rhinophyma is a dermatologic condition that can lead to severe disfiguration and psychological distress. Many therapies, both medical and surgical, have been reported, but few with acceptable and reproducible cosmesis. Objective: We assessed the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser resurfacing as a treatment modality for rhinophyma of all degrees. Design, Setting, and Participants: Eleven Caucasian male patients were classified into categories of mild, moderate, or severe rhinophyma and were treated at the University of Rochester Medical Center with a dual mode Er:YAG fully ablative laser. Measurements: Severity was graded as mild, moderate, or severe, based on the degree of distortion of normal anatomy. Results: The Er:YAG laser allowed for increased ablative precision, a decreased risk of complications, shorter downtime, and improved outcomes compared to currently available treatments. Conclusion: Our results suggest Er:YAG laser resurfacing is an effective treatment modality, with low risk and excellent, reproducible cosmetic outcomes, for patients with rhinophyma of any severity. PMID: 31531160 [PubMed] {url} = URL to article
    • Recognizing Rosacea: Tips on Differential Diagnosis J Drugs Dermatol. 2019 Sep 01;18(9):888-894 Authors: Johnson SM, Berg A, Barr C Abstract Rosacea is a common chronic inflammatory dermatosis with a variety of clinical manifestations. Rosacea primarily affects the central face, and includes papules, pustules, erythema, telangiectasias, perilesional redness, phymatous changes, and even ocular involvement. Symptoms may vary among different patients and even vary over time in an individual patient. Central facial redness affects many adults and can be an indicator of the chronic inflammatory disease rosacea. Rosacea is a clinical diagnosis based on the patient’s history, physical examination, and exclusion of other disorders. It is under-diagnosed, particularly in individuals with skin of color. The goal of this article is to provide clinicians with the tools and understanding needed to correctly identify rosacea and differentiate it from other conditions that have overlapping signs and symptoms. J Drugs Dermatol. 2019;18(9):888-894 PMID: 31524344 [PubMed - as supplied by publisher] {url} = URL to article
    • Anti-Inflammatory Dose Doxycycline Plus Adapalene 0.3% and Benzoyl Peroxide 2.5% Gel for Severe Acne J Drugs Dermatol. 2019 Sep 01;18(9):924-927 Authors: Kircik LH Abstract Acne is primarily an inflammatory disease. Anti-inflammatory dose doxycycline (40mg: 30mg immediate release and 10mg delayed release beads) is approved for the treatment of rosacea but with demonstrated efficacy for acne. Fixed combination adapalene 0.3% and benzoyl peroxide 2.5% gel is a once-daily formulation approved for the topical management of acne vulgaris. It has both anti-inflammatory and anti-comedogenic properties. Options for management of severe acne are somewhat limited; many patients are not candidates for or refuse treatment with isotretinoin. Systemic antibiotics may be indicated; acne treatment guidelines emphasize antibiotic stewardship in light of increasing concerns about antibiotic resistance and call for the judicious use of conventional systemic antibiotics. This single-center, open label pilot study involving 20 subjects with severe acne assessed the effects of combination treatment using anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel on IGA scores as well as inflammatory lesion, non-inflammatory lesion, and nodule counts. By week 12, 95% of subjects had at least a 2-grade improvement in IGA scores. Reductions in inflammatory and non-inflammatory lesion counts were statistically significant beginning at week 4 and continuing through week 12. By week 4, the percentage of patients with 0 nodules was 70%, compared to baseline of 20%. Further improvements were seen through week 12. Treatment was well-tolerated with no serious treatment-related adverse events. Combination treatment with anti-inflammatory dose doxycycline plus combination adapalene 0.3% and benzoyl peroxide 2.5% gel is safe and effective for management of severe acne. J Drugs Dermatol. 2019;18(9):924-927. PMID: 31524349 [PubMed - as supplied by publisher] {url} = URL to article
    • Intralesional Steroids for the Management of Periorificial Granulomatous Dermatitis J Drugs Dermatol. 2019 Sep 01;18(9):955 Authors: von Csiky-Sessoms S Abstract A 42-year-old male with skin type I and a history of rosacea and eczema presented with crusting, erythema, and pustules distributed on the left oral commissure. Angular cheilitis was diagnosed and regular petrolatum use recommended until resolution of the lesion. Eight days later, with no improvement in symptoms, fungal and bacterial cultures were performed which resulted in the growth of cutibacterium acnes, a variant of p. acnes. PMID: 31524997 [PubMed - as supplied by publisher] {url} = URL to article
