Article

Management of Rosacea-Prone Skin: Evaluation of a Skincare Product Containing Ambophenol, Neurosensine, and La Roche-Posay Thermal Spring Water as Monotherapy or Adjunctive Therapy

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Abstract

The objective of these studies was to investigate whether a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging can have an impact in the management of rosacea-prone skin subjects. Several studies were performed to evaluate the efficacy of this product in the management of rosacea prone skin, as either monotherapy or adjunctive therapy or to maintain the efficacy of a Metronidazole treatment. The first study was performed on 37 women aged 18-45 with added stage 2 erythro-couperosis, who applied test formula as monotherapy twice a day for 4 weeks. During a second study, a dermatological evaluation was performed on patients with stage I or II rosacea, a questionnaire containing information about patient characteristics, tolerance, clinical signs, symptoms and skin reactivity to "trigger factors" was completed by dermatologists at baseline and 2 months after treatment with the test formula as either monotherapy or adjunctive therapy. Finally, in a third study, 65 patients finishing a Metronidazole treatment applied once daily and the tested formula twice daily were divided into 2 groups using the test formula or vehicle control, twice a day for 8 weeks for the evaluation of efficacy as adjunctive therapy. We noted that the test formula, as an adjunctive therapy, helped prolong the efficacy of a Metronidazole treatment. In monotherapy, there was a significant efficacy of the test formula associated with an excellent tolerance. A significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to "trigger factors" were shown. These studies highlight the interest value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with or after a therapeutic treatment in the management of patients suffering from rosacea. J Drugs Dermatol. 2013;12(8):920-924.

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... The patient exhibits erythema, fl ushing of the face, papules, pustules, and telangiectasia. 2,3,4,11 The patient may also complain of swelling and roughness of the skin as well as stinging or burning. Rosacea can have disfi guring effects that lead to a diminished quality of life. ...
... The first aim of treatment is educating the patient about the common triggers that produce symptoms: cold, heat, sunlight, alcohol, stress, spicy foods, and cosmetic products. 2,3 Most important, the prevention of severe symptoms can improve quality of life. The treatment of rosacea involves the use of topical medications and oral antibiotics to improve appearance and relieve symptoms. ...
... 15,25,27,28 For our study, we utilized the compounds acetyl dipeptide-1 cetyl ester and 4-t-butylcyclohexanol since they have already been reported to exert effects on the sensory symptoms of sensitive skin. 15,22,29 Acetyl dipeptide-1 cetyl ester, a derivate of the dipeptide tyrosyl-arginyl, 30 was described to affect heat sensitivity and CPC-induced stinging in vivo. 20,21 It was postulated that acetyl dipeptide-1 cetyl ester exerts an effect on the TRPV1 channel. ...
... Furthermore, a correlation of the release of proinflammatory mediators such as PGE 2 with TRPV1 activation of non-neuronal cells was described. 13 Acetyl dipeptide-1 cetyl ester has been implicated in neuronal inflammation and has been reported to support the reduction in facial redness in rosacea patients 29 suggesting that this active ingredient may have an effect on inflammatory processes. As a comparative substance, we utilized licochalcone A, a reversely constructed chalcone extracted from the licorice species ...
Article
Background More than 50% of adults report to suffer from sensitive skin. This common condition is characterized by subjective sensations such as prickling, burning, skin tightness or pruritus, and is often accompanied by objective symptoms like inflammation and erythema. Objective The objective of this study was to develop an active ingredient concept for the treatment of sensitive skin. We tested compounds regarding their potential to (i) decrease the release of proinflammatory mediators, which among others induce erythema and (ii) counteract the hyperresponsiveness of nerve fibres and, thus, exert effects on cutaneous neurosensory dysfunction. Methods4-t-butylcyclohexanol, licochalcone A and acetyl dipeptide-1 cetyl ester were analysed invitro regarding their potential to (i) decrease the release of PGE(2) and activation of NFB and to (ii) inhibit TRPV1 activation or the release of neuronal CGRP. To assess subjective and objective symptoms of skin sensitivity invivo, two controlled, single-blind, randomized studies were conducted with 4-t-butylcyclohexanol and the combination with licochalcone A. ResultsIn vitro, 4-t-butylcyclohexanol significantly reduced TRPV1 activation, while acetyl dipeptide-1 cetyl ester had no effect on receptor activation. Licochalcone A significantly decreased NFB signalling and PGE(2) secretion, at lower concentrations than acetyl dipeptide-1 cetyl ester. A formulation containing 4-t-butylcyclohexanol showed a significant immediate anti-stinging/anti-burning effect invivo, and a cream base containing a combination of 4-t-butylcyclohexanol and a licochalcone A-rich licorice extract reduced shaving-induced erythema. Conclusion In vitro and invivo data indicate that the combination of the TRPV1 antagonist 4-t-butylcyclohexanol and the potent anti-inflammatory licochalcone A provide an effective active ingredient concept for the treatment of sensitive skin, as the topical application resulted in an immediate relief from symptoms such as erythema and stinging.
... These findings are supported by previous literature. Seite S, et al. suggest that dermatologists should encourage patients with disfiguring lesions to utilize appropriate and safe makeup to improve their appearance and their quality of life [13]. It suggests that corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence. ...
