Article

Rosacea and rhinophyma: Not curse of the Celts but Indo Eurasians

Wiley
Journal of Cosmetic Dermatology
Authors:
  • Städtisches Klinikum Dresden
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... Also, men are more prone to develop rhinophyma [3]. Ethnicity also influences the incidence of rosacea, with people with fair skin being affected the most, followed by Asians and people with dark skin [4]. ...
... It seems that the clinical and histopathological findings point toward the involvement of various inflammatory and immune-mediated processes. Recent data suggest that alteration in the immune response, genetic factors, vascular dysfunctions, oxidative stress, neurogenic inflammation, and Demodex and/or Helicobacter pylori infection are possible causes of the disease [1,3,4]. There are several factors that appear to have main contributions to its development [19][20][21][22]: I. abnormal immunity; II. ...
Article
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Rosacea is a chronic skin disorder that affects more than 5% of the world’s population, with the number increasing every year. Moreover, studies show that one-third of those suffering from rosacea report a degree of depression and are less compliant with treatment. Despite being the subject of prolonged studies, the pathogenesis of rosacea remains controversial and elusive. Since most medications used for the management of this pathology have side effects or simply do not yield the necessary results, many patients lose trust in the treatment and drop it altogether. Thus, dermato-cosmetic products with natural ingredients are gaining more and more notoriety in front of synthetic ones, due to the multiple benefits and the reduced number and intensity of side effects. This review is a comprehensive up-to-date report of studies that managed to prove the beneficial effects of different botanicals that may be useful in the short and long-term management of rosacea-affected skin. Based on recent preclinical and clinical studies, this review describes the mechanisms of action of a large array of phytochemicals responsible for alleviating the clinical symptomatology of the disease. This is useful in further aiding and better comprehending the way plant-based products may help in managing this complex condition, paving the way for research in this area of study.
... Rosacea has four broad subtypes: erythematotelangiectatic, papulopustular and phymatous that affect the skin and ocular that affects the eyes. The patient may have more than one subtype [4]. Erythematotelangiectatic rosacea exhibits erythema with a tendency to flush and this type often have sensitive, dry and flaky skin [5]. ...
... Approximately 4% of rosacea patients are of African, Latino, or Asian descent [3]. Rosacea has four broad subtypes: erythematotelangiectatic, phymatous that affect the skin and ocular he patient may have more than one subtype [4]. Erythematotelangiectatic rosacea exhibits and blush. ...
... Показано, что наиболее высокая заболеваемость розацеа фиксируется среди индоевропейских народов [9]. Самая высокая заболеваемость розацеа отмечается в США и странах Европы. ...
... Примечательно, что нарушение кожного барьера при розацеа ограничивается областью кожи лица. Повышенная ТЭПВ активирует ряд эпидермальных протеаз, в том числе сериновую протеазу калликреин-5 (трипсиноподобный фермент рогового слоя), который участвует в активации и расщеплении кателицидина LL-37 [9,[63][64][65]. ...
Article
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This literature review examines principal aspects of rosacea prevalence in the Russian Federation and abroad, shows present-day opinions about the pathogenesis and histological picture of rosacea and presents actual classification and a number of key clinical forms of the disease.
... 3 One Indian study reported that rosacea/rhinophyma accounted for almost 0.5% of all dermatology consultations indicating that it is more common than previously thought. 4 A study conducted among Saudi females with rosacea reported its highest prevalence in skin type 6 (42%), followed by skin type 4 (40%) and skin type 5 (18%). 5 In China, Taiwan, Korea and Japan, rosacea is a common disease. ...
... 20 An Indian study suggested that rosacea and rhinophyma may not be as common in the Indian population as compared to other Asian countries, however epidemiological data is scarce. 4 Steroid-induced rosacea is also being increasingly reported in India. 3 Another study from Seoul, Korea assessed the prognosis of 234 rosacea patients according to clinical subtype. ...
Article
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Rosacea is a relatively common inflammatory dermatosis in persons with fair skin. It is uncommonly reported in people with skin of color (darker skin tone; Fitzpatrick skin types IV, V or VI). Apart from reduced incidence, underreporting due to decreased awareness might also be a probable explanation. Rosacea commonly presents with telangiectasias and persistent facial erythema on the sun-exposed parts, which can be distressing to the patient and affect the quality of life. The diagnosis is made clinically, in the absence of any confirmatory investigation. Several treatment modalities have been employed to date with varying results. Light-based therapies should be used cautiously in the colored skin to avoid distressing pigmentation. This article focuses on the pathogenesis, clinical features, treatment recommendations and other aspects of this uncommon disorder along with a review of the literature.
... [1,2] One Indian study has reported that rosacea accounts for almost 0.5% of all dermatology consultations. [3] Ocular rosacea is a form of rosacea that involves the eyelids and the front of the eye. Ocular rosacea commonly leads to blepharitis, conjunctival hyperemia, and rosaceaassociated keratitis. ...
Article
Full-text available
Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Cutaneous involvement primarily affects the central face, with findings, such as persistent centrofacial redness, papulopustules, flushing, telangiectasia, and phymatous skin changes (e.g., rhinophyma). Ocular involvement may manifest with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms. In this review, we focus on the ophthalmological manifestations of rosacea and its management.
... The incidence of rosacea varies among ethnicities, affecting most commonly fair-skinned persons, i.e., skin phototypes I and II, followed by Asians and dark-skin persons. 3 The classification and staging for rosacea developed by National Rosacea Society Expert Committee (NRSEC) is used in practice across the world. 4,5 The diagnosis of rosacea is suggested by the presence of one or more features with a central facial distribution (Table 1). 4 The constellation of primary and secondary features of rosacea form four patterns or disease subtypes ( Table 2) 4 Many patients may present with more than one subtype. ...
Article
Rosacea is a chronic cutaneous disorder affecting primarily the face, characterized by erythema, transient or persistent, telangiectasia, and inflammatory lesions including papulo‐pustules and swelling. The essential component of the disease is the persistent erythema of facial skin. Episodes of flushing (acute‐subacute intermittent vasodilation) are common. Swelling and erythema of the nose along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, can be noted in chronic cases. Rosacea affects up to 10% of the world population and is especially noted in fair skinned individuals aged 35 to 50. Women are affected more often than men. Several treatment modalities including topical medications, systemic drugs, lasers and light‐based therapies have been used for the management of rosacea with variable results. Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulphur, oral antibiotics such as tetracyclines, and oral retinoids alone or, most commonly, in combination form the mainstay of treatment. Light therapies such as intense pulsed light and pulsed dye laser are best used for the eythemato‐telangiectatic type. Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimercrolimus, low‐dose modified release tetracyclines and botulinum toxin are the new additions to the therapeutic armamentarium. This article provides a comprehensive review of the various therapies used for rosacea.
