Treatment Of Rosacea Research Articles

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.

New approaches to the treatment of rosacea on the basis pathogenesis factors and clinical forms

Uncovering the molecular mechanisms of the rosacea pathogenesis and treatment are still of great importance. The review encompasses the modern knowledge of rosacea classification, characterization of the severity of the course of the subtypes, and pathogenesis features. Recent methods of rosacea treatment are presented, including the use of botulinum neuroprotein for the correction of the erythematous-telangiectatic subtype of the dermatosis.
 The relevance of this problem is due to the chronic course of the disease and the peculiarity of the localization of rosacea manifestations that leads to a traumatic effect and often causes social exclusion of patients.
 The rise of the rosacea incidences, along with other reasons like characteristics of the course of dermatosis, accompanied by frequent long-term relapses, is due to the resistance to generally accepted methods of drug therapy, often resulting in shortened clinical remission. All the factors lead to decreasing of patients life quality that require the search for effective therapy approaches. Among modern rosacea therapy, the application of botulinum neuroprotein is widely used; however, the clinical studies confirming the effectiveness of this technique are not presented enough.

Development of a Specific Variant of Patient Benefit Index (PBI) Assessing Patient Needs, Goals and Benefits in Rosacea Treatment.

Evaluation of patient-reported outcomes including health-related quality of life (HRQoL) and perceived benefits from treatment has become a fundamental component of medical decision-making. Standardized evaluation of treatment benefits in rosacea based on patient preferences is still lacking. Development and validation of an instrument for recording patient-defined benefits in rosacea therapy based on the Patient Benefit Index (PBI) methodology. In an open survey of n = 50 patients, potential benefits of therapy from the patient's perspective were examined. The generated item pool was combined with pre-existing PBI items for other skin conditions and reviewed by an expert panel of dermatologists, psychologists and patients. Items were condensed to n = 25 and converted into a Likert-scaled questionnaire. The validity and feasibility of the resulting Patient Benefit Index for rosacea (PBI-RO) were tested on individuals with rosacea recruited from a German rosacea patient organization. N = 446 patients with rosacea completed the PBI-RO. The internal consistencies measured by Cronbach's alpha were high (Patient Needs Questionnaire [PNQ] 0.94). Mean PBI-RO was 1.9 ± 1.2 (scale from 0 = no benefit to 4 = maximum benefit), 23.5% of the patients experienced a PBI-RO < 1 (no clinically relevant benefit). The PBI-RO correlated with HRQoL, health state, current extent of rosacea lesions and treatment satisfaction. The highest correlation was found between PBI-RO and satisfaction with previous treatment (r = -0.59, p < 0.001); correlation with the extent of rosacea lesions was low (r = 0.16, p < 0.001). The PBI-RO shows satisfying internal consistency and construct validity. It offers the option of a patient-weighted evaluation of the therapeutic benefit of rosacea therapy and may add to more stringent goal orientation in therapy.

The Role of Cosmetology in an Effective Treatment of Rosacea: A Narrative Review.

Rosacea is a chronic inflammatory facial skin disease usually occurring in middle-aged patients. It manifests itself as an inflammatory condition with perivascular infiltrate, dilated blood vessels, lymphoedema, hyperplasia of sebaceous glands, and disorders of connective tissue structures brought on by fibrosis. Rosacea is characterized by multifactorial inflammatory mechanisms, and therefore it requires an interdisciplinary approach including adequate skin care, topical and/or systemic therapy, and physical modalities to successfully treat the various symptoms and disease subtypes. However, data regarding the possible role of cosmetologists in rosacea remains scanty and equivocal. The objectives of cosmetology therapy include restoration and regeneration, anti-inflammatory effects, the strengthening of blood vessels and regulation of their permeability, and the regulation of keratinization. Vascular abnormalities can be targeted with specific light and laser devices. Therefore, the present paper aims to review the latest advances and summarize different aspects concerning skin care in rosacea. Particular attention has been paid to the co-operation of cosmetologists with other specialists in order to bring about the interdisciplinary management of rosacea. It is also important to keep in mind that it is usually necessary to combine various methods of treatment, as this approach is more effective than monotherapy for attaining satisfactory cosmetic results in rosacea patients.