... Active cosmetic ingredients in skin care products for use in rosacea play a minor role compared to dermocosmetics for other purposes. Additives of substances with skin-calming, anti-inflammatory, or vessel-stabilizing properties seem reasonable, but the benefit of such ingredients has been documented in clinical studies for only a few additives, like kinetin [40], retinaldehyde [41], and licochalcone A [42], as well as for some special mixtures of active ingredients [43,44]. ...
Article
Full-text available
Rosacea is a widespread inflammatory skin disease that is chronically recurrent and affects predominately the central parts of the face. Affected individuals typically react to numerous cosmetics with redness, burning, and/or worsening of the complexion. Consequently, there is a high demand for dermocosmetics that do not provoke such reactions and are suitable for use in rosacea. The present guideline of the Society for Dermopharmacy describes the requirements that dermocosmetics for use in rosacea should meet. They include, inter alia, methods to prove the efficacy of and tolerance to these cosmetics, as well as the product documentation that the manufacturer or the distributing company should make available to professionals, like dermatologists and pharmacists, counseling patients with rosacea.
... 111 The usefulness of various cosmetics has been addressed in a few studies and has shown some benefit. 104,113 Studies with oral treatments One study judged at low risk of bias evaluated treatment with isotretinoin in papulopustular rosacea. 99 The study consisted of two phases: the first was a dosefinding phase for the optimum dosage of isotretinoin; and we included data for the second phase only, where the most efficacious dosage of isotretinoin of 0Á3 mg kg À1 was compared with doxycycline 100 mg (after 2 weeks tapered to 50 mg). ...
Article
Full-text available
Rosacea is a common chronic facial dermatosis. This update of our Cochrane review on interventions for rosacea summarises the evidence, including GRADE assessments, of the effects of the currently available treatments. Searches included: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and ongoing trials registries (July 2014). One hundred six randomised controlled trials (RCT's) with 13,631participants were included, a more than 80% increase since the last update in 2011. Pooling of data was feasible for a few outcomes; for topical metronidazole and azelaic acid and both appeared to be more effective than placebo (moderate and high quality evidence respectively). Topical ivermectin was more effective than placebo based on two studies (high quality evidence), and slightly more effective than metronidazole in one study. Brimonidine was more effective than vehicle in reducing erythema in rosacea (high quality evidence). Cyclosporine ophthalmic emulsion was effective for ocular rosacea (low quality evidence). For oral treatments there was moderate quality evidence for the effectiveness of tetracycline based on two old studies, and high quality evidence for doxycycline 40 mg compared to placebo according to physician assessments. One study at high risk of bias demonstrated equivalent effectiveness for azithromycin and doxycycline 100 mg. Minocycline 45 mg may be effective for papulopustular rosacea (low quality evidence). Low-dose isotretinoin appeared to be slightly more effective than doxycycline 50-100 mg (high quality evidence). Laser and light-based therapies for erythema in rosacea were effective (low quality evidence). Further RCT's are required for ocular rosacea.
... 111 The usefulness of various cosmetics has been addressed in a few studies and has shown some benefit. 104,113 Studies with oral treatments One study judged at low risk of bias evaluated treatment with isotretinoin in papulopustular rosacea. 99 The study consisted of two phases: the first was a dosefinding phase for the optimum dosage of isotretinoin; and we included data for the second phase only, where the most efficacious dosage of isotretinoin of 0Á3 mg kg À1 was compared with doxycycline 100 mg (after 2 weeks tapered to 50 mg). ...
Article
Full-text available
Rosacea is a common chronic facial dermatosis. This update of our Cochrane review on interventions for rosacea summarises the evidence, including GRADE assessments, of the effects of the currently available treatments. Searches included: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and ongoing trials registries (July 2014). One hundred six randomised controlled trials (RCT's) with 13,631participants were included, a more than 80% increase since the last update in 2011. Pooling of data was feasible for a few outcomes; for topical metronidazole and azelaic acid and both appeared to be more effective than placebo (moderate and high quality evidence respectively). Topical ivermectin was more effective than placebo based on two studies (high quality evidence), and slightly more effective than metronidazole in one study. Brimonidine was more effective than vehicle in reducing erythema in rosacea (high quality evidence). Cyclosporine ophthalmic emulsion was effective for ocular rosacea (low quality evidence). For oral treatments there was moderate quality evidence for the effectiveness of tetracycline based on two old studies, and high quality evidence for doxycycline 40 mg compared to placebo according to physician assessments. One study at high risk of bias demonstrated equivalent effectiveness for azithromycin and doxycycline 100 mg. Minocycline 45 mg may be effective for papulopustular rosacea (low quality evidence). Low-dose isotretinoin appeared to be slightly more effective than doxycycline 50-100 mg (high quality evidence). Laser and light-based therapies for erythema in rosacea were effective (low quality evidence). Further RCT's are required for ocular rosacea. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
... Skin care products moisturizing the skin, and thereby reducing stinging, burning and the feeling of tightness of skin, are an adjuvant measure. The applications for such adjuvant treatments are subtypes 1 and 2 [48,49]. Some open questions remain. ...
Chapter
Topical treatment is a cornerstone of rosacea management in all stages of the disease. Topical treatment aims to reduce signs of inflammation (redness, pustules), prevent common relapses, and avoid triggers such as skin irritation and ultraviolet (UV)-irradiation.
... Skin care products moisturizing the skin, and thereby reducing stinging, burning and the feeling of tightness of skin, are an adjuvant measure. The applications for such adjuvant treatments are subtypes 1 and 2 [48,49]. Some open questions remain. ...
