Rosacea Research Articles

41958 Efficacy and safety of topical agents for moderate-to-severe papulopustular rosacea: a systematic review and network meta-analysis

41958 Efficacy and safety of topical agents for moderate-to-severe papulopustular rosacea: a systematic review and network meta-analysis

41395 Combination of skin micro-needling and topical application of tranexamic acid and vitamin C: New clinical application: A pilot study for treatment of erythematotelangiectatic rosacea

41395 Combination of skin micro-needling and topical application of tranexamic acid and vitamin C: New clinical application: A pilot study for treatment of erythematotelangiectatic rosacea

Follicular scales, scalp and ocular involvement in patients with papulopustular rosacea: prevalence and association with Demodex mite proliferation.

Facial follicular scales, dandruff, scalp itching and ocular alterations are lesser-known signs of rosacea and demodicosis. The aim of this prospective original study was to investigate the presence of these signs and symptoms in patients with almost-clear, mild and moderate papulopustular rosacea (PPR) and to study the differences between Demodex-positive (D+) and Demodex-negative (D-) rosacea. Twenty-seven out of 60 patients (45%) presented follicular scales, 24 (40%) ocular involvement and 22 (36.67%) scalp involvement. Follicular scales were more frequently observed in mild and moderate than in almost-clear rosacea (P<0.001). Itching of the scalp was more frequently reported in patients with moderate rosacea than in those with mild disease (P=0.05). Follicular scales (P=0.002) and scalp itching (P=0.05) were more frequently reported in D+ than in D- patients. Among D+ patients, scalp itching was more frequently reported in mild than in almost clear rosacea (P=0.01) and ocular symptoms associated to scalp itching were more frequently reported in moderate than in almost-clear rosacea (P=0.05). We suggest looking for these signs and symptoms in all patients with PPR, because they can be a sign of a more severe form of rosacea or of demod-icosis.

CHRONIC INFLAMMATORY DERMATOSIS: ROSACEA, OVERVIEW, DESCRIPTION, PRESENTATION, EPIDEMIOLOGY, PATHOPHYSIOLOGY, TYPES, DIFFERENTIAL DIAGNOSIS, TREATMENT OF THE DISEASE AND ITS ROLE IN PREGNANCY

Introduction: Rosacea is a chronic inflammatory dermatosis involving especially the cheeks, nose, chin and forehead, characterized by repetitive episodes of transient flushing or erythema, persistent erythema, in addition to phymatous changes, papules, pustules and telangiectasias. Objective: to detail the current information related to rosacea, description, presentation, epidemiology, pathophysiology, types, differential diagnosis, treatment of the disease and its role in pregnancy. Methodology: a total of 50 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 39 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: rosacea, treatment, chronic inflammatory dermatosis. Results: Phymatous changes are not frequent, however they occur primarily in the nose (rhinophyma) and more commonly in men. Rosacea usually begins between 30 and 50 years of age, however it can occur at any age. The approximate population prevalence is between less than 1 to 22%. The neurocutaneous mechanisms in rosacea, reflecting reactivity to temperature change, alcohol, sports, UV rays and spicy foods, may be mediated by the ankyrin and vanilloid subfamilies of the transient receptor potential (TRP). Increased rosacea can occur in pregnancy and multiple cases linked to rosacea fulminans (RF) are reported in the literature. Conclusions: Rosacea is characterized by repetitive episodes of redness, persistent erythema, inflammatory papules-pustules and telangiectasias. Previously rosacea was divided into ocular, phymatous, fulminant and granulomatous types, however there is now a new classification of rosacea. In the treatment the first thing is to identify the trigger, then make some general recommendations on the skin such as the use of sunscreen and finally give treatment that can be both topical and systemic or even to use laser or other procedures. The differential diagnosis of rosacea is broad and should be carefully analyzed. Treatment in pregnant women is a huge challenge, because several of the treatments for rosacea are contraindicated or have limited evidence of probable side effects to the fetus. KEYWORDS: rosacea,treatment,dermatosis,inflammatory.