    • The gut microbiome alterations in allergic and inflammatory skin diseases - an update. J Eur Acad Dermatol Venereol. 2019 Sep 14;: Authors: Polkowska-Pruszyńska B, Gerkowicz A, Krasowska D Abstract The human microbiome is a wide range of microorganisms residing in and on our body. The homeostasis between host immune system and the microbial environment allows mutual benefits and protection. Physiological bacterial colonization is essential for the establishment of organism immunity. The human microbiota ecosystem can be divided into several compartments, out of which intestinal flora strongly affects our health and plays a crucial role in the pathophysiology of many diseases. The gastrointestinal tract, being a major guardian of the immune system, maintains the homeostasis with the commensal microorganisms by tolerating the typical flora antigens. The dysbiosis may trigger an inflammatory response followed by tissue damage or autoimmune processes. The gut microbiome alterations are linked to the pathogenesis of the allergic, cardiovascular, gastrointestinal, metabolic, neurodevelopmental, psychiatric and neurodegenerative diseases and cancer. Moreover, there is increasing evidence connecting the skin condition with the gastrointestinal microbiome, which has been described as the skin-gut axis. The aim of this study was to review the literature regarding the role of the gut microbiome alterations in the pathogenesis of selected allergic and inflammatory skin diseases. PMID: 31520544 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Erythema of Rosacea Affects Health-Related Quality of Life: Results of a Survey Conducted in Collaboration with the National Rosacea Society. Dermatol Ther (Heidelb). 2019 Sep 11;: Authors: Baldwin HE, Harper J, Baradaran S, Patel V Abstract INTRODUCTION: Persistent facial erythema associated with rosacea may negatively impact quality of life (QoL), self-esteem, and self-confidence. We evaluated burden and health-related QoL (HRQoL) impacts of centrofacial erythema of rosacea. METHODS: A cross-sectional, Web-based survey conducted in collaboration with the National Rosacea Society enrolled adults who self-reported having received a physician diagnosis of rosacea and self-evaluated their current erythema as mild to severe on the validated Subject Self-Assessment for Rosacea Facial Redness. Sociodemographic and clinical characteristics, rosacea symptoms, and their impacts on QoL [validated Impact Assessment for Rosacea Facial Redness (IA-RFR)] and HRQoL [validated Dermatology Life Quality Index (DLQI)] were recorded. RESULTS: A total of 708 eligible respondents completed the survey (white/Caucasian, 93.5%; female, 83.1%; mean age, 52.4 years). Respondents had mild (59.2%), moderate (33.2%), or severe (7.6%) erythema. The most bothersome symptoms were persistent facial erythema (69.2%) and blushing/flushing (60.9%). Mean IA-RFR scores showed negative impacts across all severities of erythema. The mean (standard deviation) total DLQI score was 5.2 (6.0) overall [mild erythema, 3.8 (4.9); moderate, 5.7 (5.4); severe, 13.4 (8.9); P < 0.0001]. CONCLUSION: Centrofacial erythema of rosacea represents a substantial HRQoL burden, especially for those with more severe erythema. FUNDING: Allergan plc, Dublin, Ireland. PMID: 31512178 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Characterization and Analysis of the Skin Microbiota in Rosacea: A Case-Control Study. Am J Clin Dermatol. 2019 Sep 09;: Authors: Rainer BM, Thompson KG, Antonescu C, Florea L, Mongodin EF, Bui J, Fischer AH, Pasieka HB, Garza LA, Kang S, Chien AL Abstract BACKGROUND: The efficacy of antibiotics in rosacea treatment suggests a role for microorganisms in its pathophysiology. Growing concern over the adverse effects of antibiotic use presents a need for targeted antimicrobial treatment in rosacea. OBJECTIVE: We performed a case-control study to investigate the skin microbiota in patients with rosacea compared to controls matched by age, sex, and race. METHODS: Nineteen participants with rosacea, erythematotelangiectatic, papulopustular, or both, were matched to 19 rosacea-free controls. DNA was extracted from skin swabs of the nose and bilateral cheeks of participants. Sequencing of the V3V4 region of the bacterial 16S ribosomal RNA gene was performed using Illumina MiSeq and analyzed using QIIME/MetaStats 2.0 software. RESULTS: Compared with controls, skin microbiota in erythematotelangiectatic rosacea was depleted in Roseomonas mucosa (p = 0.004). Papulopustular rosacea was enriched in Campylobacter ureolyticus (p = 0.001), Corynebacterium kroppenstedtii (p = 0.008), and the oral flora Prevotella intermedia (p = 0.001). The highest relative abundance of C. kroppenstedtii was observed in patients with both erythematotelangiectatic and papulopustular rosacea (19.2%), followed by papulopustular (5.06%) and erythematotelangiectatic (1.21%) rosacea. C. kroppenstedtii was also associated with more extensive disease, with the highest relative abundance in rosacea affecting both the cheeks and nose (2.82%), followed by rosacea sparing the nose (1.93%), and controls (0.19%). CONCLUSIONS: The skin microbiota in individuals with rosacea displays changes from that of healthy skin, suggesting that further studies examining a potential role for the skin microbiota in the pathophysiology of rosacea may be warranted. PMID: 31502207 [PubMed - as supplied by publisher] {url} = URL to article