Article
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Rosacea is a chronic relapsing inflammatory facial dermatosis. There are several known triggers but the pathogenesis remains unknown. Recent achievements in understanding this disease point to the importance of skin-environmental interactions. This includes physical and chemical factors, but also microbial factors. The impairment of the skin barrier function and the activation of the innate immune defences are major and connected pathways contributing to an ongoing inflammatory response in the affected skin. This becomes modulated by endogenous factors like neurovascular, drugs, and psychological factors. These factors offer new therapeutic targets for rosacea treatment. There is a broader range of anti-inflammatory compounds available with a favourable safety record. Only recently have persistent erythema and flushing been addressed by new drug formulations.
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Background: Interest in the skin microbiome and the cosmetic benefits of probiotics, prebiotics, and postbiotics is increasing. Aim: The current review explores the influence of the skin microbiome on facial skin aging and the effects of oral and topical probiotics, prebiotics, and postbiotics use on skin aging and cosmetic outcomes. Methods: Five dermatologists who treat clinical signs of facial skin aging and a microbiome scientist (advisors) explored the relationship between the skin microbiome and skin aging. Published evidence and the advisors' knowledge lead to guidance on the skin microbiome using oral and topical prebiotics, probiotics, and postbiotics to reduce signs of aging. Results: The role of the microbiome in aging skin is an emerging concept. A diverse skin microbiome is essential for skin health. Preliminary studies suggest oral probiotics and prebiotics may play a role in reducing signs of skin aging, likely through shifting to a greater skin and gut microbiome diversity. Thermal spring water contains probiotics and prebiotics. Preliminary studies suggest topically applied probiotics, prebiotics, and postbiotics may improve signs of skin aging, including a reduction in fine lines and increased hydration. Conclusions: The panel agreed that oral and topical prebiotics, probiotics, and postbiotics may play a role in improving signs of aging by improving the skin microbiome. Larger studies with more prolonged treatment trials are needed to better understand the microbiome's role in skin aging and the possible benefits of prebiotics, probiotics, and postbiotics use.
Chapter
Rosacea is one of the most common diseases in adulthood, although children can also be affected. Colloquially, this benign disease is also called copper fin or couperose. The clinical picture is very variable and ranges from erythema, telangiectasia, papules, and pustules to ocular changes or phymatous swelling. Since the symptoms are mostly centrofacial, most patients suffer on a high level with a limited quality of life. With adequate therapy and suitable skin care, an improvement of the symptoms is possible. This chapter deals with these aspects and more about rosacea.
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Rosacea is a common, chronic skin condition causing flushing, redness, red pimples and pus‐filled spots (pustules) on the face. It affects about 1‐20% of people worldwide. Rosacea can also cause inflammation of the eyes/eyelids (ocular rosacea) and thickening of the skin, especially the nose (rhinophyma). Although the cause of rosacea is unclear, treatments are available for this distressing disease. This review from the Netherlands, U.K. and Canada aimed to find out which treatments are effective for rosacea. The authors included data from 152 studies. For reducing redness, brimonidine and oxymetazoline worked from three up to 12 hours after being applied. For reducing pimples and pustules with topical (applied to the skin) treatments, azelaic acid, ivermectin and metronidazole were effective and safe. Ivermectin was slightly more effective than metronidazole. Minocycline foam also showed a large reduction in pimples and pustules. With oral (taken by mouth) antibiotics, tetracycline, doxycycline 40 mg or minocycline 45 mg reduced the number of pimples and pustules. Doxycycline 40 mg was likely as effective as 100 mg, with fewer side effects like diarrhoea and nausea. Oral minocycline 100 mg was as effective as doxycycline 40 mg. Azithromycin may be as effective as 100 mg doxycycline. Isotretinoin 0.25 mg/kg decreased pimples and pustules by 90%, and increased quality of life and patients’ satisfaction. Isotretinoin 0.3 mg/kg appeared to be slightly more effective than 50‐100 mg doxycycline. However, isotretinoin is known to cause serious birth defects, so pregnancy must be avoided when using it. For treating dilated blood vessels, laser therapy and intense pulsed light therapy were both effective, but these studies had limited data. In ocular rosacea, ciclosporin 0.05% ophthalmic emulsion increased quality of life and improved the amount/quality of tears, and was slightly more effective than oral doxycycline. Omega‐3 fatty acids likely improve dry eyes and tear gland function. Linked Article: van Zuuren et al. Br J Dermatol 2019; 181:65–79
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Background Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping. Objectives Updating our systematic review on interventions for rosacea. Methods We searched: CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index, and ongoing trials registers (March 2018) for randomised controlled trials. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. GRADE was used to assess certainty of evidence. Results We included 152 studies (46 were new), comprising 20,944 participants. Topical interventions included: brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included: oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light‐based treatment. We present the most current evidence for rosacea management based on a phenotype‐led approach. Conclusions For reducing temporarily persistent erythema: there was high certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia: low to moderate certainty evidence for laser and intense pulsed light therapy. This article is protected by copyright. All rights reserved.
Chapter
Bei der Rosazea handelt es sich um eine der häufigsten Erkrankungen im Erwachsenenalter, wobei jedoch bereits Kinder betroffen sein können. Umgangssprachlich wird diese gutartige Erkrankung auch Kupferfinne oder Couperose genannt. Das klinische Bild ist sehr variabel und reicht von Erythemen, Teleangiektasien, Papeln und Pusteln bis hin zu okulären Veränderungen oder phymatösen, also verdickenden Schwellungen. Da die Symptome meist zentrofazial ausgeprägt sind, besteht bei den meisten Patienten ein großer Leidensdruck mit eingeschränkter Lebensqualität. Bei adäquater Therapie und geeigneter Hautpflege ist eine deutliche Besserung der Symptomatik möglich. Um diese Aspekte und weitere über die Rosazea geht es im vorliegenden Kapitel.