ApoB-depleted serum-mediated macrophage cholesterol efflux is preserved in Erythematotelangiectatic Rosacea

ApoB-depleted serum-mediated macrophage cholesterol efflux is preserved in Erythematotelangiectatic Rosacea

Clinicopathological Survey of 204 Rosacea Patients Regarding Rosacea Subgroups and Severity.

Few studies have evaluated the histopathological characteristics of clinical rosacea subtypes in detail. To assess rosacea histopathological features in correspondence to clinical subgroups. The histopathological findings of 204 rosacea patients were analyzed retrospectively and were compared among clinical subtypes. Thirt-Two Percent of patients were male and 68% were female. Seventy-three patients had erythematotelangiectatic rosacea (ETR) and 110 had papulopustular rosacea (PPR), 12 were ETR + PPR, 4 ocular, 2 phymatous, and 3 had Morbihan's edema. Perivascular and perifollicular lymphohistiocytic infiltration, perifollicular exocytosis, follicular spongiosis, and ectatic vessels were almost found in all subtypes. Solar elastosis was higher in ETR. Spongiosis, exocytosis of inflammatory cells into epidermis, acanthosis, and granulomatous reaction were higher in PPR. Inflammatory cells exocytosis was more in PPR and phymatous. Demodex folliculorum was identified in 27% of ETR, 33.6% of PPR, 50% of phymatous, one ocular patient, and none of Morbihan edema. Demodex brevis were found in 5% of ETR, 3% of PPR, and 50% of phymatous. Demodex brevis not folliculorum was more in phymatous. Spongiosis was the most common finding in ocular rosacea. Spongiosis, exocytosis of inflammatory cells, and granulomatous reactions were more in PPR. Solar elastosis was more in ETR. Histopathological findings were compatible with clinical subgroups.

Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin.

Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.

A Prospective Randomized Controlled Pilot Study to Assess the Response and Tolerability of Cold Atmospheric Plasma for Rosacea

Introduction: Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. Methods: In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 s/area) for 6 weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after 6 weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p values were calculated using the Wilcoxon signed-rank test. Results: Twelve subjects (ETR, n = 3; ETR and PPR, n = 9) completed the study. DLQI was significantly improved after 6 weeks (p = 0.007). On the CAP-treated side, lesions (p = 0.007) and erythema size (p = 0.041) were significantly reduced compared to the control. IGA (p = 0.2) and skin redness intensity (p = 0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. Conclusion: CAP is a promising new treatment of rosacea, especially for PPR.

Current views on pathogenesis of rosacea

Rosacea is a chronic inflammatory disease that usually affects the central part of the face. The primary symptoms include facial flushing, persistent erythema, telangiectasia, inflammatory pustules and papules. Based on groups of these symptoms, four basic rosacea subtypes have been defined: erythematotelangiectatic, papulopustular, ocular, phymatous; and one variant, granulomatous rosacea. Although the pathophysiology of this disorder is not fully known, many components such as immune and neurovascular dysregulation, oxidative stress, genetic background, gut microbiome, skin microbiome as well as external aspects are thought to play a role. In this article, we present the main factors that are speculated to be involved in the pathogenesis of rosacea. Methods and materials: We reviewed the literature available on PubMed and Google Scholar using the words "rosacea”, „rosacea pathogenesis”, „demodex”, „reactive oxygen species”, „rosacea microbiome”. Summary Rosacea is a chronic dermatosis whose etiology, despite many studies, is not fully understood. Currently, an abnormal inflammatory reaction caused by excessive stimulation of TLR-2 receptors is suspected as the main factor in the pathomechanism of the disease. Vascular disorders, transmission disorders, genetic factors, skin and intestinal dysbiosis also participate in the pathogenesis of rosacea. It is assumed that exogenous factors such as diet and exposure to UV radiation also play a role in the development of the disease.

Application of topical 2% cyclosporine A in inflammatory ocular surface diseases.

