Article

Oral zinc sulfate in the treatment of rosacea: A double-blind, placebo-controlled study

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Abstract

Rosacea is a skin problem not uncommonly encountered world-wide. There is a need for an effective and well-tolerated treatment for this disease. To evaluate the efficacy and side-effects of zinc sulfate in rosacea in a randomized, controlled, double-blind trial. Patients with rosacea who attended the outpatient Clinic of Dermatology and Venereology in Baghdad Teaching Hospital were recruited into this study between October 2002 and August 2004. A disease severity score was calculated for each patient. The patients were randomly allocated to receive either zinc sulfate 100 mg or identical placebo capsules three times per day. Zinc sulfate and placebo capsules were given in a double-blind manner. Following 3 months of starting the treatment, the patients crossed over, i.e. patients on placebo crossed over to zinc sulfate and those on zinc sulfate crossed over to placebo. Twenty-five patients with rosacea were included in this study: 16 (64%) females and nine (36%) males. Nineteen patients completed the study: 11 (58%) females and eight (42%) males. Patient age ranged from 21 to 64 years with a mean +/- SD of 48.2 +/- 9.3 years. Duration of the disease ranged from 1 to 14 years with a mean +/- SD of 4.4 +/- 3.2 years. In the group started on zinc sulfate, the score before therapy ranged from 5 to 11 with a mean +/- SD of 8 +/- 2.0. The mean started to decrease directly after the first month of therapy with zinc sulfate to a significantly lower level. After shifting to placebo treatment, the mean started to rise gradually in the fifth month but remained significantly lower than the levels before therapy. In the group started on placebo, the score before therapy ranged from 5 to 9 with a mean +/- SD of 7 +/- 1.3. The mean remained high in the first 3 months of therapy while the patients were on placebo. After shifting to zinc sulfate, the mean started to decrease after the fourth month to significantly low levels. No important side-effects were reported apart from mild gastric upset in three (12%) patients on zinc sulfate. Zinc sulfate was found to be a good option in the treatment of rosacea, as it was safe, effective and lacking important side-effects.

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... [8] Oral zinc sulfate was used in treatment of Kalazar [9] , Behcet disease. [10,11] Rosacea. [10] Topical Zinc sulfate was used in viral warts [11] , actinic Keratosis. ...
... [10,11] Rosacea. [10] Topical Zinc sulfate was used in viral warts [11] , actinic Keratosis. [12,13] Silymarin is a compound derived from milk thistle plants, it contains three isomers Silibinin, Silidianin and Silichristin [14] with wide range of biological activity. ...
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Objective: Nephrotoxicity (NT) is a serious state with multi factorial
... 54 This was not replicated in a study of 25 patients over six months. 55 Here, zinc sulphate 100mg three times daily was found to be a good treatment for rosacea with signi cant improvements in rosacea severity score (p<0.01). 55 Zinc sulphate is water-soluble, meaning it is not absorbed well by the body. ...
... 55 Here, zinc sulphate 100mg three times daily was found to be a good treatment for rosacea with signi cant improvements in rosacea severity score (p<0.01). 55 Zinc sulphate is water-soluble, meaning it is not absorbed well by the body. 56 To increase zinc levels, nutritionists use zinc picolinate, the form the body absorbs best. ...
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ABSTRACT: Objective. Rosacea is a common inflammatory cutaneous condition with a complex yet unknown etiopathogenesis. Diet and certain food items are known to trigger or worsen rosacea symptoms, but conflicting and often inconsistent advice is given to patients regarding this link. We provide an up-to-date literature review on the relationship between rosacea and diet. Methods. Using the keywords “alcohol,” “diet,” “flushing,” “food,” “inflammation,” “rosacea,” “skin-gut axis” and “spice” we systemically searched the databases PubMed, MEDLINE and EMBASE for English-language articles in July 2020. Results. The most frequently reported triggers implicated in rosacea include alcohol, spicy food, cinnamaldehyde-containing foods (e.g., tomatoes, citrus fruits, chocolate), hot drinks, and histamine-rich foods (e.g., aged cheese, wine, processed meats). Some food items appear to play a protective role, such as omega-3, which appears to protect against ocular rosacea. The relationship between certain food items and the subtype of rosacea is varied, with inconsistent results shown in the few studies that examined this. As an example, alcohol worsens flushing and fatty food triggers both erythematotelangiectatatic and phymatous rosacea in susceptible individuals. Conclusion. While several food types appear to be associated with exacerbation of rosacea, there are no recommendations that can be applied to all patients. Further studies are needed to examine the exact link between diet and rosacea subtypes.