... Among 6,822 patients who presented to the consultation at the Dermatology Department (Hôtel-Dieu de France University Hospital) in Beirut (Lebanon) the prevalence rate of rosacea was around 2% [15]. In India, rosacea was referred as not being as uncommon as in other Asian countries, and accounting for about 0.5% of dermatological consultations [16]. As per black patients, rosacea is less common but not rare in patients with skin of colour [17]. ...
... VIP ist auch von Bedeutung für eine häufige entzündliche Gesichtsdermatose -die Rosazea. Bei Proben aus Resektaten von Rhinophymen konnten wir die Expression sowohl von VIP in paravaskulären Zellen als auch des VIP-Rezeptors nachweisen [10]. Wir haben als Erste die therapeutische Wirkung von Ondansetron -einem Sertonin-Uptake-Hemmer -bei erythematöser Rosazea belegen [11]. ...
Article
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Die Dermatologie besticht durch ihren Facettenreichtum - von A wie Andrologie bis Z wie Zecken -, durch die Gegenständlichkeit, Unmittelbarkeit und morphologisch-ätiologische Vielfalt. Meine persönliche Sicht auf das Fachgebiet, meine Erfahrungen und Schlussfolgerungen sollen in dieser Darstellung zu Sprache kommen.
... It has been nicknamed as the "curse of the Celts" although such claim has been disputed. 2 Caucasians are more commonly affected by rosacea, 3 which also concerns women between the ages 30 and 60, almost three times as much as men. The diagnosis of rosacea is based on specific clinical features as there is no laboratory test to confirm the diagnosis. ...
Article
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Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms “rosacea”, “H.pylori”, “gastrointestinal disorders and H.pylori”, “microorganisms and rosacea”, “pathogenesis and treatment of rosacea”, and “risk factors of rosacea”, and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.
... Rosacea is not a disease specific to people of northern Europe; it may have a wider distribution, consistent with the migra-tion of people and mixture of genes between races. Rosacea in persons with Fitzpatrick skin type IV-V is less common, but is probably underdiagnosed, as shown in a study from India (10). Unfortunately, rosacea is often misdiagnosed (11). ...
... Rosacea is among the highest mobility in Indo-Eurasians. 2 And it is increased from South Europe to North Europe with incidence 2.2%, 10% and 22% in Germany, Sweden and Estonia, respectively. [3][4][5] Rosacea usually starts among adult females. ...
Article
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Objective To evaluate the clinical characteristics and epidermal barrier function of papulopustular rosacea by comparing with acne vulgaris. Methods Four hundred and sixty-three papulopustular rosacea patients and four hundred and twelve acne vulgaris patients were selected for the study in Xiangya Hospital of Central South University from March 2015 to May 2016. They were analyzed for major facial lesions, self-conscious symptoms and epidermal barrier function. Results Erythema, burning, dryness and itching presented in papulopustular rosacea patients were significantly higher than that in acne vulgaris patients (P<0.001). The clinical scores of erythema, burning, dryness and itching in papulopustular rosacea patients were significantly higher than those in acne vulgaris patients (P<0.001). The water content of the stratum cornuem and skin surface lipid level were both significantly lower in papulopustular rosacea patients than that of the acne vulgaris patients (P<0.001) and healthy subjects (P<0.001); Water content of the stratum cornuem and skin surface lipid level were higher in acne vulgaris patients in comparison with that of healthy subjects (P>0.05, P<0.001; respectively). Transepidermal water loss was significantly higher in papulopustular rosacea patients than that of acne vulgaris patients and healthy subjects (P<0.001); transepidermal water loss was lower in skin of acne vulgaris patients than that of healthy subjects (P<0.001). Conclusion Erythema, burning, dryness and itching are the characteristics of papulopustular rosacea, which makes it different from acne vulgaris. The epidermal barrier function was damaged in papulopustular rosacea patients while not impaired in that of acne vulgaris patients.
... Treatment success, defined as an IGA score of 0 or 1 was achieved in 74.6 %, and 74.3 % of patients with FST I-III and IV-VI, respectively. AEs were not different between the two skin type groups [14]. ...
Article
Subantimicrobial doxycycline is an anti-inflammatory drug that decreases cathelicidin, kallikrein 5, reactive oxygen species, nitric oxide, and matrix metalloproteinases. Clinical trials demonstrated a comparable efficacy to 100-mg doxycycline in papulopustular rosacea with improvement of inflammatory lesions, quality of life, and improved safety profile. Case series and case reports suggested efficacy in other inflammatory skin diseases. The response of papulopustular rash during targeted anticancer therapies is mixed. Further studies are needed.
... It affects mainly adults, but rare cases during childhood and adolescence have been observed. The prevalence of rosacea is highest among Indo-Eurasians [1]. In Europe, there is an increasing prevalence from South to North: in Germany prevalence is 2.2%, in Sweden 10%, and in Estonia 22% [2][3][4]. ...
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.
... It affects mainly adults, but rare cases during childhood and adolescence have been observed. The prevalence of rosacea is highest among Indo-Eurasians [1]. In Europe, there is an increasing prevalence from South to North: in Germany prevalence is 2.2%, in Sweden 10%, and in Estonia 22% [2][3][4]. ...
Article
Full-text available
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.
... Rhinophyma is also a rarity among African or African American people. This is different from what is reported from India, were rosacea might be underdiagnosed but can seen more often.11 The pathogenesis of rosacea is yet not fully understood; however, some major contributing factors have been identified:66 1. exposure to UV radiation and cutaneous reactive oxygen species (ROS), including superoxide and hydroxyl radicals, hydrogen peroxide, and singlet oxygen;69 2. vascular hyperreactivity and neuropeptides; 70 3. exacerbation of innate immune response; and 71 4. microbes and mites, in particular Helicobacter pylori Rosacea is a disease mostly seen in centrofacial skin.UV light exposure, which initiates a cascade of biochemical Innate immunity seems to be involved in rosacea. ...
Article
Rosacea is a chronic inflammatory disease with a predominance of facial manifestations. The prevalence is increasing with age, peaking in the group aged older than 65 years. In 1997, one in eight Americans was aged 65 years and older. By 2030, more than 70 million individuals will be in this age group. This contribution reviews the current understanding of pathogenesis, aggravating factors, classification, comorbidities, and treatment options. Rosacea is a manageable disease that negatively affects quality of life. Rosacea increases the risk of depression and shows a significant proportion of extracutaneous manifestations, in particular ocular rosacea.