To report our experience with the 2% cyclosporin A (CsA) in a series of challenging inflammatory ocular surface diseases due to different etiologies. The records of patients who received topical 2% CsA for different indications were reviewed retrospectively. Demographic characteristics, indications for treatment, patient symptoms and clinical findings were recorded. Fifty-two eyes of 52 patients were included. Mean age was 43.2 ± 14.3 (11-66) years with a F/M ratio of 34/18. Indications included pediatric acne rosacea (n = 4), adenoviral corneal subepithelial infiltrates (n = 12), filamentary keratitis (n = 14), pterygium recurrence (n = 15), herpetic marginal keratitis (n = 2) and graft versus host disease (n = 5 patients). Mean duration of treatment was 7.3 ± 2.8 (3-10) months. Forty-three (83%) patients reported favorable outcome with improvement in symptoms after a mean time of 4.4 ± 2.7 (2-6) months. Topical 2% CsA may address the needs of different cases with ocular surface inflammation, as a safe option for long-term therapy.

Treatment of severe erythematotelangiectatic rosacea with intense pulsed light: a case report

Treatment of severe erythematotelangiectatic rosacea with intense pulsed light: a case report

H08 The Crimson Chronicles of acne rosacea: a fascinating tale of medicine and culture

Abstract Acne rosacea is a common skin condition that affects people with Fitzpatrick skin types I–III and is characterized by flushing, erythema, telangiectasia, pustules, papules and phyma (Jansen T. Clinical presentations and classification of rosacea. Ann Dermatol Venereol 2011; 138:3). This condition has been around for centuries and is referred to in literature and art throughout history. The earliest reference to acne rosacea can be traced back to the third century Bc, where it was mentioned in the writings of Greek poet Theocritus. It has also been referred to in various forms of literature, including the character of Summoner in Chaucer’s Canterbury Tales and Bardolf in Shakespeare’s Henry VI (Cribier B. Histoires de visages rouges. Ann Dermatol Venereol 2011; 138:2). In art, the condition is famously depicted in Italian Renaissance painter Domenico Ghirlandaio’s ‘The Old Man and His Grandson’, now housed in the Louvre. The colour red, a prominent characteristic of acne rosacea, has had a significant role in literature, symbolizing everything from love and passion to anger and violence. French novelists Balzac and Proust used it as a motif in ‘The Red Face’ or ‘Le Visage Rouge’ to denote violence and as a marker of the working classes. In the 14th century, French surgeon Guy de Chauliac was the first to document clinically the condition, referring to it as goutterose or ‘pink droplet’. It was in the 18th and 19th centuries that significant strides were made in understanding the nature of acne rosacea. Dr Jean Astruc, known as the father of venereal diseases, characterized the condition as ‘erythematous, varicose and scaly’. In 1812, the official term ‘acne rosacea’ first appeared in a medical text by English dermatologist Dr Thomas Bateman. Further references to the condition can be found in the 1817 publication On Cutaneous Diseases by dermatology pioneer Dr Robert Willan. In 1834, physician Robert Macnish explicitly linked acne rosacea to alcohol consumption in his book Anatomy of Drunkenness. The differentiation between acne vulgaris and acne rosacea was firmly established following the work of Austrian dermatologist Hebra and French dermatologist Darier. In the past, treatments for acne rosacea included salves containing mercury, sulfur, bull’s blood, blood-letting and leeches. Today, topical and oral antibiotics are the standard treatments, a far cry from the remedies of yesteryear. In conclusion, the history of acne rosacea, which is so much more than just le visage rouge, is a captivating journey that spans centuries, from its earliest references in literature and art to the contemporary understanding and treatment of the condition.

Optical coherence tomography angiography aspects of the retinal and optic disc microvascular morphology in erythemato-telangectatic rosacea