    • The Presence of Demodex Mites in Patients with Dermatologic Symptoms of the Face Turkiye Parazitol Derg. 2019 Sep 10;43(3):143-148 Authors: Yazısız H, Çekin Y, Koçlar FG Abstract Objective: The aim of the study was to investigate the Demodex prevalence in patients with dermatological complaints who were admitted to our hospital, and to evaluate the socio-demographic characteristics and risk factors of the patients. Methods: A total of 133 patients who were sent for Demodex screening were included and questionnaire for risk factors was administered. Samples were taken by standard superficial skin biopsy method and the different developmental stages were investigated under microscope. Results: Demodex species were found in 93 (69.9%) of the patients. Demodex folliculorum was found in 58 (62.4%) of the patients, Demodex brevis in 13 (14%), Demodex folliculorum and Demodex brevis in 4 (4.3%) and Demodex species in 18 (19.4%) of the patients. At least one of the Demodex species was found in 77.1% of patients with acne rosacea. No statistically significant relation was found between Demodex positivity and age, gender, number of weekly baths, use of makeup, and common towel use. Though statistically not significant, an increase of Demodex infestation with increasing age was observed. Conclusion: Demodex mite infestations are widespread worldwide without showing important racial and gender differences. In the present study, prevalence of Demodex infestation in patients with acne rosacea was high and this should be taken into consideration, when such patients are treated for their symptoms. PMID: 31502805 [PubMed - as supplied by publisher] {url} = URL to article
    • A new paper published in the September 2019 issue of The Journal of the European Academy of Dermatology and Venereology states that treatment using benzyl benzoate and crotamiton has been shown to decrease demodex density counts and improve demodectic rosacea. Benzyl Benzoate is a medication and insect repellent also used to treat scabies and lice. Crotamiton has been used to treat rosacea for sometime now and has traditionally been used to treat scabies. For more information. 
    • Evaluating rosacea noninvasively and objectively. Br J Dermatol. 2019 Sep 08;: Authors: Tan J PMID: 31494921 [PubMed - as supplied by publisher] {url} = URL to article
    • The Role of Topical Probiotics on Skin Conditions: A Systematic Review of Animal and Human Studies and Implications for Future Therapies. Exp Dermatol. 2019 Sep 08;: Authors: Knackstedt R, Knackstedt T, Gatherwright J Abstract There is increasing evidence that the intestinal microbiome plays an important role in modulating systemic inflammation and disease. Oral probiotics can modulate the intestinal microbiome and have demonstrated to be efficacious in treating topical skin conditions, such as atopic dermatitis, acne and rosacea. By proxy, exogenous application to the skin of probiotics should also promote a positive bacterial balance to mitigate or potentially eliminate pathologic conditions. The goal of this article is to provide a systematic review of studies that have investigated the role of topical probiotics in mitigating skin conditions. Additionally, skin conditions where dysbiosis have been identified but topical probiotics have not been investigated are discussed. We hope this review both analyzes the evidence for the role that topical probiotics could play in topical skin conditions, as well as highlights additional areas in need of research and exploration. PMID: 31494971 [PubMed - as supplied by publisher] {url} = URL to article
    • Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms. J Eur Acad Dermatol Venereol. 2019 Sep 07;: Authors: Forton FMN, De Maertelaer V Abstract BACKGROUND: Patients with rosacea or demodicosis have high facial skin Demodex densities (Dds). Topical ivermectin, benzyl benzoate (BB) and crotamiton have been shown to decrease Dds in vivo, but there are few data on the clinical and acaricidal effects of BB among patients with rosacea. OBJECTIVE: To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms of rosacea and demodicosis, and compare three BB treatment regimens. METHODS: In this retrospective observational study, 394 patients (117 with rosacea, 277 with demodicosis) were included. Three BB (+crotamiton) treatment regimens were compared: 12% once daily, 12% twice daily and 20% once daily. Dds were measured using two consecutive standardized skin surface biopsies (superficial [SSSB1] and deep [SSSB2]) before treatment and at the first follow-up. Symptoms were evaluated using investigator global assessment. Treatment was considered effective if the Dd had normalized (SSSB1 ≤5 D/cm2 AND SSSB2 ≤10 D/cm2 ) or symptoms had cleared and curative if the Dd had normalized and symptoms had cleared. RESULTS: At an average of 2.7 months after treatment start, the total Dd (SSSB1+2) had decreased by 72.4±2.6% from the initial value across the whole cohort. Dds had normalized in 139 patients (35%) and symptoms had cleared in 122 (31%). Treatment was effective in 183 (46%) patients and curative in 78 (20%). Compliance was good: 77% of patients correctly followed treatment instructions. Results were similar in patients with rosacea and those with demodicosis. The 12% once daily regimen was less effective than the other doses, and had poorer compliance than the 12% twice daily regimen. CONCLUSION: Topical treatment with BB (+crotamiton) may be an effective treatment for rosacea as well as demodicosis, indirectly supporting a key role of the mite in the pathophysiology of rosacea. The two higher dose regimens were more effective than the lower dose. PMID: 31494991 [PubMed - as supplied by publisher] {url} = URL to article
    • There are a number of papers warning about allergic contact dermatitis to topical brimonidine (Mirvaso):  Case Report: Allergic Contact Dermatitis to Topical Brimonidine Demonstrated With Patch Testing: Insights on Evaluation of Brimonidine Sensitization. Allergic contact dermatitis caused by Mirvaso®, brimonidine tartrate gel 0.33%, a new topical treatment for rosaceal erythema. [Allergic contact dermatitis to Mirvaso® (brimonidine tartrate)]. Allergic contact dermatitis to topical brimonidine. Sensitization to and allergic contact dermatitis caused by Mirvaso(®) (brimonidine tartrate) for treatment of rosacea - 2 cases.
    • Related Articles Case Report: Allergic Contact Dermatitis to Topical Brimonidine Demonstrated With Patch Testing: Insights on Evaluation of Brimonidine Sensitization. J Cutan Med Surg. 2018 Nov/Dec;22(6):636-638 Authors: Ringuet J, Houle MC PMID: 30016883 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Do blood groups play a role in etiology of rosacea? J Cosmet Dermatol. 2019 Sep 05;: Authors: Ozturk M, An I Abstract BACKGROUND: The pathogenesis of rosacea is not fully understood. The innate immune system is impaired in patients with rosacea. This leads to abnormal inflammatory cytokine release. It has been proposed that the molecular mechanism for the role of the ABO antigenic system in human diseases may arise from its relationship with the von Willebrand factor and several pro-inflammatory and adhesion molecules. To our knowledge, the relationship between ABO-Rh groups and rosacea has not been investigated previously. MATERIALS AND METHODS: One hundred and fourteen patients with rosacea and 258 healthy individuals who had blood group record were included in this study. The results were analyzed statistically. RESULTS: In terms of ABO blood groups, 54 (47.4%) patients had A, 14 (12.3%) patients had B, 7 (6.1%) patients had AB, and 39 (34.2%) patients had O blood groups in the patient group. In the control group, 109 (42.2%) individuals had A, 45 (17.5%) individuals had B, 29 (11.2%) individuals had AB, and 75 (29.1%) individuals had O blood group. There was no significant difference between the groups (P > .05). In terms of Rh groups, 103 (90.4%) patients were Rh (+) and 11 (9.6%) patients were Rh (-). In the control group, 220 (85.3%) individuals were Rh (+) and 38 (14.7%) were Rh (-). There was no significant difference between the groups (P > .05). CONCLUSION: We did not find a relationship between blood groups and rosacea. But, we think this is an interesting hypothesis. To clarify this possible relationship, comprehensive and further studies are needed in different races and geographic regions. PMID: 31486572 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Establishing the diagnosis of rosacea in skin of color patients. Cutis. 2019 Jul;104(1):38-41 Authors: Onalaja AA, Lester JC, Taylor SC Abstract Rosacea is a chronic inflammatory cutaneous disorder that may be underreported and underrecognized in skin of color (SOC) patients. There are several skin disorders that can present with the classic features of rosacea, such as erythema, papules, and pustules, which can confound the diagnosis. To promote accurate and timely diagnosis of rosacea, we review possible rosacea mimickers in SOC patients. PMID: 31487335 [PubMed - in process] {url} = URL to article