... Zinc sulphate has been used as an immunomodulator in the treatment of many dermatological problems such as cutaneons leishmaniasis 15 , recalcitrant common warts, 16 Behcet's disease 17 , rosacea 18 , erythema nodosum leprosum 19 and alopecia areata. 20 There are reports documenting serum zinc level is lower in psoriatic in comparison to non psoriatic patients. ...
... Their mean serum zinc level was 63.6 ±13.1 µg/dl compared to a normal serum values of 87 ± 9 µg/dl for adult and 92.9 ± 16 µg/dl for children. 18 Low serum level of zinc could be due to exfoliation 21 from the skin of psoriatic patient or due to consumption of low zinc containing foods. It was also found in other studies that a level of zinc of 70.08±4.23 ...
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Objectives: To evaluate the effectiveness of oral zinc sulphate in treatment of psoriasis alone or in combination with methotrexate.Materials and methods: A Total of 60 patients with psoriasis vulgaris were recruited for the study during the period October 2006 to October 2007. The patients were divided in to three groups according to their systemic treatments, as follows: Patients in Group1 (20 patients) were treated with oral zinc sulphate, Group 2 (20 patients) were treated with zinc sulphate plus oral methotrexate and patients in Group 3 (20 patients) were treated with oral methotrexate alone.Results: There were 34 (56.7%) men and 26 (43.3%) women, with a male: female ratio 1.3:1.Their age ranged from 15-70 years with a mean of 32±11 years. Oral zinc sulphate produced a good response in about 60% of the cases; with a relapse rate amounts to 58% noticed 4 weeks after cessation of treatment. Combination of oral zinc sulphate and methotrexate induced a good response in 85% of the patients, with a relapse rate of 59 % that was noticed 4 weeks after treatment cessation. Methotrexate alone induced a good response in 70% of the patients with a relapse rate of 64%. Mild adverse effects were reported in 30% of the cases on zinc sulphate treatment.Conclusion: Zinc sulphate is an effective treatment of psoriasis but the combination of zinc sulphate plus methotrexate could be more effective than zinc sulphate or methotrexate alone. J Clin Exp Invest 2010; 1(3): 143-149
... [37][38][39][40] Rosacea Oral Oral zinc sulphate 100 mg thrice a day was effective in rosacea after 3 months of therapy. [48] Hidradenitis suppurativa Oral Oral zinc gluconate 90 mg/day showed significant clinical improvement. [50] Psoriasis and psoriatic arthritis Topical Topical 0.25% zinc pyrithione applied twice daily was found useful in plaque psoriasis. ...
... A number of drugs, which include antibiotics (tetracyclines, metronidazole), immunosuppressants (calcineurin inhibitors-tacrolimus, pimecrolimus), retinoids, and vascular lasers, are the commonly used treatments. Oral zinc sulphate was found useful in the management of rosacea by Sharquie et al. [48]. They used zinc sulphate 100 mg thrice daily in 25 patients of rosacea in a double blind randomized control trial and observed a statistically significant decrease in disease activity after three months of therapy without any serious adverse effects. ...
Article
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Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc.
... Recently zinc sulfate solution has shown to be effective in treatment of superficial fungal infection in 10% and 15% concentrations [13,14]. Oral zinc sulfate has been successfully tried in the treatment of cutaneous leishmaniasis, acne rosacea and viral warts [15,16]. ...
... Patients were instructed to stop any other medications at least one month before starting the therapy. Physical Examination of the patients and assessment of their disease was done according to the disease severity score (Sharquie's score) [16] which includes: severity of erythema, number of papules and pustules, telangectasia, and presence or absence of rhinophyma. The severity of erythema was determined according to a color chart (Figure 1, Table 1). ...