BackgroundTo investigate retinal and optic disc (OD) microvascular morphological changes in erythemato-telangiectatic rosacea (ETR) patients using optical coherence tomography angiography (OCTA), and compare the findings to age- and gender-matched healthy individuals. MethodsThis study included newly diagnosed 31 ETR patients (31 right eyes, group 1) who were clinically diagnosed by two experienced dermatologists. A control group had 32 healthy individuals (32 right eyes, group 2). Demographic data, including age and gender were collected, followed by a thorough ophthalmologic exam. A 6 × 6 mm macular OCTA analysis of superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), as well as foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), foveal VDs 300 µm area around FAZ (FD-300), and flow areas in the outer retinal and choriocapillaris, was then performed. ResultsMean age in groups 1 and 2 was 43.70 ± 13.02 and 43.62 ± 12.30 years, respectively (p=0.979). Male-to-female ratio in group 1 was 4:27 and 4:28 in group 2. Capillary flow analysis revealed slightly higher values in group 1 than in group 2, with the former having a significantly higher select area in the outer retinal layer (p=0.001) and flow area in the choriocapillaris (p=0.002). Despite slightly higher values in group 1, there were no significant differences in SCP and DCP VDs (p > 0.05), FAZ area (p=0.471), PERIM (p=0.778), or FD-300 (p=0.527). ConclusionsETR appears to be associated with posterior segment changes, especially retinal microvascular morphology, even in asymptomatic ocular conditions. Given the disease's high rate of misdiagnosis, understanding rosacea-induced ocular manifestations is critical for ophthalmologists

#2950 IGA NEPHROPATHY: PUTTING THE A IN THE UNACQUAINTED

Abstract Background and Aims IgA nephropathy (IgAN) is a common glomerulonephritis. Rarely it can be associated with other diseases and screening for these associations can be missed. We present 2 cases diagnosed as IgAN which were associated with rare underlying conditions. The first (patient X) is a 51-year-old female, who presented with new onset haematoproteinuria on a background of inflammatory arthritis, interstitial lung disease (ILD) and a recurrent maculopapular rash. The second case (patient Y) is a 34-year-old male, who presented with unexplained rapidly progressive chronic kidney disease and proteinuria. He had a background of hidradenitis suppurativa, acne rosacea, Crohn's disease and recurrent infections. Method X's immunology was negative aside from a weakly positive ANA and p-ANCA but negative ELISA. Her myositis panel was positive for PM/ScL antibody. Imaging showed multifocal ground glass opacification, consistent with ILD. Her renal function was normal, but renal histology demonstrated IgAN, without evidence of vasculitis. With these findings in mind, a diagnosis of anti-synthetase syndrome (AS) with IgAN was proposed. Y, conversely, had abnormal renal function, with significant proteinuria. Immunology screen was unremarkable other than a raised serum IgA, weakly positive MPO and equivocal PR3. Renal biopsy showed IgAN with severe interstitial fibrosis and tubular atrophy, and over 50% sclerosed glomeruli. Y later developed haemolytic anaemia; his neutrophil oxidase activity was absent, raising the possible diagnosis of chronic granulomatous disease (CGD). This was subsequently confirmed with genetic testing demonstrating an autosomal recessive gene for CGD. Results Both X's proteinuria and symptomatic burden significantly improved with methotrexate. Y was commenced on antibiotics and antifungals in light of the heightened risk of infection which CGD carries. He is now on maintenance haemodialysis. The only curative treatment for CGD is allogenic hematopoietic stem cell transplantation from a matched donor, for which he is being considered. Conclusion AS is a poorly defined, rare syndrome characterised clinically by ILD, arthritis and myositis. It is immunologically characterised by autoantibodies against aminoacyl tRNA synthetases; whilst X did not test positive, this does not preclude AS, as autoantibody titres fluctuate depending on disease activity [1]. Renal involvement in AS is extremely rare, or so the data would suggest. Couvrat-Desvergnes et al. examined 14 biopsies of patients with inflammatory myopathies plus renal involvement. Only 3 had AS; of these, 2 had IgAN. Other cases of IgA are described only in case reports. In all cases, immunosuppressive treatments were effective in achieving remission. Some cases describe other renal implications in AS, namely TMA and amyloidosis (Table 1). CGD is a rare primary immunodeficiency caused by genetic defects in the NADPH oxidase complex, which is critical in the destruction of phagocytes. Consequently, patients have recurrent infections and abnormal inflammatory responses result in granuloma formation. The incidence of renal disease in CGD has been suggested by some papers as being as low as 2.7% [2]. From review of the other cases of CGD with associated IgAN, it seems the patient we present is the oldest (Table 2). Interestingly, only 1 other case reports glomerulonephritis as the presenting complaint for CGD [3]. These cases highlight that, while IgAN is a disease in its own right, its diagnosis may shine light on other associated pathologies. It is crucial for nephrologists to be aware of rare associations as often it has impact on further management.