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Trądzik różowaty (łac. rosacea, acne rosacea) jest przewlekłą, zapalną chorobą skóry twarzy. Rozpoczyna się zwykle w wieku dorosłym, z wyraźną progresją w następnej dekadzie życia i pełnym rozwojem w wieku 40-50 lat. Etiopatogeneza jest wieloczynnikowa, złożona i nadal nie do końca poznana. Obraz kliniczny jest zróżnicowany, ze skłonnością do częstego powstawania rumienia na skórze. Rhinophyma (guzowatość nosa) z kolei, to końcowe stadium rozwoju trądziku różowatego. Jest to powolny, postępujący i bezbolesny proces przerostu tkanek miękkich wskutek długotrwałego stanu zapalnego, który w konsekwencji prowadzi do deformacji i zaburzenia funkcji nosa. Acne rosacea przebiega z okresami zaostrzeń i remisji, a każde zaostrzenie przyczynia się do postępującego uszkodzenia skóry i nasilenia objawów choroby. W leczeniu wykorzystuje się głównie różne preparaty farmakologiczne. Istotne znaczenie odgrywa także odpowiednia pielęgnacja i styl życia. W pracy przedstawiono aktualne poglądy na etiopatogenezę, przebieg kliniczny i możliwości terapeutyczne choroby. Wprowadzenie Rosacea jest zapalną, przewlekłą chorobą, dotyczącą powyżej 10% ludności zamieszkującej tereny północnej Europy, występującą głównie u osób z I i II fototypem skóry twarzy według Fitzpatricka. Kobiety chorują częściej, natomiast postacie ciężkie o typie rhinophyma dotyczą głównie mężczyzn [1]. Zmiany skórne pojawiają się w centralnej części twarzy (czoło, nos, policzki, broda) i w początkowym okresie mają charakter rumieni i
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Cathelicidin has dual functions in the skin, acting as an innate antibiotic and as an immunomodulator in diseases such as rosacea and psoriasis. The serine proteases kallikrein 5 (KLK5) and kallikrein 7 (KLK7) control enzymatic processing of cathelicidin precursor in the skin and regulate the eventual function of the final forms of these peptides. We analyzed factors that control expression of KLK5 and KLK7 in normal human epidermal keratinocytes to better understand how these may influence cathelicidin processing and function. Increased extracellular calcium-induced KLK5 and KLK7 mRNA expression and protein release in a time-dependent manner that is similar to induction of differentiation markers such as keratin 10 and involucrin. However, 1,25(OH)(2) vitamin D(3), 9-cis retinoic acid (RA), and 13-cis RA also induced the KLKs, but the timing and pattern of KLK induction for each were different and distinct from changes in differentiation markers. Increased protease activity and differential processing of cathelicidin accompanied increased KLK expression. These findings show that the expression and activity of KLK are under fine control and can be distinctly influenced by variables such as differentiation, calcium, vitamin D, and RA. Thus, these variables may further control the functions of antimicrobial peptides in the skin.
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Rhinophyma represents a severe variant of rosacea, a common mid-facial erythematous dermatosis. Increased blood flow and pooling in skin are thought to be involved in its pathogenesis. Since neuropeptides and their receptors are responsible for local blood flow regulation, immunolocalization for the vasoactive intestinal peptide (VIP)-receptor(R) was performed in slice biopsies taken from five patients with glandular rhinophyma. Additional immunostainings included intermediate filaments (keratin, vimentin) and neuroglandular antigen (NGA). In contrast to controls, rhinophyma disclosed not only a more dense distribution of VIP-R positive cells within the endothelium but immunoreactive perivascular large cells. The immature sebocytes stained positive with monoclonal antibody Cam5.2 against glandular antigens and polyclonal anti-S100A. Elastotic connective tissue in the dermis showed a strong immunoreactivity for vimentin and NGA. From these results we suggest that, (a) ligands of the VIP-R may contribute to vascular and dermal alterations in rosacea and (b) immature sebocytes show an unusual antigen expression of S100A and glandular keratin.
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Rosacea is a chronic skin disease that requires long-term therapy. Oral antibiotics and topical metronidazole successfully treat rosacea. Because long-term use of systemic antibiotics carries risks for systemic complications and adverse reactions, topical treatments are preferred. To determine if the use of topical metronidazole gel (Metrogel) could prevent relapse of moderate to severe rosacea. A combination of oral tetracycline and topical metronidazole gel was used to treat 113 subjects with rosacea (open portion of the study). Successfully treated subjects (n = 88) entered a randomized, double-blind, placebo-controlled study applying either 0.75% topical metronidazole gel (active agent) or topical metronidazole vehicle gel (placebo) twice daily (blinded portion of the study). Subjects were enrolled at 6 separate sites in large cities at sites associated with major medical centers. One hundred thirteen subjects with at least 6 inflammatory papules and pustules, moderate to severe facial erythema and telangiectasia entered the open phase of the study. Eighty-eight subjects responded to treatment with systemic tetracycline and topical metronidazole gel as measured by at least a 70% reduction in the number of inflammatory lesions. These subjects were randomized to receive 1 of 2 treatments: either 0.75% metronidazole gel or placebo gel. Subjects were evaluated monthly for up to 6 months to determine relapse rates. Inflammatory papules and pustules were counted at each visit. Relapse was determined by the appearance of a clinically significant increase in the number of papules and pustules. Prominence of telangiectases and dryness (roughness and scaling) were also observed. In the open phase, treatment with tetracycline and metronidazole gel eliminated all papules and pustules in 67 subjects (59%). The faces of 104 subjects (92%) displayed fewer papules and pustules after treatment, and 82 subjects (73%) exhibited less erythema. In the randomized double-blind phase, the use of topical metronidazole significantly prolonged the disease-free interval and minimized recurrence compared with subjects treated with the vehicle. Eighteen (42%) of 43 subjects applying the vehicle experienced relapse, compared with 9 (23%) of 39 subjects applying metronidazole gel (P<.05). The metronidazole group had fewer papules and/or pustules after 6 months of treatment (P<.01). Relapse of erythema also occurred less often in subjects treated with metronidazole (74% vs 55%). In a majority of subjects studied, continued treatment with metronidazole gel alone maintains remission of moderate to severe rosacea induced by treatment with oral tetracycline and topical metronidazole gel.