... Decreasing the release of both TNF-α [53,59] and IL-6, which are involved in inflammatory processes [30] 5. ...
... They observed that the mean disease severity score in patients undergoing oral Zn therapy started to decrease directly after the first month of therapy to significantly lower levels. Their study showed that oral Zn could be a good therapeutic option for rosacea [53]. Conversely, in a randomized, double-blinded study, Bamford et al. revealed that oral Zn sulfate was not associated with greater improvement in the rosacea severity compared with placebo [54]. ...
Article
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Abstract Zinc is an essential trace element important for a large number of structural proteins, enzymatic processes and transcription factors. It plays main roles in the cell-mediated immunity, bone formation, tissue growth, brain function, growth of the fetus and child. It also has roles in pathogenesis of some dermatological disorders. Zinc can be used as effective agent for treatment of some skin and hair disorders, but generally, it seems that with the exception of states relating to zinc deficiency, there is very little evidence to support the efficacy of zinc as a first-line treatment for most of dermatological conditions. Herein, we collected and summarized the appropriate manuscripts and papers regarding the importance of zinc in some of the most important dermatological disorders.
... Esse estudo foi conduzido entre 4 meses a 2 anos e melhorou significativamente as lesões da pele, suavizando e clareando (Khalifa et al., 2008). Na rosácea o zinco também demostrou eficácia no controle das lesões, com uso oral de 100 mg sulfato de zinco, três vezes ao dia (Sharquie et al., 2006). Por fim, na alopecia areata, após seis meses de tratamento de sulfato de zinco de 5mg por quilo de peso ao dia, dividido em três doses diárias, estimulou o crescimento dos fios (Sharquie et al., 2012). ...
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A pele é o maior órgão do corpo humano e seu estado reflete intimamente o estado de saúde em que o complexo organismo humano se encontra. Além disso, a pele está exposta diariamente a danos ambientais que podem acarretar envelhecimento precoce, hiperpigmentações, desidratação e até mesmo doenças de pele, como o câncer. Junto com aumento da expectativa de vida tem-se buscado cada vez mais, alternativas que possibilitem a manutenção da saúde da pele, a fim de protegê-la contra os danos nocivos do ambiente ou sintomas de degeneração celular, com consequentes hiperpigmentações, fotoenvelhecimento e até mesmo o câncer de pele. Diante disso, as ciências da nutrição juntamente com a medicina estética se fazem conjuntamente presentes, visto que a pele se mostra como indicador sensível de deficiências nutricionais. Para tanto, para a manutenção de uma pele saudável é preciso nutri-la com nutrientes importantes para o corpo através de uma dieta diversificada e balanceada. Muitos compostos agem de forma efetiva na prevenção do envelhecimento da pele, com comprovações em modelos in vitro, animais e humanos. O objetivo desse estudo, portanto, foi revisar a literatura para demonstrar como as substâncias bioativas presentes na dieta influenciam no processo de envelhecimento e sua importância nos aspectos físicos da pele como hidratação, elasticidade, coloração, firmeza e rugas.
... IAP is also activated by dietary zinc [33] and by vitamin A [39][40][41]. The first clinical trial of zinc sulfate supplementation in rosacea patients showed significant improvements in symptoms of the study group as compared to the placebo group [42]. The synthetic vitamin A analogs such as isotretinoin which are used to treat severe rosacea and other forms of acne have also been shown to increase IAP activity [43], and as such may represent an additional unrecognized mode of action of these compounds. ...
Article
Rosacea is a common inflammatory condition of the facial skin of unknown etiology, which frequently occurs in combination with gastrointestinal disorders. Many dietary and hormonal factors are known to affect the severity of rosacea symptoms, several of which also modulate the activity of the enzyme intestinal alkaline phosphatase (IAP). The role of IAP in inhibiting an inflammatory response to intestinal bacteria suggests a mechanism by which intestinal pathologies may be linked to the skin inflammation characteristic of rosacea. Analysis of alkaline phosphatase activity is routinely performed on blood samples, and methods to quantify enzyme activity of the intestinal isoform specifically have been described. Correlations between IAP activity and rosacea symptoms in patients and controls can thus be screened by noninvasive and inexpensive means. If IAP activity is found to be low in rosacea patients, acute symptoms could be treated with oral IAP supplementation, and trials of IAP-activating medications currently used in gastrointestinal disease could be initiated in rosacea patients. More importantly, the safe and long-term control of rosacea could be undertaken by patients themselves through dietary modification to naturally increase IAP activity.