Article
Rosacea is a common chronic inflammatory disease, especially in patients with fair skin and positive family history. Typical locations are forehead, nose, cheeks and chin; the periorbital region is usually not involved. Clinical features can be very heterogeneous. Besides different subtypes (erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea), which often overlap, various special forms of rosacea exist. Up to 60 % of patients with cutaneous rosacea suffer from ocular rosacea. In Germany, brimonidine, metronidazol, azelaic acid, and ivermectin are approved for topical therapy of rosacea; for systemic therapy, doxycycline at a subantimicrobial dose (40 mg/day) is the only approved substance. In case of resistance to this therapy, contraindications or side effects, various alternative therapies are available, however off-label.
Article
Background The validity of randomized controlled trials (RCT) is determined by several statistical factors.Objective To determine the level of recent statistical reporting in RCT from the dermatology literature.Methods We searched MEDLINE for all RCT published between May 1, 2013 and May 1, 2014 in 45 dermatology journals.ResultsTwo hundred and ten articles were screened, of which 181 RCT from 27 journals were reviewed. Primary study outcomes were met in 122 (67.4%) studies. Sample size calculations and beta values were reported in 52 (28.7%) and 48 (26.5%) studies, respectively, and non-significant findings were supported in only 31 (17.2%). Alpha values were reported in 131 (72.4%) of studies with 45 (24.9%) having two-sided P-values, though adjustment for multiple statistical tests was performed in only 16 (9.9% of studies with ≥2 statistical tests performed). Sample size calculations were performed based on a single outcome in 44 (86.3%) and multiple outcomes in 6 (11.8%) studies. However, among studies that were powered for a single primary outcome, 20 (45.5%) made conclusions based on multiple primary outcomes. Twenty one (40.4%) studies relied on secondary or unspecified outcomes. There were no differences for primary outcome being met (Chi-square, P=0.29), sample size calculations and beta values (P=0.55), alpha values (P=0.65), correction for multiple statistical testing (P=0.59), two-sided alpha (P=0.64), support of non-significant findings (Fisher's exact, P=0.23) based on the journal's impact factor.Conclusion Levels of statistical reporting are low in RCT from the dermatology literature. Future work is needed to improve these levels of reporting.This article is protected by copyright. All rights reserved.
Article
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BACKGROUND: Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. OBJECTIVES: To assess the efficacy and safety of treatments for rosacea. SEARCH METHODS: We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS: Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. MAIN RESULTS: We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed adverse events, although often only limited data were provided. In most comparisons there were no statistically significant differences in number of adverse events, most were mild and transient. Physician assessments including investigators' global assessments, lesion counts and erythema were evaluated in three-quarters of the studies, but time needed for improvement and duration of remission were incompletely or not reported.The quality of the body of evidence was rated moderate to high for most outcomes, but for some outcomes low to very low.Data for several outcomes could only be pooled for topical metronidazole and azelaic acid. Both were shown to be more effective than placebo in papulopustular rosacea (moderate quality evidence for metronidazole and high for azelaic acid). Pooled data from physician assessments in three trials demonstrated that metronidazole was more effective compared to placebo (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.29 to 3.02). Four trials provided data on participants' assessments, illustrating that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30 to 1.63). The results from three studies were contradictory on which of these two treatments was most effective.Two studies showed a statistically significant and clinically important improvement in favour of topical ivermectin when compared to placebo (high quality evidence). Participants' assessments in these studies showed a RR of 1.78 (95% CI 1.50 to 2.11) and RR of 1.92 (95% CI 1.59 to 2.32),which were supported by physicians' assessments. Topical ivermectin appeared to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study, for improving quality of life and participant and physician assessed outcomes (high quality evidence for these outcomes).Topical brimonidine in two studies was more effective than vehicle in reducing erythema in rosacea at all time points over 12 hours (high quality evidence). At three hours the participants' assessments had a RR of 2.21 (95% CI 1.52 to 3.22) and RR of 2.00 (95% CI 1.33 to 3.01) in favour of brimonidine. Physicians' assessments confirmed these data. There was no rebound or worsening of erythema after treatment cessation.Topical clindamycin phosphate combined with tretinoin was not considered to be effective compared to placebo (moderate quality evidence).Topical ciclosporin ophthalmic emulsion demonstrated effectiveness and improved quality of life for people with ocular rosacea (low quality evidence).Of the comparisons assessing oral treatments for papulopustular rosacea there was moderate quality evidence that tetracycline was effective but this was based on two old studies of short duration. Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99) (high quality evidence). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doxycycline, but there was evidence of fewer adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54) (low quality evidence). There was very low quality evidence from one study (assessed at high risk of bias) that doxycycline 100 mg was as effective as azithromycin. Low dose minocycline (45 mg) was effective for papulopustular rosacea (low quality evidence).Oral tetracycline was compared with topical metronidazole in four studies and showed no statistically significant difference between the two treatments for any outcome (low to moderate quality evidence).Low dose isotretinoin was considered by both the participants (RR 1.23, 95% CI 1.05 to 1.43) and physicians (RR 1.18, 95% CI 1.03 to 1.36) to be slightly more effective than doxycycline 50-100 mg (high quality evidence).Pulsed dye laser was more effective than yttrium-aluminium-garnet (Nd:YAG) laser based on one study, and it appeared to be as effective as intense pulsed light therapy (both low quality evidence). AUTHORS' CONCLUSIONS: There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea. Time needed to response and response duration should be addressed more completely, with more rigorous reporting of adverse events. Further studies on treatment of ocular rosacea are warranted.