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Although it is debatable whether Helicobacter pylori may play a role in the pathogenesis of rosacea, some authors suggested that the treatment of H. pylori might have a beneficial effect. The aim of this investigation was to compare the prevalence of H. pylori between rosacea patients and controls, and to evaluate an effect of H. pylori eradication on rosecea by a 2-week triple therapy that was composed of amoxicillin, clarithromycin and omeprazole. H. pylori was detected by using gastroscopic biopsy with Warthin-Starry stain. Forty-two (84%) of 50 patients with rosacea and 39 (78%) of 50 controls had H. pylori, showing no significant difference in prevalence. The cure rates of H. pylori in rosacea patients and controls were 80% (16/20) and 85% (17/20), respectively. There was no significant decrease in the intensity of erythema in active treatment and placebo groups both during and after the treatment. Temporary improvement in papulopustules exclusively during the treatment (within 2 weeks) could be independent of H. pylori eradication. Overall, no significant reduction in the number of papulopustules was observed in active treatment and placebo groups after the treatment (in 2 months). Taken together, our study found no significant lessening of rosacea lesions by treating H. pylori infection, which conclusively does not concur with a view that H. pylori may be related to rosacea.
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Many studies have demonstrated beneficial health effects of topical antioxidant application; however, the underlying mechanisms are not well understood. To better understand the protective mechanism of oxogenous anti-oxidants, it is important to clarify the physiological distribution, activity and regulation of antioxidants. Also, the generation of ROS by the resident and transient microbial flora and their interaction with cutaneous antioxidants appears to be of relevance for the redox properties of skin. Our studies have demonstrated that alpha-tocopherol is, relative to the respective levels in the epidermis, the major antioxidant in the human SC, that alpha-tocopherol depletion is a very early and sensitive biomarker of environmentally induced oxidation and that a physiological mechanism exists to transport alpha-tocopherol to the skin surface via sebaceous gland secretion. Furthermore, there is conclusive evidence that the introduction of carbonyl groups into human SC keratins is inducible by oxidants and that the levels of protein oxidation increase towards outer SC layers. The demonstration of specific redox gradients within the human SC may contribute to a better understanding of the complex biochemical processes of keratinization and desquamation. Taken together, the presented data suggest that, under conditions of environmentally challenged skin or during prooxidative dermatological treatment, topical and/or systemic application of antioxidants could support physiological mechanisms to maintain or restore a healthy skin barrier. Growing experimental evidence should lead to the development of more powerful pharmaceutical and cosmetic strategies involving antioxidant formulations to prevent UV-induced carcinogenesis and photoaging as well as to modulate desquamatory skin disorders.
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Recent reports have suggested an increased prevalence of Helicobacter pylori infection in patients with rosacea, with some evidence of dermatological improvement in patients treated with antibiotics for this infection. Our study investigates the prevalence of H. pylori infection in rosacea patients in Kerman. Serological examination was done for 29 patients with classical identification of rosacea using the enzyme-linked immunosorbent assay IgG antibody method. Comparison of antibody titres with those of a control group revealed that the prevalence of positive serological tests for H. pylori was significantly higher in the test group. This supports the suggestion of some form of relationship between rosacea and H. pylori infection, though further investigations with larger sample sizes are required for a definite conclusion.
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Rosacea is a common skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often also involved. The cause of rosacea is unclear. It is a chronic disease, which can be controlled in most cases with appropriate treatment. Numerous treatments are in use although it is unclear which are best, and which are most appropriate for the different types of rosacea. To assess and summarise current evidence for the efficacy and safety of treatments for rosacea. We searched the Skin Group Specialised Trials Register (March 2002), Cochrane Central Register of Controlled Trials (CENTRAL, March 2002), MEDLINE (from 1966 to March 2002), EMBASE (from 1980 to March 2002), Biosis (from 1970 to March 2002) and the Science Citation Index (from 1988 to March 2002). Reference lists of trials and key review articles were also searched. Relevant manufacturers and experts were contacted. Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the reviewers to have seriously flawed methodology were excluded. Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent reviewers. The evidence provided by twenty-two included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea could be included. Pooled data from two trials involving 174 participants indicated that topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95 to 12.06). Data from a between-patient trial (114 patients) and a within-patient trial (33 patients) of azelaic cream versus placebo were not pooled, but both showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians' ratings, tetracycline was effective (odds ratio 6.06, 95% confidence interval 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid cream have a therapeutic effect. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. As many of these treatments are used for rosacea, good RCTs are urgently needed.
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Understanding the genetic origins and demographic history of Indian populations is important both for questions concerning the early settlement of Eurasia and more recent events, including the appearance of Indo-Aryan languages and settled agriculture in the subcontinent. Although there is general agreement that Indian caste and tribal populations share a common late Pleistocene maternal ancestry in India, some studies of the Y-chromosome markers have suggested a recent, substantial incursion from Central or West Eurasia. To investigate the origin of paternal lineages of Indian populations, 936 Y chromosomes, representing 32 tribal and 45 caste groups from all four major linguistic groups of India, were analyzed for 38 single-nucleotide polymorphic markers. Phylogeography of the major Y-chromosomal haplogroups in India, genetic distance, and admixture analyses all indicate that the recent external contribution to Dravidian- and Hindi-speaking caste groups has been low. The sharing of some Y-chromosomal haplogroups between Indian and Central Asian populations is most parsimoniously explained by a deep, common ancestry between the two regions, with diffusion of some Indian-specific lineages northward. The Y-chromosomal data consistently suggest a largely South Asian origin for Indian caste communities and therefore argue against any major influx, from regions north and west of India, of people associated either with the development of agriculture or the spread of the Indo-Aryan language family. The dyadic Y-chromosome composition of Tibeto-Burman speakers of India, however, can be attributed to a recent demographic process, which appears to have absorbed and overlain populations who previously spoke Austro-Asiatic languages. • agriculture • genetic origins • India • paternal lineages
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Rosacea is a common chronic skin and ocular condition. It is unclear which treatments are most effective. We have conducted a Cochrane review of rosacea therapies. This article is a distillation of that work. We sought to assess the evidence for the efficacy and safety of rosacea therapies. Multiple databases were systematically searched. Randomized controlled trials in people with moderate to severe rosacea were included. Study selection, assessment of methodologic quality, data extraction, and analysis were carried out by two independent researchers. In all, 29 studies met inclusion criteria. Topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95-12.06). Azelaic acid is more effective than placebo (odds ratio 2.45, 95% confidence interval 1.82-3.28). Firm conclusions could not be drawn about other therapies. The quality of the studies was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.