... The resulting interference with copper uptake has led to severe anemia, leukopenia, and neutropenia at doses that exceeded 100 mg elemental Zn per day [33,34]. Zinc administration has so far been found to be ineffective for the treatment of atopic eczema [35], but there are single reports that it was successfully used to treat rosacea and recurring oral ulcers [36]. A significant lowering of the serum Zn concentration in psoriasis without an improvement in serum Zn levels after oral Zn therapy is also observed [37]. ...
Article
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Psoriasis is a noncontiguous common and chronic skin disorder. The aim of the present study was to compare the level of trace elements cadmium (Cd), chromium (Cr), Nickel (Ni), and zinc (Zn) in biological samples (whole blood, urine, and scalp hair) of psoriasis patients of both gender age ranged (25-55 years) at mild, moderate severe, and more severe stage (n = 418) living in the vicinity of cement factory. For comparison purposes, healthy age-matched referent subjects, residents of industrial and non-industrial area, of both gender were also selected (n = 241). The concentrations of trace and toxic elements were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of methodology was checked by using certified reference materials (CRMs) and conventional wet acid digestion method on same CRMs and real samples. The results of this study showed that the mean values of Cd, Cr, Ni, and Pb were significantly higher in scalp hair, blood, and urine samples of mild and severe psoriasis patients as compared to referents (p < 0.001), while the concentration of Zn was lower in the scalp hair and blood, but higher in the urine samples of psoriasis patients. The deficiency of Zn in psoriasis patients may be undoubtedly caused by the toxic element exposures via cement factory.
... We included studies which examined topical clindamycin vs. tetracycline, rilmenidine, dark sulphonated shale oil, zinc sulphate and nadolol but the data from these studies were considered largely unusable. [63][64][65][66][67] Studies with laser-and ⁄or light-based treatment ...
Article
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Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. The aim of this review was to assess the evidence for the efficacy and safety of treatments for rosacea. Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40mg and 100mg but there were fewer adverse effects. One study reported that ciclosporin ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid and doxycycline (40mg) in the treatment of moderate to severe rosacea, and ciclosporin 0·05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately powered randomized controlled trials are required.
... In a randomized, controlled, double-blind, crossover study of 19 patients receiving 100 mg zinc sulfate capsules or placebo three times daily, significantly reduced scores were seen in both treatment arms during the zinc treatment arm, with a relative plateau during the placebo phase. 76 In contrast, a similar trial of 220 mg zinc sulfate dosed twice daily showed no difference in patients receiving zinc therapy versus placebo. 77 Neither of the studies on oral zinc products produced any side effects of concern. ...
Article
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Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies.
... Oxidative stress potentially results in disturbed wound healing. 49 Increases in the allantoin:uric acid percentage ratio (AUR) and 8-isoprostane levels are reported in chronic wounds. 50 Selenium, zinc, and iron levels as well as GPX activity are decreased, and ROS-elevated iron deposition and superoxide are increased. ...
Article
Oxidative stress results from a prooxidant-antioxidant imbalance, leading to cellular damage. It is mediated by free radicals, such as reactive oxygen species or reactive nitrogen species, that are generated during physiological aerobic metabolism and pathological inflammatory processes. Skin serves as a protective organ that plays an important role in defending both external and internal toxic stimuli and maintaining homeostasis. It is becoming increasingly evident that oxidative stress is involved in numerous skin diseases and that antioxidative strategies can serve as effective and easy methods for improving these conditions. Herein, we review dysregulated antioxidant systems and antioxidative therapeutic strategies in dermatology.
... We included studies which examined topical clindamycin vs. tetracycline, rilmenidine, dark sulphonated shale oil, zinc sulphate and nadolol but the data from these studies were considered largely unusable. [63][64][65][66][67] Studies with laser-and ⁄or light-based treatment ...