    • Related Articles Update on rosacea classification and its controversies. Cutis. 2019 Jul;104(1):70-73 Authors: Wang YA, James WD Abstract Rosacea is an inflammatory skin condition that, despite its prevalence, remains imperfectly understood. Without "gold standard" laboratory markers, the diagnosis depends greatly on clinical judgment and the nomenclature used. Throughout the years, the classification schemas for rosacea have changed as clinicians and researchers study the condition. Herein, we highlight the fundamental differences between the proposed classification systems for rosacea, emphasize the areas for improvement, and discuss the implications on clinical decision-making and patient care. PMID: 31487337 [PubMed - in process] {url} = URL to article
    • Related Articles Severe Acne and Metabolic Syndrome: A Possible Correlation. Dermatology. 2019 Sep 04;:1-7 Authors: Biagi LG, Sañudo A, Bagatin E Abstract BACKGROUND/PURPOSE: Chronic inflammatory skin diseases have been shown to increase or predispose metabolic or vascular damage. However, little is known about systemic effects of the pro-inflammatory state of severe acne. We analyzed data of 85 patients at Lipid Outpatient Clinics (UNIFESP/EPM) who were treated for metabolic syndrome (MS). Medical history and physical examinations were performed in order to search characteristics of acne scars. METHODS: Patients' electronic records were accessed for one year. The ones presenting MS were evaluated by clinical examination in order to detect presence of acne scars. Clinical analysis comprised anamnesis, measurement of abdominal circumference, blood pressure, and body mass index (BMI). Laboratory tests included fasting glucose, CBC, serum levels of insulin, triglycerides, LDL, HDL, ALT, AST, urea, and creatinine. Statistical analysis consisted of prevalence (95% CI) of acne history/scars among patients treated at the Lipid Outpatient Clinics. The χ2 test, Pearson's test, or Fisher's exact test was used to evaluate the association of social and demographic data, clinical and lab exams with the presence of MS or acne scars. Statistical 5% significance level was adopted. RESULTS: Fifty-two patients confirmed having a medical history of acne, and 33 denied. Acne scars were found in 61.17%. There was no statistical difference between the groups according to medium value of BMI, hypertension, abdominal circumference, and serum levels of hemoglobin, leucocytes, platelets, triglycerides, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. Twenty-seven out of the 52 patients with acne history presented acne scars, which symbolizes a 31.76% prevalence. This equals a 51.92% prevalence among all patients with acne history. There was no statistical difference among groups according to mean (±SD) in data such as family history, weight, BMI, hypertension, abdominal circumference, serum levels of hemoglobin, leucocytes, platelets, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. A statistical difference in the triglyceride level was present, being elevated in patients with acne scars. DISCUSSION: Apart from the limitation (small sample size), a correlation between acne and MS could be suggested. The high prevalence of acne history/scars in patients treated for MS may indicate a possible correlation with any type of acne. This hypothesis may raise discussion about an association like the already proven risk of metabolic alterations in other inflammatory chronic dermatoses, such as psoriasis or rosacea, regardless of acne severity. We highlight the importance of early treatment and follow-up for patients with MS that could be observed in this study, as clinical and laboratory criteria were all within normal levels among patients from that specific outpatient clinic. Results can draw attention to evaluation of clinical and laboratory investigation related to risk of MS. It corroborates to early diagnosis and prevention of complications of MS. Further studies are needed to confirm our findings. PMID: 31484190 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles A case of fractional microneedling radiofrequency induced rosacea. J Cosmet Laser Ther. 2019 Sep 02;:1-3 Authors: Aşiran Serdar Z, Aktaş Karabay E Abstract Fractional microneedling radiofrequency (FMR) has been reported to improve cutaneous wrinkles due to its effects of inducing neoelastogenesis and neocollagenosis. Furthermore, FMR has shown to be effective in acne scars, acne lesions, hyperhidrosis, acne-related postinflammatory erythema and recently in rosacea. FMR treatment has been suggested to improve rosacea by reducing inflammation and abnormal vessel proliferation. Here we present a 61-year-old female who developed rosacea symptoms after the treatment of FMR for cutaneous wrinkles. Since the case shows conflictory findings with the previous data, it was found worthy presentation. PMID: 31476963 [PubMed - as supplied by publisher] {url} = URL to article
    • The benzoyl peroxide only clears papules/pustules for me. It doesn't have any effect on reducing redness in my case but it can increase redness if I leave in on too long. Short contact therapy can be a good alternative for those with sensitive skin but if you're only dealing with subtype 1 rosacea (red face) then I don't think it will help.
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