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Rosacea is a common chronic disease of unclear pathogenesis, characterised by inflammation and vascular abnormalities of the facial skin and ocular surface. Recognising that vascular endothelial growth factor (VEGF) is vasoactive and has inflammatory activities, the expression of this molecule and its receptors, VEGF-R1 and VEGF-R2, in rosacea was investigated. Formalin-fixed, paraffin wax-embedded sections of skin obtained from 20 patients with rosacea were immunostained to detect expression of VEGF, VEGF-R1 and VEGF-R2, using an indirect methodology incorporating antigen retrieval. Adjacent sections were stained with haematoxylin and eosin. Biopsy specimens were characterised by perivascular and perifollicular lymphohistiocytic infiltration and dilated vascular channels. In addition to keratinocyte and epithelial staining, which was also noted in normal skin, vascular endothelium frequently stained positive for VEGF-R1 (14/20, 70%) and VEGF-R2 (20/20, 100%), but infrequently for VEGF (2/20, 10%). In most specimens, infiltrating leucocytes, including lymphocytes, macrophages and plasma cells, expressed VEGF (17/20, 85%), VEGF-R1 (20/20, 100%) and VEGF-R2 (20/20, 100%). Expression of VEGF receptors, both by vascular endothelium and infiltrating mononuclear cells, is observed in rosacea. Although not expressed by endothelium, VEGF is present in epidermis and epithelium, and is expressed by infiltrating cells. VEGF receptor-ligand binding may contribute to the vascular changes and cellular infiltration that occurs in rosacea.
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Demodex folliculorum and Demodex brevis are acari that can be found in hair follicles and sebaceous glands of the skin, especially on face of humans. In this study, Demodex sp was investigated in regard to allergic diseases, age and gender. A total of 197 patients (117 with rosacea, 29 with akne vulgaris, and 51 with allergic diseases) were examined using the standardized skin surface biopsy (SSSB) and 97 out of 197 (49.23%) cases were found to be positive by the Inonu University Medical Faculty Department of Parasitology. There was no significant difference between mite positivity and negativity between the genders, while a higher rate of Demodex sp. was found in patients with rosacea and a lower rate in patients under 20 years old (p0,005). As a result, patients over 20 years old, especially those with rosacea, must be investigated for Demodex sp.
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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.
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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.
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Background: Erythematotelangiectatic (ET) rosacea is commonly treated with a variety of laser and light-based systems. Although many have been used successfully, there are a limited number of comparative efficacy studies. Objective: To compare nonpurpuragenic pulsed dye laser (PDL) with intense pulsed light (IPL) treatment in the ability to reduce erythema, telangiectasia, and symptoms in patients with moderate facial ET rosacea. Methods: Twenty-nine patients were enrolled in a randomized, controlled, single-blind, split-face trial with nonpurpuragenic treatment with PDL and IPL and untreated control. Three monthly treatment sessions were performed with initial PDL settings of 10-mm spot size, 7 J/cm(2), 6-ms pulse duration and cryogen cooling, and initial IPL settings of 560-nm filter, a pulse train of 2.4 and 6.0 ms in duration separated by a 15-ms delay, and a starting fluence of 25 J/cm(2). Evaluation measures included spectrophotometric erythema scores, blinded investigator grading, and patient assessment of severity and associated symptoms. Results: PDL and IPL resulted in significant reduction in cutaneous erythema, telangiectasia, and patient-reported associated symptoms. No significant difference was noted between PDL and IPL treatment. Conclusion: A series of nonpurpuragenic PDL and IPL treatments in ET rosacea was performed with similar efficacy and safety, and both modalities seem to be reasonable choices for the treatment of ET rosacea.
Article
Background and Objectives Rosacea results from sun-induced hyper-vascularity of exposed facial skin, often accompanied by acneiform papules and pustules. The pulsed-dye laser has an unparalleled safety record and emits an ideal wavelength for treating the abnormal vessels that occur in rosacea patients. In this study we investigate the ability of the long pulse-duration pulsed-dye laser to improve rosacea.Study Design/Materials and Methods Twenty subjects with rosacea were treated with the high-energy, long pulse-duration pulsed-dye laser. An elliptical spot and long pulse-duration was used to spot-treat linear telangiectasias, while a circular spot and short pulse-duration was used to treat the entire face. Improvement was determined by blinded evaluation of photographs and by the treating physician's subjective evaluation, before and 8 weeks following the final treatment.ResultsThe average rosacea score as estimated by the treating physician decreased from 2.7±1.1 to 1.4+ 0.7 (mean+SD) on a 0–6 scale with 0 representing no rosacea and 6 representing the most severe rosacea (P<0.001 level). The average rosacea score as rated by blinded physician observers scoring digital photos was 2.3±1.3 before treatment and 1.4±0.9 8 weeks following treatment, using a 0 (mild) to 6 (severe) scale.Conclusions The high-energy, long pulse-duration pulsed-dye laser improves rosacea with a very favorable safety profile, and less purpura than resulted from earlier generation pulsed-dye lasers. Lesers Surg. Med. 40:233–239, 2008. © 2008 Wiley-Liss, Inc.
Article
Rosacea is a common chronic inflammatory disease of the skin and is associated with a number of etiological causes and inciting factors. It is characterized by erythematous changes of the facial skin, and commonly presents with papules, pustules, or telangiectasias. The 4 subtypes of rosacea are categorized according to secondary symptoms, such as pain, erythema, dryness, and edema. A number of therapies are available to treat rosacea, some of which can be used in combination. The mainstays of therapy are topical metronidazole, topical azelaic acid, and oral tetracyclines. Other pharmacotherapeutic interventions have been shown to improve the signs and symptoms of rosacea, although many of these have not yet received approval by the US Food and Drug Administration for this indication.
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Facial corticosteroid addictive dermatitis (FCAD) has rapidly emerged as a health problem in China in recent years, because of the uncontrolled use of topical steroids. In total, 312 patients with FCAD from Guiyang, China were entered into a study. In this study, FCAD was classified into five types: dermatitis (n = 109; 34.9%), acne (n = 78; 25%), rosacea (n = 64; 20.5%), angiotelectasia (n = 30; 9.6%) and dermotrophia/hyperpigmentation (n = 31; 9.9%). Improper advertisement by manufacturers, availability of steroids without prescription, improper prescribing by doctors, and patient misuse of medication has resulted in the rapid emergence of FCAD in China. Public awareness and physician and patient education of the potential side-effects of topical corticosteroids should be improved.
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Apoptosis is an active form of cell death that is initiated by a variety of stimuli, including reactive oxygen species (ROS) and ultraviolet (UV) radiation. Results in this study demonstrated that 1) Poly(ADP-ribose) (PAR) is a new marker of UVB- and H2O2-induced HaCaT cell apoptosis. 2) UVB and H2O2 induce HaCaT cell apoptosis in different pathways, DNA damage in the form of cyclobutane thymine dimmer formation may play a major role in UVB-induced apoptosis. Furthermore, ERK signaling pathway is not involved in UVB-induced HaCaT cell apoptosis.