... The hair mount, showing a tapered or bayonet anagen hair with black pigmentation at the base, which may be highly diagnostic before the onset of alopecia. 12 Zinc sulphate had been used in the treatment of many skin diseases such as cutaneous leishmaniasis 15 , recalcitrant viral warts 16 , Behcet's disease 17 , rosacea 18 . Perifolliculitis capitis abscedens et suffodiens 19 , alopecia areata and recurrent aphthous stomatitis 20 , and it was proved to be safe and effective. ...
... Zinc sulphate Zinc sulphate 100 mg daily showed significant superiority over placebo in a randomized, controlled, doubleblind trial (n = 25). 204 Conclusion: Oral zinc may be used (A) for subtype II rosacea. ...
Article
Rosacea (in German sometimes called ‘Kupferfinne’, in French ‘Couperose’ and in Italian ‘Copparosa’) is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.
... The resulting interference with copper uptake has led to severe anemia, leukopenia , and neutropenia at doses that exceeded 100 mg elemental zinc per day (Porea et al., 2000; Salzman et al., 2002). Zinc administration has so far been found to be ineffective for the treatment of atopic eczema (Ewing et al., 1991), but there are single reports that it was successfully used to treat rosacea (Sharquie et al., 2006) and recurring oral ulcers (Merchant et al., 1977). Another form of ulcers, chronic leg ulcers, were seemingly unaffected by zinc in two studies (Floersheim and Lais, 1980; Greaves and Ive, 1972), but another report did find an effect, and especially a correlation between serum zinc levels and healing (Hallbook and Lanner, 1972). ...
Article
Zinc is a nutritionally essential trace element, and thus zinc deficiency may severely affect human health. Many studies were published in which the effect of nutritional zinc supplementation on the incidence or severity of a certain disease was investigated. This review summarizes the main observations and aims to evaluate the use of nutritional zinc supplementation for prevention and treatment of human disease.
... Studies on zinc supplementation in rosacea have produced conflicting results. While one trial noted significant improvement with 100 mg of zinc sulfate three times a day [62], another found no difference in improvement after 90 days of 220 mg of zinc sulfate twice a day [63]. ...
Article
Dietary change may play a role in the therapy of rosacea. Certain foods and beverages may act as "triggers" for rosacea exacerbations. These may be divided into heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related. One potential pathogenic mechanism may be via the activation of transient receptor potential cation channels, which result in neurogenic vasodilatation. Further research is needed on the role of the gut skin connection in rosacea. Epidemiologic studies suggest that patients with rosacea have a higher prevalence of gastrointestinal disease, and one study reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth. While further research is required in this area, patients may be advised on measures to support a healthy gut microbiome, including the consumption of a fiber-rich (prebiotic) diet.
... Zinc is used to treat numerous dermatological conditions, such as infections (e.g., warts), inflammatory dermatoses (acne vulgaris, rosacea, atopic dermatitis and alopecia areata) and pigmentary disorders (melasma) [97][98][99]107,110]. Zinc administered orally or topically has been shown to have therapeutic applications in skin ageing (a 0.1% copperzinc malonate cream applied topically for 6 weeks significantly reduced wrinkles) [111]; melasma (a 10% zinc sulphate solution applied topically twice daily for 2 months significantly reduced MASI scores) [112]; actinic keratoses (a 25% zinc sulphate solution applied topically twice daily for 12 weeks was safe and effective, especially in patients with multiple actinic keratosis lesions) [113]; xeroderma pigmentosum (a 20% topical application of a zinc sulphate solution for 4 months to 2 years improved all types of skin lesions, softened the skin, lightened the skin color, and cleared the skin of solar keratosis and small malignancies) [114]; eczema (a 0.05% Clobetasol + 2.5% zinc sulphate cream applied topically was effective in hand eczemas) [115]; rosacea (100 mg of oral zinc sulphate three times per day was effective after 3 months of therapy) [116]; and alopecia areata (5 mg/kg/day, in three divided doses, of oral zinc sulphate induced significant hair growth after 6 months) [117]. ...