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The curative use of thermal spring water is well known, but further investigation of its biological properties and therapeutic benefits is necessary. This present article reports all available scientific data concerning La Roche-Posay Thermal Spring Water and provides a better understanding of the biological mechanism of action of this water in regard to its composition and physicochemical properties and its clinical benefits for patients. These data justify the use of this selenium-rich water as an active or "cosmeceutical" ingredient in topical formulations to increase quality of life and compliance in patients with chronic disease.
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Disfiguring dermatoses may have a significant impact on patients' quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. One hundred and twenty-nine patients with various skin diseases affecting the patients' face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients' significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P < 0.0001). Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence.
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Ce travail est consacré à l'étude phytochimique de quatre plantes : deux Ericaceae, Agauria salicifolia Hook.f ex Oliver et Agauria polyphylla Baker, une Monimiaceae, Tambourissa trichophylla Baker et une Myrsinaceae, Embelia concinna Baker sélectionnées pour leur utilisation en médecine traditionnelle malgache. Trois flavonoïdes et un triterpène ont été isolés des deux espèces de Agauria. Trois flavonols ont été isolée des feuilles de T. trichophylla. Dix composés ont été identifiés de E. concinna : un triterpène, six flavonols, un acide phénolique, ainsi qu'un alkyle résorcinol et un acide gras. Les structures des composés ont été élucidées par l'utilisation de techniques de RMN 1D et 2D et par spectrométrie de masse. La comparaison par spectrométrie de masse des fractions flavonoïdiques de A. salicifolia et A. polyphylla a permis d'identifier neuf composés supplémentaires. Deux composés sont spécifiques de A. salicifolia et permettent de distinguer chimiquement les deux espèces. ABSTRACT : This report contributes to complete the phytochemical knowledge on four plants: Agauria salicifolia Hook.f ex Oliver, Agauria polyphylla Baker (Ericaceae), Tambourissa trichophylla Baker (Monimiaceae) and, Embelia concinna Baker (Myrsinaceae) used in traditional medicine in Madagascar. Four compounds were isolated from the extracts of the Agauria: a flavonoid type compound and a triterpene. Three flavonol O-glycosides were isolated from T. trichophylla extracts. The study of E. concinna led to the isolation and characterization of a triterpènes, six flavonoïdes, a phenolic acid, a fatty acid and an alkylresorcinol. The use of these compounds as phytochemical markers was evaluated. Identification of the compounds was carried out by interpretation of MS, MS/MS, 1D and 2D NMR spectra. Liquid chromatography coupled mass spectrometry was used to compare the flavonoid fractions of A. salicifolia and A. polyphylla. Two flavonol O-glucuronides were found to differentiate the two populations.
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Acne rosacea is an inflammatory skin disease that affects 3% of the US population over 30 years of age and is characterized by erythema, papulopustules and telangiectasia. The etiology of this disorder is unknown, although symptoms are exacerbated by factors that trigger innate immune responses, such as the release of cathelicidin antimicrobial peptides. Here we show that individuals with rosacea express abnormally high levels of cathelicidin in their facial skin and that the proteolytically processed forms of cathelicidin peptides found in rosacea are different from those present in normal individuals. These cathelicidin peptides are a result of a post-translational processing abnormality associated with an increase in stratum corneum tryptic enzyme (SCTE) in the epidermis. In mice, injection of the cathelicidin peptides found in rosacea, addition of SCTE, and increasing protease activity by targeted deletion of the serine protease inhibitor gene Spink5 each increases inflammation in mouse skin. The role of cathelicidin in enabling SCTE-mediated inflammation is verified in mice with a targeted deletion of Camp, the gene encoding cathelicidin. These findings confirm the role of cathelicidin in skin inflammatory responses and suggest an explanation for the pathogenesis of rosacea by demonstrating that an exacerbated innate immune response can reproduce elements of this disease.
Article
This is a richly illustrated account of the clinical features and microscopic anatomy of acne, acne-like disorders, and rosacea. Since its last edition the text has been completely revised. All aspects of these diseases are covered succinctly in the text: physiology, pathology, bacteriology, and endocrinology. Special emphasis is placed on the histopathology of these disorders. The text is supplemented by selected references, and a richly illustrated portfolio of gross and histopathological pictures. There are many new chapters including one on the history of acne and rosacea. The book is designed for those physicians - dermatologists, general practitioners, pediatricians, gynecologists, pharmacologists and surgeons - who must identify and treat the many different forms of these diseases. The spectrum of pharmacological and physical methods of controlling acne, acne-like diseases, and rosacea are critically examined. The authors present in detail their personal strategies for successfully treating these distressing diseases.