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
Current treatments for acne rosacea are often associated with unsatisfactory outcomes and adverse effects. To determine the efficacy and tolerability of a new moisturizing lotion for improving the clinical signs and symptoms of mild-to-moderate acne rosacea. In a 12-week, open-label study, a moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK124 (0.125%, Pyratine-XR, Senetek PLC, Napa, CA) was applied twice daily to subjects with mild-to-moderate rosacea. Improvement in the appearances of erythema and papules were assessed by the treating physician. Skin barrier function was measured by transepidmal water loss after treatment. Tolerability and cosmetic outcome were evaluated by patients. Twenty-one participants completed the study. Overall clinical improvement was observed in 80% of subjects, with most showing mild-to-moderate improvement. Erythema, papule counts, and telangiectasia were reduced. The reduction in TEWL was significant at weeks 4 (p = 0.01), 8 (p < 005), and 12 (p < 0.001). Rosacea symptoms (burning, stinging, dryness) were progressively reduced, with reduction in dryness achieving statistical significance at weeks 4 (p = 0.035), 8 (p = 0.037) and 12 (p = 0.016). Treatments were well tolerated and cosmetic outcomes were acceptable. Treatment-induced irritation was not observed. The new moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK124 shows a continued trend toward improvement of skin barrier function and the appearances of erythema and papules associated with mild-to-moderate rosacea during 12 weeks of treatment.
Article
Tetracyclines have long been used to treat a wide variety of medical conditions, especially in the field of dermatology. Unfortunately, safety concerns, especially gastrointestinal (GI), have always been present. Other safety concerns have included tooth development in children, candidiasis, vestibular concerns, photosensitivity/phototoxicity, and more unusual adverse effects such as uncontrolled hypertension. This article first discusses the pharmacological development of the tetracyclines from the first to the second generation versions with an emphasis on the safety concerns, especially with regards to doxycycline hyclate (DH). Second, the adverse effects of the tetracyclines are discussed. Third, the favorable side effect profile of DH delayed release capsules (Doryx) is compared with DH powder contained in tablets (Vibramycin). Fourth, the increased use with a continued favorable safety profile is also discussed concerning the subantimicrobial dosing of DH for acne. Fifth, the safety of periodontic uses of DH is discussed. Last, the favorable safety profiles of the 2006 approved uses of an anti-inflammatory dose of 40 mg doxycycline for rosacea and an extended-release minocycline tablet for acne are also discussed.
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
Rhinophyma is an end stage of acne rosacea. It results in a large nose due to a proliferation of sebaceous glands and fibrous tissue. Many cases of rhinophyma have been reported in the Western world; however, in Japan, rhinophyma has been an uncommon disease. We present two patients associated with rhinophyma who were treated by cross-shaped full-thickness excision followed by direct closure and compare the rhinophyma in Japan with that in the West. To date, only 20 rhinophyma cases including our 2 cases have been reported in Japan. Epidemiologic factors of rhinophyma between the West and Japan do not differ except for location, malignancy and surgical treatment. In Japan, almost all cases are located on the lower half of the nose, treated by full-thickness excision followed by application of either skin grafts or direct closure. None have been malignant.
Article
A 24-year-old woman with lymph vessel dysplasia had experienced a progressive edema of her legs since her second year of life and progressive facial edema for the past year. She also had telangiectasias and papules on the background of a diffuse erythema as well as marked seborrhea on her face. Histopathological examination of a representative facial lesion revealed a granulomatous dermatitis with periadnexal distribution mainly consisting of lymphocytes and histiocytes. In addition, there was a moderate fibrosis of the dermis with numerous mast cells. By duplex ultrasound, a diagnosis of a massive edema of the legs without evidence for chronic venous insufficiency was made. The clinical and histopathological findings were consistent with solid persistent erythema and edema of the face associated with rosacea and lymph vessel dysplasia. The chronic course, absence of serological abnormalities and nonspecific histopathological features as well as resistance to therapy are the most important diagnostic criteria of this disease also known as Morbihan's disease.
Article
Vasoactive intestinal peptide (VIP) is known as a potent regulator for the development of the central nervous system (CNS). The neonatal period of brain development is characterised by rapid cellular proliferation in parallel with neuronal differentiation and angiogenesis. We examined the expression of native VIP and the VIP receptor-associated protein by immunohistochemistry as well as the expression of VIP mRNA by in situ hybridisation in the brain stem of newborn piglets. We found both the mRNA and the protein of VIP as well as the VIP receptor-associated protein in endothelial cells of veins, arteries and capillaries in the marginal zone of brain stem tissue sections, especially in pons and mesencephalon, as well as in pial vessels. The coexpression of native VIP, VIP mRNA and the VIP receptor-associated protein within the endothelium suggests the presence of an autocrine loop, which has been detected so far only in neuroblastoma cells. This expression pattern gives evidence to the immaturity of endothelial cells at birth and the presence of an adaptive response in the VIP-regulated system during the change from intra- to extrauterine life.
Article
Although diseases of the skin have been studied in some African countries, the provision of dermatology services is as yet a relatively underdeveloped aspect of medicine in sub-Saharan Africa. To determine the pattern of skin diseases seen in a sub-Saharan community and to compare it with that seen in a European community. The diagnoses of the principal presenting complaint of 2254 consecutive new patients seen at the dermatology clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, are presented and compared with those of 3383 consecutive new patients seen at the dermatology clinic of The William Harvey Hospital (WHH), Ashford, Kent, UK. The most common conditions in Ghana were infections (46.3%; UK, 12%). In the UK, the most common conditions were malignant and premalignant diseases of the skin (22.2%; Ghana, 0.5%) and benign tumors (16.8%; Ghana, 0.5%). Dermatitis was common in both countries (Ghana, 18.4%; UK, 16.0%). Psoriasis was more common in the UK (6.2%) than in Ghana (0.4%). In Ghana, fixed drug eruption, mainly due to cotrimoxazole (Septrin), was not rare (27 cases), and complications from cosmetic skin lightening creams were a frequent problem among women (86 cases). No cases of rosacea were found in Ghana, but it was not uncommon in the UK (1.6%). The patterns of skin diseases are different in the two countries. It is hoped that this study may help to catalyze the further development of dermatology services in Ghana.
Article
Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously.