Markedly clinical improvement of papulopustular rosacea with multimodality therapeutic approach: a case report

Introduction: Rosacea is a chronic inflammatory skin disease that mainly affects the central area of the face. There are four subtypes, and they may progress between subtypes or span multiple subtypes. Due to its long course of the disease, optimum treatments are needed to control the disease progression. Case: We reported rapid improvement of combining topical metronidazole, doxycycline, and light emitting diode for treating a patient with papulopustular rosacea in a 44-years-old woman, a week from the initial therapy. Discussion: Therapeutic approaches to rosacea mainly focus on controlling the symptoms with anti-inflammatory agents. More recently, photodynamic therapy, especially light-emitting diodes, has been introduced as a valid alternative or an adjuvant therapy to conventional treatment through their synergic mechanism between therapeutic modalities. Conclusions: This combination treatment may be effective for treating papulopustular rosacea without any side effects.

Solid Facial Edema: A Rare Complication in Acne

Solid persistent facial edema is a rare and poorly understood condition that can be a serious complication of acne vulgaris and rosacea. It manifests as a slow onset of persistent lymphedema in the upper two-thirds of the face and can lead to significant cosmetic disfigurement affecting a patient's self-esteem and mental health. This article presents a case of persistent facial edema in a patient with severe acne and discusses the diagnosis and management of this rare condition.

Cytokine profile of the epidermis is region specific and may determine the characteristics of inflammation.

Recent data indicate that distinct skin areas show different microbial/chemical milieu. Keratinocytes (KC) respond to these stimuli by producing cytokine mediators. Therefore, we aimed to determine KC-derived cytokine expression in distinct healthy skin regions (gland-poor [GP], sebaceous gland-rich [SGR] and apocrine gland-rich [AGR]), and their changes in skin diseases of the given regions (atopic dermatitis [AD], papulopustular rosacea [PPR] and psoriasis). Cytokines were analysed at the mRNA and protein levels, and literature analysis was performed for functional categorization. The three regions showed characteristically different cytokine patterns. GP was featured by an IL-25/IL-33/IL-36RA/IL-38/IL-18 cytokine milieu, SGR was characterized by IL-23/IL-17C/IL-18, and AGR skin exhibited a mixed IL-25/IL-33/IL-23/IL-18 profile. Literature analyses revealed different homeostatic and proinflammatory roles of these cytokine patterns (Th2 related in GP, Th17 related in SGR and mixed Th2/Th17 in AGR). In skin diseases which are primarily epidermal cytokine-driven (AD, PPR), the level of the regionally characteristic cytokines were further elevated, in contrast to the autoantigen-driven psoriasis, where the cytokine pattern was independent from the localization. Healthy skin regions are equipped with different KC-derived cytokine profiles, which may influence each region's capability of mediator production in certain types of dermatoses.

628 The efficacy and safety of minocycline, metronidazole, ivermectin, and azelaic acid in moderate-to-severe papulopustular rosacea: A systematic review and network meta analysis

628 The efficacy and safety of minocycline, metronidazole, ivermectin, and azelaic acid in moderate-to-severe papulopustular rosacea: A systematic review and network meta analysis

648 Sequential therapy for erythematotelangiectatic rosacea: Alpha-hydroxy acid (AHA) 30% chemical peels in combination with intense pulsed light (IPL) could be an alternative to carvedilol

648 Sequential therapy for erythematotelangiectatic rosacea: Alpha-hydroxy acid (AHA) 30% chemical peels in combination with intense pulsed light (IPL) could be an alternative to carvedilol

647 Combination treatment of daylight photodynamic therapy (DL-PDT) and alpha-hydroxy acid(AHA) 30% chemical peels as a novel effective treatment for severe papulopustular rosacea

647 Combination treatment of daylight photodynamic therapy (DL-PDT) and alpha-hydroxy acid(AHA) 30% chemical peels as a novel effective treatment for severe papulopustular rosacea