Article
Rosacea is a chronic skin disease affecting up to 10% of the population. It includes various combinations of characteristic signs and symptoms in a centrofacial distribution. There is a lack of consensus in the understanding of the different expressions of rosacea and the classification of the disease. It has been previously classified into four stages (pre-rosacea, stages I-III) and a variety of variants (persistent erythema and edema in rosacea, rosacea conglobata, rosacea fulminans, etc.). The National Rosacea Society (NRS) has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, ocular) and one variant (lupoid or granulomatous) avoiding assumptions on pathogenesis and progression. This classification system uses diagnostic criteria which assess both primary and secondary features of the disease. Suggestions for rosacea severity assessment have been included. Classification of rosacea into stages or subtypes, with or without progression, remains controversial until there is a better understanding of the pathogenesis of the disease.
Article
The role of free radicals in the etiology and development of a wide range of clinical disorders has continued to fuel the suggestion that phenolic antioxidants can offer a realistic promise to reduce the incidence of a number of pathologies involving oxidative stress. In this study, the total phenol, flavonoid, and proanthocyanidin contents of the Mauritian medicinal plants Crinum mauritianum. Lodd. (Asteraceae), Gaertnera psychotroides. DC (Rubiaceae), Psidia terebinthina. A.J. Scott (Asteraceae), and Tylophora coriacea. Marais. (Monimiaceae) were assessed and contrasted with their antioxidant potential. The antioxidant propensity was evaluated by the ability of the extracts to scavenge hypochlorous acid and hydroxyl radical and the ABTS + radical including their abilities to inhibit microsomal lipid peroxidation. The endemic plants Badula multiflora. A. DC. (Myrsinaceae), Croton vaughanii. L. (Euphorbiaceae), Erythroxylum macrocarpum. Lam. (Erythroxylaceae), Ochna mauritiana. Lam. (Ochnaceae), Tambourissa cordifolia. Lorence. (Monimiaceae), and Turraea rigida. Vent. (Meliaceae) were similarly investigated. Badula multiflora. and Erythoxylum macrocarpum. showed highest antioxidant activity in the TEAC and FRAP assay. Badula multiflora., Ochna mauritiana., and Gaertnera psychotroides. were very potent scavengers of hypochlorous acid and inhibited microsomal lipid peroxidation induced by 2,2′-azobis.(2-amidinopropane) hydrochloride (AAPH), suggesting that the inhibition was intrinsically linked to peroxyl radical scavenging. The antioxidant activity of Gaertnera psychotroides., Tylophora coriacea., Psidia terebinthina., and Crinum mauritianum. may account for the therapeutic effects of these extracts, in particular, in conditions characterized by inflammation and oxidative mechanisms. While these polyphenolic-rich endemics are good sources of natural prophylactic antioxidants, there is an urgent need for sustainable conservation programs for their protection.
Article
Rosacea is a chronic skin disease affecting up to 10% of the population. It includes various combinations of characteristic signs and symptoms in a centrofacial distribution. There is a lack of consensus in the understanding of the different expressions of rosacea and the classification of the disease. It has been previously classified into four stages (pre-rosacea, stages I-III) and a variety of variants (persistent erythema and edema in rosacea, rosacea conglobata, rosacea fulminans, etc.). The National Rosacea Society (NRS) has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, ocular) and one variant (lupoid or granulomatous) avoiding assumptions on pathogenesis and progression. This classification system uses diagnostic criteria which assess both primary and secondary features of the disease. Suggestions for rosacea severity assessment have been included. Classification of rosacea into stages or subtypes, with or without progression, remains controversial until there is a better understanding of the pathogenesis of the disease. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Article
Rosacea is a chronic skin disease affecting up to 10% of the population in some European countries. Rosacea manifests as various combinations of characteristic signs and symptoms in a centrofacial distribution. At present, there is no consensus about the definition or classification of the clinical patterns of rosacea. Initially, four stages were differentiated (pre-rosacea then stages I through III), with several variants (e.g., persistent erythema and edema, rosacea conglobata, and rosacea fulminans). The National Rosacea Society (NRS) in the USA has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (lupoid or granulomatous rosacea). This classification scheme does not mention progression from one type to another and makes no reference to pathophysiological considerations. It uses major and minor diagnostic criteria based on the physical findings and symptoms. The NRS has also developed criteria for grading disease severity. The classification of rosacea into stages or subtypes, without considering the possibility of progression from one to another, will probably remain controversial until additional knowledge on the pathophysiology of rosacea is obtained.
Article
The absence of specific histological or serological markers, the gaps in understanding the aetiology and pathophysiology of rosacea, and the broad diversity in its clinical manifestations has made it difficult to reach international consensus on therapy guidelines. The main objective was to highlight the global diversity in current thinking about rosacea pathophysiology, classification and medical features, under particular consideration of the relevance of the findings to optimization of therapy. The article presents findings, proposals and conclusions reached by the ROSacea International Expert group (ROSIE), comprising European and US rosacea experts. New findings on pathogenesis provide a rationale for the development of novel therapies. Thus, recent findings suggest a central role of the antimicrobial peptide cathelicidin and its activator kallikrein-5 by eliciting an exacerbated response of the innate immune system. Cathelicidin/kallikrein-5 also provide a rationale for the effect of tetracyclines and azelaic acid against rosacea. Clinically, the ROSIE group emphasized the need for a comprehensive therapy strategy - the triad of rosacea care - that integrates patient education including psychological and social aspects, skin care with dermo-cosmetics as well as drug- and physical therapies. Classification of rosacea into stages or subgroups, with or without progression, remained controversial. However, the ROSIE group proposed that therapy decision making should be in accordance with a treatment algorithm based on the signs and symptoms of rosacea rather than on a prior classification. The ROSIE group reviewed rosacea pathophysiology and medical features and the impact on patients and treatment options. The group suggested a rational, evidence-based approach to treatment for the various symptoms of the condition. In daily practice this approach might be more easily handled than prior subtype classification, in particular since patients often may show clinical features of more than one subtype at the same time.