Article
The aim of this retrospective study was to determine the nature and frequency of skin diseases observed at the Dermatology Department (Hôtel-Dieu de France University Hospital) between January 1st, 1995 and December 31, 1999, and to compare them according to age and sex. All the patients who presented to the consultation were enclosed in the study. Their file included sex, age, one or several diagnoses, the number of visits for each disease. Only new diagnoses were taken into account. Data were handled by Epilnfo program. 6822 patients (59.01% women, 40.99% men, average age 31 years) were seen with 8552 diagnoses. Fungal infections represent the most frequent disease (14.6%), followed by acne (14.1%), eczema (8.56%), viral infections (7.9%) and skin tumors (7.28%). Women consulted more often than men for acne, rosacea, eczema, hair loss, melasma and stretch marks; whereas men consulted more often for fungal and viral infections, and alopecia areata. The most frequent skin diseases (all ages merged), were fungal infections, acne and eczema. The same three diagnoses were found before as the most frequent in a previous Lebanese study. The profile of skin diseases in Lebanon turns out very close to observations made in developed countries, but it differs from the Western profile on two fundamental points: absence of leg ulcers and rarity of skin tumors. This profile seems, besides, very remote from the Middle-Eastern and Arabic context especially because of the absence of some endemic diseases such as tinea capitis, leprosy and leishmaniosis.
Article
Rosacea is a chronic disorder characterized by hypersensitivity of the facial vasculature, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistently found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones. The possible relevance of this hypothesis to other conditions featuring afferent hypersensitivity, such as fibromyalgia, is considered.
Article
To understand the relationship between Demodex and bacteria infection in rosacea (brandy nose), and to find effective means for the treatment. Cellophane tape was used to detect Demodex on the nasolabial grooves and the face; sebum and tissue on face was scraped and cultured to examine bacteria under microscope. The hospital-made anti-rosacea lotion was used on the affected part two times a day for 7 days. It was found that 193 (74.2%) of 260 cases with rosacea were infected by Demodex and 209 (80.4%) of the patients were infected by bacteria. The overall effective rate of the treatment for rosacea was 73.5%. Bacteria infection in rosacea is an important factor inducing rosacea. The curative effect of the anti-rosacea lotion is good.
Article
Ocular rosacea is a common and potentially blinding eye disorder with an uncertain etiology. Therapies currently in vogue for ocular rosacea have not been rigorously studied with regards to specific indications, optimal dosing regimens, or treatment efficacy. This review will summarize the recent literature with regards to etiology and therapy of ocular rosacea, and will also examine current thinking about the parent disorder, acne rosacea. Comparatively few papers on ocular rosacea were published in the past year. Recent articles on the prevalence of ocular rosacea in patients with acne rosacea suggested that between 6 and 18% of acne rosacea patients have signs or symptoms of ocular rosacea, but few cases were confirmed by an ophthalmologist. Recent articles on the pathogenesis of ocular rosacea have focused on the role of bacterial lipases, and interleukin-1alpha and matrix metalloproteinases in the blepharitis and corneal epitheliopathy, respectively. Other reports highlighted the presence of the disorder in children, and the lack of masked, placebo-controlled studies for those therapies currently in common use. The epidemiology, etiology, and optimal therapy of ocular rosacea remain to be determined, and will require a more concerted effort to delineate.
Article
Patients with rosacea form a unique subset of the sensitive skin population because of the barrier defects inherent in this condition and the increased propensity for burning/stinging from topical products. This propensity for burning/ stinging when medications, skin care products, or cosmetics are applied to the facial skin has been frequently documented but never quantified. The objective of this 2-week study was to determine the prevalence of heightened neurosensory perceptions of burning/stinging in a random population of 40 women with mild to moderate rosacea defined as 15 or fewer inflammatory papules or pustules. Also evaluated was the effect of azelaic acid 15% gel on barrier function and facial stinging utilizing transepidermal water loss (TEWL), corneometry, and lactic acid facial sting tests as noninvasive measurement criteria. At baseline, the incidence of lactic acid stinging among these rosacea subjects was 62.5%, which is substantially higher than observed in the general population. Two weeks after application of azelaic acid 15% gel, no evidence of barrier damage was noted on TEWL or corneometry tests. Moreover, there was no statistical relationship between lactic acid stinging and a stinging response that is occasionally reported with exposure to azelaic acid 15% gel.
Article
Rosacea is a chronic inflammatory disorder that affects 10% of the population. The prevalence of rosacea is highest among fair-skinned individuals, particularly those of Celtic and northern European descent. Since a cure for rosacea does not yet exist, management and treatment regimens are designed to suppress the inflammatory lesions, erythema, and to a lesser extent, the telangiectasia involved with rosacea. This review outlines the treatment options that are available to patients with rosacea. Published literature involving the treatment or management of rosacea was examined and summarized. Patients who find that they blush and flush frequently, or have a family history of rosacea are advised to avoid the physiological and environmental stimuli that can cause increased facial redness. Topical agents such as metronidazole, azelaic acid cream or sulfur preparations are effective in managing rosacea. Patients who have progressed to erythematotelangiectatic and papulopustular rosacea may benefit from the use of an oral antibiotic, such as tetracycline, and in severe or recalcitrant cases, isotretinoin to bring the rosacea flare-up under control. Treatment with a topical agent, such as metronidazole, may help maintain remission. Patients with ocular involvement may benefit from a long-term course of an antibiotic and the use of metronidazole gel. A surgical alternative, laser therapy, is recommended for the treatment of telangiectasias and rhinophyma. Patients with distraught feelings due to their rosacea may consider cosmetic camouflage to cover the signs of rosacea. With the wide variety of oral and topical agents available for the effective management of rosacea, patients no longer need to feel self-conscious because of their disorder.
Article
Unlabelled: Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. Learning objective: At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.
Article
In this report, we demonstrate a possible molecular mechanism by which a hydrophilic extract of the leaves of the fern Polypodium leucotomos (Fernblock, PL) blocks ultraviolet (UV)-induced skin photodamage. The extract inhibits UVA and UVB light induced photoisomerization of trans-urocanic acid (t-UCA), a common photoreceptor located in the stratum corneum, and also blocks its photodecomposition in the presence of oxidizing reagents such as H2O2, and titanium dioxide (TiO2). PL protects in vitro human fibroblasts from UV-induced death as well. These results suggest the potential of employing the PL extract as a component of sunscreen moistures in order to prevent photodecomposition of t-UCA, to inhibit UV-induced deleterious effects of TiO2 and to protect skin cells and endogenous molecules directly involved in skin immunosurveillance.
Article
Tetracyclines are broad-spectrum antibiotics that act as such at the ribosomal level where they interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s when it was discovered that they were effective as a treatment for acne. More recently, biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in various diseases have also been investigated. These include rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis, and autoimmune disorders such as rheumatoid arthritis and scleroderma. We review the nonantibiotic properties of tetracycline and its analogues and their potential for clinical application.