Analysis and Characterization of the Facial Skin Microbiota in Rosacea

Background: The evidence has shown the relationship between the microbiota of the face and several skin conditions. However, for rosacea patients, the changes in the facial skin microbiota still remain unknown. Objectives: This study was performed to explore the correlation between the facial skin microbiota and rosacea and analyze and characterize the facial skin microbiota of rosacea patients in comparison to healthy controls using 16S rDNA amplicon sequencing. Methods: A total of 27 rosacea patients and 25 healthy controls were matched. The DNA was extracted from participants’ skin swabs taken from the nose, chin, forehead, and bilateral cheeks. The V3V4 region of the 16S rRNA gene was sequenced using Illumina MiSeq technology. The diversity of the face skin microbiota was examined using alpha and beta diversity. Utilizing linear discriminant analysis effect size (LEfSe), the quantitative study of biomarkers in the two groups was carried out. Clusters of orthologous groups and Kyoto encyclopedia of genes and genomes function predictions were made at the genus level utilizing phylogenetic investigation of communities by reconstruction of unobserved states. Results: The alpha diversity of the facial skin microbiota increased significantly in rosacea patients, and beta diversity showed substantial differences between the rosacea and healthy control groups. The facial skin microbiota community structure changed in rosacea patients; however, the dominant strains were the same as in healthy controls, both being Propionibacterium acnes and Staphylococcus epidermidis. The LEfSe demonstrated that Xanthomonas, Acinetobacter, and Pseudomonas were enriched in the rosacea patients; nevertheless, Corynebacterium, Finegoldia, and Peptoniphilus were enriched in the healthy controls. The rosacea patients showed significantly decreased expression in the pathways of membrane transport, carbohydrate metabolism, metabolic diseases, amino acid transport and metabolism, carbohydrate transport and metabolism, transcription, and inorganic ion transport and metabolism. Conclusions: The facial skin microbiota diversity and community structure changed, and the expression of several metabolic pathways was downregulated in the rosacea patients in comparison to the healthy controls, which might outline new strategic methods for the surveillance, diagnosis, and treatment of rosacea.

Efficacy and safety of oxymetazoline for the treatment of rosacea: A meta-analysis.

Since there is currently no conclusion on the efficacy and adverse effects of oxymetazoline, this meta-analysis attempts to explore its efficacy and adverse events, so as to provide guidance for clinical medication. We searched PubMed, Embase, and Cochrane Library from the establishment of the database to May 2021. We included studies that patients were randomly assigned to receive oxymetazoline or vehicle, and we excluded duplicate publications, research without full text, incomplete information or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results show that the 3 (RR = 1.76, 95% CI: 1.53-2.03), 6 (RR = 1.71, 95% CI: 1.47-2.00), 9 (RR = 1.63, 95% CI: 1.40-1.90), 12 (RR = 1.41, 95% CI: 1.18-1.67) -hours CEA success rate and the 3 (RR = 1.65, 95% CI: 1.34-2.03), 6 (RR = 1.75, 95% CI: 1.43-2.14), 9 (RR = 1.63, 95% CI: 1.33-2.00), 12 (RR = 1.78, 95% CI: 1.45-2.18) -hours SSA success rate after oxymetazoline treatment for rosacea is significantly higher than that of vehicle. Additionally, the pooled results show that the incidence of TEAEs after treatment with oxymetazoline is significantly higher than that of vehicle (RR = 1.34, 95% CI: 1.10-1.2). However, our analysis of specific adverse events found that the oxymetazoline group was only significantly higher than the vehicle group in the incidence of application-site dermatitis (RR = 8.91, 95% CI: 1.76-45.23), and there was no statistical significance in the difference in the incidence of other adverse events. Oxymetazoline is effective and can be selected for the treatment of persistent facial erythema of rosacea. Additionally, application-site dermatitis was the most important one.

Therapeutic effects of mesoderm introduction of compound glycyrrhizin injection on the treatment of rosacea.

This study aims to introduce compound glycyrrhizin injection for the treatment of rosacea by mesoderm therapy, and further analyze the therapeutic and aesthetic effects of this treatment method and its impact on the dermatological quality of life index, which provides new ideas and methods for cosmetic dermatology treatment of rosacea. The recruited rosacea patients were divided into Control group (n=58) and observation group (n=58) according to the random number table. The control group was treated with topical metronidazole clindamycin liniment, and the study group was additionally used mesoderm introduction of compound glycyrrhizin injection. The transepidermal water loss (TEWL), water content in corneum, and dermatology life quality index (DLQI) in rosacea patients were evaluated. Our results showed that the scores of erythema, flushing, telangiectasia, and papulopustule were significantly reduced in the observation group. In addition, the observation group significantly decreased TEWL and increased the water content of the stratum corneum. Furthermore, the observation group significantly reduced the DLQI of rosacea patients compared to the control group. The use of mesoderm therapy combined with compound glycyrrhizic acid has a therapeutic effect on facial rosacea and improves patient satisfaction.