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Human skin is continually changing. The condition of the skin largely depends on the individual’s overall state of health. A balanced diet plays an important role in the proper functioning of the human body, including the skin. The present study draws attention to bioactive substances, i.e., vitamins, minerals, fatty acids, polyphenols, and carotenoids, with a particular focus on their effects on the condition of the skin. The aim of the study was to review the literature on the effects of bioactive substances on skin parameters such as elasticity, firmness, wrinkles, senile dryness, hydration and color, and to define their role in the process of skin ageing.
... Notably, this drug is teratogenic and absolutely contraindicated during pregnancy; use during lactation is also to be avoided. 37 Two randomized control trials have been found dealing with zinc sulfate; in one randomized control trial significant improvement was seen in 19 patients with zinc sulfate (100 mg thrice daily) compared to placebo, 44 while the other study did not show any significant advantage over placebo (220 mg twice daily for 3 months; 44 patients). 45 Further studies are needed to corroborate this finding. ...
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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.
... The authors concluded that the tea lotion induced a significant reduction of the inflammatory lesions while the 5% zinc sulphate solution decreased inflammation but at a lower level compared to the tea lotion [48]. In another clinical study [49], zinc sulphate was orally given to patients with rosaceae, a skin condition that affects people worldwide. Zinc sulphate was orally given 100mg/3x/day for three months. ...
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Maslinic acid is a pentacyclic triterpene with a plethora of biological activities, including anti-inflammatory, antioxidant, antimicrobial, cardioprotective, and antitumor effects. New derivatives with improved properties and broad-spectrum activity can be obtained following structural changes of the compound. The present study was aimed to characterize a benzylamide derivative of maslinic acid—benzyl (2α, 3β) 2,3-diacetoxy-olean−12-en-28-amide (EM2)—with respect to the anti-angiogenic and anti-inflammatory effects in two in vivo experimental models. Consequently, the compound showed good tolerability and lack of irritation in the chorioallantoic membrane assay with no impairment of the normal angiogenic process during the tested stages of development. In the acute ear inflammation murine model, application of EM2 induced a mild anti-inflammatory effect that was potentiated by the association with zinc chloride (ZnCl2). A decrease in dermal thickness of mice ears was observed when EM2 and ZnCl2 were applied separately or in combination. Moreover, hyalinization of the dermis appeared only when EM2 was associated with ZnCl2, strongly suggesting the role of their combination in wound healing.
... The sole side effect to be reported was gastric upset in 12% of the patients. 47 Oral ivermectin (200 micrograms/ kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well. ...
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Burhan Engin, Defne Özkoca, Zekayi Kutlubay, Server Serdaroğlu Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Dermatology and Venerology, İstanbul, TurkeyCorrespondence: Burhan EnginIstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Dermatology and Venerology, İstanbul 34098, TurkeyEmail burhanengin2000@yahoo.comAbstract: Rosacea is a common skin disease that is troublesome for both the patients and the dermatologists. Erythema, telengiectasia, papulopustular changes and phymatous changes are the main problems faced by the patients and dermatologists in everyday practice. Due to the chronic and relapsing nature of the disease, patients are usually unsatisfied with conventional treatment methods. This article aims at redefining rosacea according to the 2017 consensus and reviewing the different treatment modalities for different manifestations of the disease in depth.Keywords: new, resistant, rosacea, treatment
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The visual perception of individually flakes and sebum on the scalp and hair is an abnormal condition referred, in the public domain, to as dandruff and seborrheic dermatitis. More than 50% of adults may be affected by these conditions, which suggest a high socio economical impact, manifested in the loss of self-esteem generating a negative image. This image may be further worsened when hair damages for the excessive exposure to chemicals and environmental aggressions occur. The regular use of appropriate hair cleansing agents (shampoos) and surface lubricating products (conditioners), reducing the presence of flakes and sebum on the scalp, result also of hair benefits in terms of smoothness, softness, breakage reduction, and manageability. This paper reports the activity of two shampoos and two conditioners which, enriched of zinc and chitin nanofibrils, are active both in vitro and in vivo in reducing hair flakes and sebum, ameliorating the hair shine and manageability.