Article
One hundred seven patients presenting to a cosmetic skin clinic were treated with intense pulsed light (IPL) over a 12-month period. The main categories of patients offered treatment were those with vascular problems such as rosacea, facial telangiectasia, and spider nevi; pigmentation disorders such as solar damage, lentigines, and hyperpigmentation; and assorted problems such as scarring and poikiloderma. Each patient who entered into the study had the full medical history taken and a dermatologic assessment. Polaroid photographs were taken and the images used for comparison before and after treatment. Outcomes were assessed by physicians' global assessment and a patients' postal questionnaire. Patients were treated with a Lumina IPL (Lynton Lasers Ltd) using a multiple pulsing facility with variable interpulse spacing, incorporating a 585-nm head. Fluence levels varied between 10 and 40 J/cm(2), although the average fluence over all patients was 25 J/cm(2). The delay was set between 10 and 30 ms and two to four pulses were used. Results Excellent results were seen in 80% of patients treated. There was a high patient satisfaction rate and low prevalence of side effects. IPL has been shown to provide a safe and effective noninvasive treatment for a wide range of dermatologic disorders and is suitable for wider use in primary care.
Article
The complete safety and efficacy of a new extended-release (ER) minocycline hydrochloride formulation were assessed in an analysis of a phase 2 dose-finding study and 2 phase 3 safety and efficacy studies. The studies were similar in design, subject populations, and shared common dose groups of subjects given ER minocycline 1 mg/kg daily or placebo over 12 weeks. The similar designs were prospective, multicenter, randomized, double-blinded, and placebo-controlled. A total of 1038 subjects with moderate to severe acne were available for the pooled analysis. Independently, each study showed that treatment with ER-minocycline significantly reduced (P < .001) the number of inflammatory lesions and significantly improved (P < .001) their Evaluator's Global Severity Assessment (EGSA) scores (phase 3 studies). Analysis of the pooled population confirmed the results of the individual studies. The percentage of subjects reporting acute vestibular adverse events (AVAEs) was comparable between those receiving the ER-minocycline 1-mg/kg dose and placebo (approximately 10% of subjects in each group) for both the individual studies and the pooled population. It was concluded that a novel ER-minocycline formulation that delivers consistent levels of drug at a 1-mg/kg dose reduces dose-dependent AVAEs while reducing inflammatory lesions and improving the overall appearance of patients with acne vulgaris.
Article
The topical calcineurin inhibitors (TCIs) pimecrolimus and tacrolimus are approved for atopic dermatitis but have additional potential in other inflammatory skin diseases. This article reviews their clinical use in non-atopic dermatitis diseases. In seborrheic dermatitis, asteatotic eczema, and contact dermatitis, TCIs are of great benefit and can compete with topical corticosteroids. In psoriasis, TCIs have shown clinical efficacy and safety in facial and intertriginous lesions. Further investigations into possible combinations of TCIs with other established treatments such as UVB irradiation in this disorder are necessary. Initial studies in cutaneous lupus erythematosus have been promising, whereas the response in rosacea and rosacea-like eruptions has been mixed. TCIs have been associated with good clinical responses in oral lichen planus and anogenital lichen sclerosus et atrophicus. In vitiligo, TCIs are associated with some degree of repigmentation, with better results being seen in children and in facial and neck areas. TCIs have a synergistic effect with UVB irradiation in vitiligo. There is a long list of small series and case reports documenting use of TCIs in various other skin conditions that warrant further validation. Although the established mode of action of TCIs is T-cell control, other effects also need to be considered. Specifically, TCIs reduce pruritus and erythema, which cannot be explained by T-cell interactions, and further investigations are needed in these fields.
Article
Rosacea is a common and chronic disorder characterized by flushing, erythema, papules, pustules, and telangiectasia on the central part of the face. Because the facial skin of individuals with rosacea is particularly sensitive, irritants can trigger a worsening of the signs and symptoms of the disease. This enhanced sensitivity is thought to be linked to a deficient stratum corneum barrier function. In the present study, 20 individuals receiving twice-daily applications of metronidazole 0.75% gel for at least 15 days applied a gentle non-irritating moisturizing cream (Cetaphil Moisturizing Cream) twice daily for 15 days on one half of the face; the other side remained treated with metronidazole only and served as the control. Clinical assessments, confirmed by biophysical measurements (electrical capacitance, transepidermal water loss (TEWL), and lactic acid stinging test), provided evidence that the moisturizer contributed to the restoration of the skin barrier: skin dryness, roughness and desquamation were much improved and skin sensitivity was significantly reduced. Skin properties and skin discomfort were also greatly enhanced and the patients were very satisfied with the product. It can thus be concluded that in the management of rosacea, basic skin care regimens, including daily use of a therapeutic moisturizer, offer optimal benefits.
Article
In evaluating the safety of a novel cosmetic product or a new chemical, it is important to assess susceptible population. One group of subjects is known to stingers who are more likely to experience sensory effects such as stinging and burning after contacting with cosmetics. The purpose of the study is to measure skin biophysical parameters noninvasively in stingers and non-stingers and to see their correlations with stinging responses. 298 women were evaluated by modified lactic acid stinging test with 5% lactic acid solution rather than classic 10% solution because of strong reaction in Asian populations. Transepidermal water loss (TEWL), skin hydration, sebum content, and pH were measured using the bioengineering instruments in an environment-controlled room. Correlations between stinging responses and skin biophysical parameters were statistically analysed. There was a positive correlation between stinging responses and TEWL evaluation. However, no correlations was observed between stinging responses and other parameters such as skin hydration, sebum content, and pH. Our data indicate that there is a relationship between the degree of stinging and the skin barrier function. However, we believe that various additional studies are necessary to characterize skin of stingers and the pathogenesis.
Article
Ultraviolet (UV) irradiation causes multifaceted damage to the skin and adjacent tissue layers, and is one of the leading causes of premature skin aging, immunosuppression and carcinogenesis. Photoprotection can be achieved by the use of sunscreens and also by systemically administered compounds that fight the deleterious biological effects of UV exposure, or preferably both. In this review, we summarize the current knowledge on the tissue, cellular and molecular mechanisms underlying the photoprotective effect of Polypodium leucotomos fern extract. P. leucotomos blocked the deleterious effect of UV irradiation both in vivo and in vitro. The molecular basis of photoprotection relies on its ability to inhibit free radical generation, prevent photodecomposition of both endogenous photoprotective molecules and DNA, and prevent UV-induced cell death. Its complete loss of toxicity combined with its multifactor protection makes it a valuable tool not only for direct photoprotection, but also as an efficacious adjuvant to phototherapy of various skin diseases.