Article
Rosacea has a major psychosocial impact on a patient's life. To determine the impact of rosacea on patient quality of life, the relationship of quality of life scores to clinical and demographic variables, and the change in quality of life following various treatments. Patients' demographic and clinical characteristics were recorded at their initial examination and their response to treatment and side-effects were recorded additionally at their follow-up examination. Rosacea severity was scored for each of four signs from 0 to 3. Patients were requested to complete Dermatology Life Quality Index (DLQI) questionnaires. A total of 308 patients took part in this study. Mean ± SD DLQI total score at the initial visit was 6·93 ± 5·18 and was related to patients' age, sex, age at disease onset, subjective symptoms, triggering factors, previous treatments, rosacea severity scores and patients' self-assessment of ease of living with rosacea. Of these 308 patients, 164 completed the DLQI following treatment. Mean ± SD post-treatment DLQI score was 4·36 ± 4·82. Post-treatment scores were also related to sex, type of treatment modality, development of side-effects, improvement of rosacea, rosacea severity scores and patients' self-reported ease of living with rosacea. Topical metronidazole, oral tetracycline and oral isotretinoin were observed to reduce signs and symptoms of rosacea and DLQI scores significantly at this repeat examination. Rosacea affects patients' lives to a moderate extent, and this can be assessed by using DLQI. DLQI is also sensitive to quality of life changes brought about by treatment of rosacea. As a preliminary result we can say that topical metronidazole, oral tetracycline and oral isotretinoin seem to improve quality of life of patients by improving lesions of rosacea more efficiently than other therapeutic agents.
Article
Our skin is constantly challenged by microbes but is rarely infected. Cutaneous production of antimicrobial peptides (AMPs) is a primary system for protection, and expression of some AMPs further increases in response to microbial invasion. Cathelicidins are unique AMPs that protect the skin through 2 distinct pathways: (1) direct antimicrobial activity and (2) initiation of a host response resulting in cytokine release, inflammation, angiogenesis, and reepithelialization. Cathelicidin dysfunction emerges as a central factor in the pathogenesis of several cutaneous diseases, including atopic dermatitis, in which cathelicidin is suppressed; rosacea, in which cathelicidin peptides are abnormally processed to forms that induce inflammation; and psoriasis, in which cathelicidin peptide converts self-DNA to a potent stimulus in an autoinflammatory cascade. Recent work identified vitamin D3 as a major factor involved in the regulation of cathelicidin. Therapies targeting control of cathelicidin and other AMPs might provide new approaches in the management of infectious and inflammatory skin diseases.
Article
The sebum excretion rate (SER) was measured in fifty-five patients with rosacea and 126 control subjects. The mean SER in the patients with rosacea was not increased, nor was there any correlation between SER and severity of rosacea. Our data suggest that seborrhoea plays no part in the pathogenesis of rosacea.
Article
It is generally accepted that morphine exerts its analgesic effect by binding to specific opiate receptors in the brain and spinal cord. Since Hughes et al. isolated and identified two endogenous pentapeptides, Met- and Leu-enkephalin, from the brain and found that they acted as agonists at opiate receptors, alpha-, beta- and gamma-endorphins, larger peptides than enkephalins and having morphine-like activity, have been identified in either the brain or pituitary of various species. Several studies have demonstrated that enkephalins possess analgesic properties and that they are distributed in the pain-mediated pathways in the central nervous system. These findings suggest that enkephalins are important neurotransmitters or neuromodulators regulating pain transmission. We now report the isolation of a novel substance which has a Met-enkephalin releasing action. Our findings suggest the possibility of a regulating mechanism for the release of endogenous opioid peptides, especially Met-enkephalin.
Article
In a non-selected population of 809 office employees (454 women and 355 men) 81 persons were diagnosed as having rosacea, giving a prevalence of 10% (women 14%, men 5%). The rosacea group was compared with the rest of the study population. Most of the cases were rather mild. The rosacea was of an erythematotelangiectatic type in 81% of the cases and of a papulopustular type in 19%. Unilateral lesions were found in 11 subjects (14%). Only 17% of those with rosacea were impaired by sunlight, whereas 26% improved. In the rosacea group, 27% were found to suffer from migraine and 42% from a tendency to flush, compared with 13% (p less than 0.001) and 16% (p less than 0.001) respectively in the comparison group. Flushing and the regulatory mechanism of the blood vessels thus seem to be of importance in the pathogenesis of rosacea. Individuals with good pigmentation ability showed a tendency to a decreased occurrence of rosacea. The frequency of eye complaints was the same in the two groups.