Supramolecular salicylic acid ameliorates rosacea-like eruptions by suppressing NLRP3-mediated inflammasome activation in mice

Rosacea is a chronic inflammatory skin disease with immunological dysfunction. Supramolecular salicylic acid (SSA) has the properties of keratolytic, antibacterial, and anti-inflammatory. However, the mechanism of SSA in the treatment of rosacea is still unclear. To investigate the efficiencies and molecular mechanisms of SSA in rosacea. Forty mice were randomly divided into four groups (10 in each group): control, LL-37, LL-37+azelaic acid (AzA), and LL-37+SSA. Forty μl LL-37 (320μM) was administered intradermally into the dorsal skin of the mice in the latter 3 groups every 12h and 4 times altogether (0h, 12h, 24h, 36h). Twenty % AzA was applied on the eruptions after the first and third LL-37 injection (0h, 24h) in LL-37+AzA group, while 30% SSA was applied after the first injection (0h) in LL-37+SSA group. The redness score and redness area were evaluated. The skin barrier function was measured by the transepidermal water loss (TEWL) and pH. The infiltration of inflammatory cells was evaluated by hematoxylin-eosin staining, and the inflammatory biomarkers were analyzed by RT-PCR and immunohistochemistry. SSA alleviated LL-37-induced rosacea-like inflammation. The increased TEWL and pH induced by LL-37 were also reversed by SSA. In addition, SSA reduced inflammatory cell infiltration and suppressed the production of Toll-like receptor 2, Matrix metallopeptidase 9, kallikrein 5, LL-37 associated with rosacea, and inhibited LL-37-induced NOD-like receptor family, pyrin domain containing 3 (NLRP3)-mediated inflammasome activation in mice. Our findings indicated that SSA ameliorated LL-37-induced rosacea-like lesions by suppressing NLRP3-mediated inflammasome activation in mice.

Placement of High Dose Neurotoxins for Treatment-Resistant Rosacea.

Rosacea is a chronic inflammatory skin condition characterized by facial flushing, erythema, telangiectasias, and papulopustular lesions. Treatment for rosacea includes limiting inciting factors and reducing inflammation with topical and oral therapies. Traditional therapies primarily focus on the papulopustular or background erythematotelangiectatic component of rosacea, leaving symptoms of flushing poorly controlled and profoundly impacting the quality of life of patients. Neuromodulators have been speculated to improve the flushing component of rosacea by reducing mast cell degranulation and the release of neuropeptides. However, its use for symptomatic relief in refractory flushing rosacea has been limited by side effects such as facial muscle weakness or paralysis. We present the use of strategic placement of high-dose neuromodulators for treatment-resistant rosacea. This approach has resulted in the gradual stabilization of symptoms, improved quality of life, and superior side effect profile. Silence C, Kourosh AS, Gilbert E. Placement of high-dose neurotoxins for treatment-resistant rosacea. J Drugs Dermatol. 2023;22(6):605-606. doi:10.36849/JDD.7237.

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

Risk Factors for Chalazion Diagnosis and Subsequent Surgical Excision

ABSTRACT Purpose To identify factors associated with chalazion diagnosis and surgical excision. Methods Patients with an incident chalazion diagnosis from 2002 to 2019 were compared 1:5 with matched controls. Multivariable logistic regression was performed to identify variables associated with diagnosis and surgical excision. Results Chalazion patients (n = 134,959) and controls (678,160) were analyzed. Risk factors for diagnosis included female sex, non-white race, northeast location, conditions affecting periocular skin and tear film (blepharitis, meibomian gland dysfunction, rosacea, pterygium), non-ocular inflammatory conditions (gastritis, inflammatory bowel disease, sarcoidosis, seborrheic dermatitis, Graves’ disease), and smoking (p < .001 for all comparisons). Thirteen percent of patients with chalazion underwent subsequent surgical excision. Diabetes and systemic sclerosis diagnoses decreased odds of diagnosis (p < .001). Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use increased odds of surgery (p < .001). Conclusion Female sex, non-white race, conditions affecting periocular skin and the tear film, several non-ocular inflammatory conditions, and smoking were risk factors for chalazion diagnosis. Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use were risk factors for surgical intervention for chalazion. Our results prompt further study of these variables and their relationship to chalazion diagnosis to understand physiology and improve clinical outcomes. Furthermore, the results of this study suggest early recognition and treatment of concomitant rosacea may serve an important role in the management of chalazion and in the prevention of surgical intervention.