Article
A 2006 article published in the International Journal of Dermatology reported that oral zinc sulfate 100 mg three times daily was associated with improvement in the severity of facial rosacea (Sharquie et al. 2006; 45: 857-861). The current study was undertaken to further assess the role of zinc in the management of rosacea. This was a randomized, double-blind trial of 220 mg of zinc sulfate twice daily for 90 days in patients with moderately severe facial rosacea at baseline. Subjects were recruited in the Upper Midwest USA between August 2006 and April 2008, and followed until July 2008. Forty-four subjects completed the trial (22 in each arm). Rosacea improved in both groups. There were no differences in magnitude of improvement based on rosacea severity scores between subjects receiving zinc sulfate and subjects receiving placebo (P=0.284). Serum zinc levels were higher in subjects receiving zinc (P<0.001). Oral zinc sulfate was not associated with greater improvement in rosacea severity compared with placebo in this study. Additional studies are needed to determine what role oral zinc may have in the management of rosacea.
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There is a great interest in dietary modifications for both acne and rosacea. The pendulum has swung throughout history, with a recent resurgence in clinical research and evidence pointing toward nutritional implications and effect on both acne and rosacea. High-glycemic load foods and dairy products have been shown to be associated with acne and have the best evidence for recommendation for avoidance. Genetics may also increase susceptibility to diet-associated acne breakouts. In addition, studies show omega-3 fatty acids, plant polyphenols, and phytoestrogens potentially play a protective role in acne formation. Rosacea has long been associated with dietary triggers as well. The list of dietary triggers is extensive and diverse, and rosacea patients may have difficulty sifting through all the conflicting nutritional information available. Dietary triggers for rosacea flares are often very individualized, and a food diary is recommended for patients to identify personal triggers. Potential rosacea triggers include alcohol, hot food/drinks, spicy foods, histamine, niacin, and cinnamaldehyde-containing foods. For both acne and rosacea, a whole foods diet with focus on plants (other than those known to trigger rosacea) and fiber, with minimal processed foods, is recommended.
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 patients. A range of treatment options are available but it is unclear which are the most effective. Objectives: To assess the evidence for the efficacy and safety of treatments for rosacea. Search strategy: In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers. Selection criteria: Randomised controlled trials in people with moderate to severe rosacea. Data collection and analysis: Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors. Main results: Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'.Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76).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). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54).One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes). Authors' conclusions: Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.5% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
Article
The influence of dietary patterns on cutaneous disease has been an oft-posed question to dermatologists by patients in a clinical setting. Similarly, the popularity of nutritional supplementation with vitamins, minerals, and nutraceutical blends has been increasing. Dermatologists, primary care physicians, and other providers should be familiar with dietary interventions that are evidence-based and those that are more marketable than efficacious. In this review, the modification of diet, including dietary exclusion and dietary supplementation for the treatment of rosacea, hidradenitis suppurativa (HS), herpes labialis, and vitiligo was investigated. Despite abundant anecdotal evidence, the literature search found no high-quality evidence that an elimination diet for rosacea “trigger foods” improved rosacea symptoms though these elimination diets (of hot, spicy, alcohol-containing, or cinnamaldehyde-containing foods) had low risk of harm. There is evidence that zinc supplementation and vitamin D supplementation in deficient patients is helpful for treating HS. For herpes labialis, L-lysine supplementation was found to be effective for prophylaxis but not for decreasing duration of active lesions. For vitiligo, the use of the herb Polypodium leucotomos in conjunction with phototherapy was found to increase repigmentation, as well as vitamin D supplementation in deficient patients.
Article
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Zinc is a micronutrient used over the years for many dermatological conditions such as infections, inflammatory dermatoses, pigmentary disorders, neoplasias etc. It is used in both elemental as well as salt form, either in topical or in oral form as a therapy. An average adult weighing 70 kg has a body zinc content of 1.4–2.3 gm. The role of zinc in deficiency disorder like acrodermatitis enteropathica is already established and used widely as treatment. Zinc has been identified as effective in the treatment of various disorders but it cannot be used as the replacement for proven first line treatment. Zinc can be used as adjuvant therapy in many dermatological disorders. This is a narrative review where various use of zinc as therapy in dermatological disorders is highlighted.