Article
We investigated the effects of vascular endothelial growth factor (VEGF) on cyclooxygenase-2 (COX-2) expression and prostaglandin E(2) (PGE(2)) synthesis in human microvascular endothelial cells (HMEC-1). Treatment of HMEC-1 with VEGF resulted in a dose- and time-dependent up-regulation of COX-2 mRNA and protein levels. This up-regulation was accompanied by a 1.6-fold increase in PGE(2) synthesis. Pretreatment of HMEC-1 with a selective COX-2 inhibitor, NS-398, abolished VEGF-induced PGE(2) synthesis, suggesting specific up-regulation of COX-2 activity by VEGF in HMEC-1. Transient transfection assays using deletion mutants of the human COX-2 promoter fused to the luciferase reporter gene indicated critical requirement of a regulatory region spanning -828/-123 bp for VEGF induction of COX-2 promoter activity in HMEC-1. Site-directed mutation analysis demonstrated that a GATA cis-acting element at -685/-680 bp was essential for VEGF- induced COX-2 promoter activity in HMEC-1. These observations are of particular importance given the recent demonstrations of critical requirement of COX-2 isoenzyme for tumor growth and angiogenesis.
Article
Dermatoses may have a significant impact on a patient's quality of life, namely the relationship to others, self-image and self-esteem. We therefore asked whether the application of decorative cosmetics might increase their quality of life. Twenty female patients (16-69 y) with skin diseases affecting the patients' face (acne, n = 8; rosacea, n = 9; chronic discoid lupus erythematodes, n = 2; vitiligo, n = 1) were investigated. The patients were instructed by a cosmetician how to use decorative cosmetics (Unifiance , La Roche-Posay, France) and applied it daily for 2 weeks. The dermatology quality of life questionnaire (DLQI) was performed before the first application and 2 weeks afterwards. The clinical course was documented by standardised photography. Unifiance was well tolerated and no side effects occurred. It completely masked the unwanted coloration and application resulted in a significant amelioration of the appearance. The mean DLQI score dropped significantly from 9.2 to 5.5 (p = 0.0009). Improvement of quality of life reached statistical significance among patients with acne (2.8 versus 7.8, p = 0.0078) and among individuals with a less severe initial impairment of quality of life (2.4 versus 4.2, p = 0.007). Thus, the use of decorative cosmetics in disfiguring skin diseases is an effective, well-tolerated measure increasing the patients' quality of life. We therefore suggest that decorative cosmetics can complement the treatment of disfiguring skin diseases.
Article
Psychogenic factors have been considered to be important in the exacerbation and possibly the onset of rosacea. However, there are very few studies that have reported conclusive findings. To examine the association between rosacea and major depressive disease, a common and usually treatable psychiatric disorder. Data from 1995 to 2002, collected by the National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Care Survey, which are both nationally representative surveys of healthcare visits in the U.S.A., were studied. The basic sampling unit in both surveys is the patient visit or encounter. A "Rosacea" variable was created by grouping all rosacea (ICD-9-CM code 695.3) visits and a "Depression" variable was created by grouping the patient visits related to major depressive disorder (ICD-9-CM codes 296.2, 296.3 and 311). As alcohol abuse has been implicated in rosacea, and alcohol can confound symptoms of depression, an "Alcohol" variable was created by grouping all ICD-9-CM codes related to alcohol dependence and abuse (codes 303, 303.0, 303.9 and 305.0). All analyses were conducted using the Complex Samples module of SPSS version 13, to account for the multistage probability sampling design used to collect the data. The weighted data were representative of over 608 million dermatology visits between 1995 and 2002. Logistic regression analysis using "Rosacea" as the dependent variable and age, sex, "Alcohol" and "Depression" as independent variables revealed that the odds ratio for depressive disease in the rosacea group was 4.81 (95% confidence interval 1.39-16.62). The association between "Alcohol" and "Rosacea" was not significant. The comorbidity between major depressive disease and rosacea may have important clinical implications. Alcohol abuse does not appear to play a significant role in this association.
Article
Acne vulgaris significantly affects patients' quality of life (QOL) and their lives in various ways, including social behavior and body dissatisfaction. This may be heightened by acne's typical involvement of the face. We investigated whether the use of skin care and makeup could influence the QOL of affected patients without deteriorating conventional acne treatments. Fifty female patients with acne were recruited for our study. Twenty-five patients were instructed how to use skin care and cosmetics, while 25 patients received no specific instructions from dermatologists. Both groups received conventional topical and/or oral medication for acne during the study period for 4 weeks. Both groups did not show any significant difference in clinical improvement of acne severity. Two validated QOL questionnaires, World Health Organization (WHO)QOL26 and the Dermatology Life Quality Index (DLQI) were administered to all patients at first visit and 4 weeks later. The mean scores of psychological and overall domains in WHOQOL26 for patients with instructions were improved significantly, while only the overall score was significantly improved for patients without instructions. The total mean scores and all domains except work/school in DLQI for patients with instructions were improved significantly, while the total scores and all domains except discomfort for treatment in DLQI were significantly improved for patients without instructions. Thus, instructions on the use of skin care and cosmetics for female acne patients did not deteriorate acne treatment and influenced patients' QOL effectively. We therefore suggest that instructions for using skin care and cosmetics complement conventional medical treatments for acne.
Phytochemical studies and biological activities of plants endemic of the islands of Reunion and Mauritius
  • P Forgacs
  • H Jacquemin
  • C Moretti
  • J Provost
  • A Touche
Forgacs P, Jacquemin H, Moretti C, Provost J, Touche A. Phytochemical studies and biological activities of plants endemic of the islands of Reunion and Mauritius. Plant Med Phytother. 1981;15:80-91.
Interest of Ambophenol (Tambourissa extract) in the treatment of rosacea
  • V Petit
  • S Seité
Petit V, Seité S. Interest of Ambophenol (Tambourissa extract) in the treatment of rosacea. Poster presented at 21st EADV Congress, Prague, Czech Republic, October 27-30, 2012.