Symptomatic dermographism induced by oral minocycline: Areport of four cases.

Symptomatic dermographism (SD) is the most common form of chronic inducible urticarias. The etiology of this disease has rarely been reported in the literature. Minocycline is widely used in the treatment of acne, rosacea, and other inflammatory skin diseases. Herein we report four cases of SD onset during minocycline administration. These were young women in their 20s to 30s who were taking minocycline orally for acne vulgaris or rosacea. They all experienced the onset of SD 2-3 weeks after taking the drug, and then the complete disappearance of SD 1month after stopping the drug. Minocycline was thought to be the culprit drug in these cases as other drugs were ruled out on clinical grounds. Our small series suggests that oral minocycline may induce SD, thus raising the awareness of this association in clinical practice. More research is needed to further confirm this association and reveal the underlying mechanism(s).

ORAL RESVERATROL AS AN ADJUVANT THERAPY IN THE TREATMENT OF MILD TO MODERATE ACNE VULGARIS: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Acne vulgaris is an inammatory skin disease usually affecting individuals between 12 and 24 years of age. Many topical and systemic agents are used in the treatment of acne, based on the grade. Complementary and alternative medicine therapies like vitamin C, nicotinamide, zinc, resveratrol, curcumin, etc. are increasing in popularity in the treatment of acne and rosacea. Resveratrol is a natural ingredient that is most abundant in the skin of red grapes, blueberries, boiled peanuts, etc. Resveratrol has considerable anti-inammatory, antioxidant, antiaging, and anti-microbial properties. However, there is a paucity of data regarding the use of oral Resveratrol in the management of acne; hence, this study is undertaken. To study the effectiveness of oral resveratrol as a Aim: n adjuvant therapy in patients with mild to moderate acne vulgaris. Materials And Methods: Forty-six patients diagnosed with mild or moderate acne vulgaris were sampled via consecutive sampling and assigned to two groups, those receiving a combination of topical 1% clindamycin plus 0.1% adapalene and oral resveratrol 50 mg (24) and those receiving topical 1% clindamycin plus 0.1% adapalene (22). Both groups were assessed at weeks 4, 8, and 12 by applying the global acne grading system, and side effects were noted. Both groups showed remarkable responses at weeks 4, 8, a Results And Conclusions: nd 12. However, the Resveratrol group showed an earlier response at weeks 4 and 8, with an early decrease in lesion counts. On intergroup comparison, no signicant difference was found in terms of response rates at week 12. As a result of our ndings, resveratrol appears to be effective as adjuvant therapy in the treatment of acne vulgaris It has the advantage of better tolerability as compared to topical 1% Clindamycin plus 0.1% adapalene

Entzündliche Dermatosen auf pigmentierter Haut

Acne, rosacea, atopic dermatitis, and psoriasis vulgaris are common inflammatory dermatoses. Of note, the epidemiology and clinical presentation of these common dermatologic diseases varies considerably between people with different colors of skin. Yet, most dermatology textbooks present and describe the clinical pictures of White people. To provide excellent dermatological care for all patients, it is of central importance to know the epidemiology and recognize key clinical characteristics of these diseases in patients with skin of color (SOC). In acne, cultural habits of Blacks (use of steroid-based lighteners, comedogenic hair care products) may lead to manifestation of specific forms of acne. In addition, postinflammatory hyperpigmentation and keloids pose particular therapeutic challenges in this patient group. Atopic dermatitis in Asians shows aclinical and histological picture that is similar to psoriasis in Whites. By contrast, atopic dermatitis manifests on the extensor side in Black people. Due to the difficulty of recognizing erythema in SOC, the severity of the respective inflammatory diseases in these individuals is often underestimated. The treatment of acne, rosacea, atopic dermatitis, and psoriasis does not differ between people of different skin colors. The exception is the necessary therapy for postinflammatory hyperpigmentation in all the inflammatory dermatoses mentioned, and for keloids in acne.

Association between the Treatment of Rosacea and Eradication of Helicobacter Pylori Infection.

Rosacea is a multifactorial skin inflammatory disorder with an unknown cure. Genetics and environmental factors such as microorganisms are involved in the rosacea etiology, for example, Helicobacter pylori have been suggested in rosacea progression. The present study investigated the relationship between H. pylori eradication and rosacea patient's improvement. H. pylori infection was investigated in 60 rosacea patients and 65 sex- and age-matched healthy control through enzyme-linked immunosorbent assay (ELISA) and HpSag tests. After infection confirmation, randomly half of the rosacea patients were treated for H. pylori eradication (test), and others received standard treatment (control). HpSag and ELISA tests were repeated after infection eradication and disease flow was surveyed for 60 days. The groups were compared using the ANOVA (Analysis Of Variance) test at the significant level of P < 0.05. At the baseline, the mean of immunoglobulin G (IgG) (59.27 ± 41.4 RU/mL) and immunoglobulin M (IgM) (11.55 ± 6.1 RU/mL) in rosacea patients was higher than the level of IgG (41.38 ± 54.33 RU/mL) and IgM (8.11 ± 8.91 RU/mL) in healthy control (P < 0.04) and (P < 0.01), respectively. Also, the values for H. pylori infection were positive in all patients and 10 healthy controls. The mean titer of IgM and IgG in the test and control patients groups were different at baseline and after treatment. Furthermore, in the test patients group, the mean of IgG was reduced in active rosacea after treatment, and 63.9% of active patients showed rosacea remission after H. pylori eradication. Data suggest the exacerbating role of H. pylori in rosacea, and its eradication along with other therapeutic methods causes rosacea improvement.

Successful treatment of rosacea with simultaneous irradiation of two-color (blue and red) light-emitting diodes: five case reports

酒皶は一般的によく経験する疾患であるが，治療抵抗性で再発を来しやすく治療に苦慮する．本邦ではメトロニダゾール外用薬が保険適用になったが，紅斑毛細血管拡張型酒皶（ETR）に対する有効性のエビデンスはない．また，妊婦や授乳中の患者には使いづらく，接触皮膚炎などの副作用もありこれらの理由でメトロニダゾールが使用できない場合が想定される．光線力学療法は酒皶治療においてエビデンスが確立されつつあるが，この治療経験がない医師にとっては難しい．一方，過去に丘疹膿疱型酒皶（PPR）2例に対してLED単純照射（LED治療）が有効だった報告がある．今のところこの報告に追随したLED治療の報告はないため，本稿では5例の酒皶患者（ETR1例，PPR4例）にLED照射治療を行った．週1回の頻度，照射時間10分の設定で青色と赤色のLEDを8〜12週間，同時照射した．治療後は5例とも紅斑や丘疹・膿疱の皮疹スコアの改善が認められた．LED治療は安全で容認されやすく，妊娠中や授乳中の患者に行う事もできるため，将来的に酒皶治療の一手段となってゆく可能性がある．

Real-world Evidence for the Treatment of Rosacea with Sulfur or Metronidazole Preparation in Japanese Patients

Real-world Evidence for the Treatment of Rosacea with Sulfur or Metronidazole Preparation in Japanese Patients

Combined rosacea treatment protocol using a pulsed dye laser and a dermal bioreparant with trehalose

Combined rosacea treatment protocol using a pulsed dye laser and a dermal bioreparant with trehalose

Design, Formulation and Optimization of Peel-Off Face Mask Gel for the Symptomatic Treatment of Rosacea

The aim of this research work was to design formulate and optimization peel off face mask for the treatment of Rosacea. Among the 4 different types of rosacea, this research work aims to develop a user-friendly symptomatic treatment for the types which affect the facial skin. The peel off mask was formulated using 4%, 6%, 8%, 10% and 12% polyvinyl alcohol (PVA) as a gelling agent and the main ingredient was chamomile oil. Evaluation of peel off mask included physical characteristics (organoleptic properties, homogeneity, viscosity, spreadability, film drying time), chemical characteristics (pH value), stability and antimicrobial activity. The variation in PVA affects the pH value, viscosity and film drying time significantly. Stability test showed that all peel off mask show no significant changes at room temperature with and without exposure to sunlight and at low temperature. The peel off mask containing chamomile oil using 10% PVA has the inhibitory effect against bacteria (S. aureus, E. coli) and fungi (C. albicans) as compared with the positive controls (clindamycin gel, gentamycin and clotrimazole gel). Variation in the concentration of PVA in the formula affected the physical, chemical characteristic and antimicrobial activity of the chamomile oil peel off gel face mask significantly. The preparation using 10% PVA was found to be the best formula with optimal results and better antimicrobial action

Эффективность комбинированного лечения розацеа с использованием неодимового лазера и фотодинамической терапии

Эффективность комбинированного лечения розацеа с использованием неодимового лазера и фотодинамической терапии