Article
The potential adverse effects associated with some of the more common oral vitamin supplements--vitamins A, D, and E and niacin (forms include nicotinic acid and nicotinamide), and mineral supplements--zinc, copper, and iron, used in dermatology are manifold. Although the dermatologist may be familiar with adverse effects of vitamins A and D, less well-known adverse effects, such as hematologic and neurologic effects from zinc, are presented.
Article
Severe zinc deficiency states, such as acrodermatitis enteropathica, are associated with a variety of skin manifestations, such as perioral, acral, and perineal dermatitis. These syndromes can be reversed with systemic zinc repletion. In addition to skin pathologies that are clearly zinc-dependent, many dermatologic conditions (eg, dandruff, acne, and diaper rash) have been associated and treated with zinc. Success rates for treatment with zinc vary greatly depending on the disease, mode of administration, and precise zinc preparation used. With the exception of systemic zinc deficiency states, there is little evidence that convincingly demonstrates the efficacy of zinc as a reliable first-line treatment for most dermatologic conditions. However, zinc may be considered as an adjunctive treatment modality. Further research is needed to establish the indications for zinc treatment in dermatology, optimal mode of zinc delivery, and best type of zinc compound to be used.
Article
Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple therapeutic options.
Article
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Oral flucloxacillin is less effective than local antibiotics for impetigo in limited disease. Topical metronidazole and azelaic acid are effective for rosacea. Betadine is effective for minor infections following partial thickness burns. Terbinafine is effective against fungal infections of the nail. Miconazole is effective against oral thrush.
Article
Rosacea is a common chronic inflammatory cutaneous disorder, primarily manifesting on the cheeks, nose, chin, and forehead with a classic relapsing-remitting course that affects mostly fair skin types (Fitzpatrick I and II). The pathogenesis remains unclear, but the complex interplay between environmental and genetic factors may augment the innate immune response and neurovascular dysregulation. Potentially, different nutrients may play a role in the pathogenesis of rosacea. Many dietary triggers for this disease have been postulated, ranging from hot beverages, alcohol, spicy foods, caffeine, vanilla, cinnamon, niacin, and marinated meats to dairy products; however, there is a lack of well-designed and controlled studies evaluating the causal relationship between rosacea and dietary factors. We have explored the available evidence and hypothesis based on trigger food categories of rosacea, the role of the skin-gut microbiome axis, and potentially benefiting dietary factors such as probiotics, prebiotics and high fiber diet.
Article
To evaluate effectiveness of 2% tea lotion in comparison with 5% zinc sulphate solution in the treatment of acne vulgaris. This is a single-blind randomly comparative therapeutic clinical trial carried out in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from June 2006 to December 2007. Full history and clinical examination were studied for each patient regarding all relevant points of the disease, to evaluate the severity of acne. Forty-seven patients with acne vulgaris were divided randomly into 2 groups, and were instructed to use the following solutions twice daily for 2 months; group A used 2% tea lotion, group B used 5% zinc sulphate solution. Patients with papulopustular lesions were included in the study, while patients with severe acne were excluded. The clinical improvement was scored by counting the number of inflammatory lesions before, and after treatment. Forty patients completed the study, their ages ranged from 13-27 years with a mean+/-standard deviation of 19.5+/-3.5 years with 20 patients in each group. Two percent tea lotion was statistically significant in decreasing the number of the inflammatory lesions in acne vulgaris, while 5% zinc sulphate solution was beneficial, but did not reach statistically significant level as tea lotion. Two percent tea lotion was a good alternative remedy to be used in the treatment of acne vulgaris, and was much superior than topical 5% zinc sulphate solution.
Article
Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.
Article
Background: Novel rosacea treatments are needed. Assessment methodologies for clinical trials of rosacea treatments are not standardized and are relatively inadequate. To determine the efficacy of new treatments, a valid and reliable assessment methodology is needed.
Article
Background Novel rosacea treatments are needed. Assessment methodologies for clinical trials of rosacea treatments are not standardized and are relatively inadequate. To determine the efficacy of new treatments, a valid and reliable assessment methodology is needed. Objective We sought to determine the assessment methodologies used in clinical trials for rosacea treatments, to demonstrate the need for a valid and reliable assessment tool, and to describe the relevant properties of such a tool. Methods PubMed and MEDLINE were searched for clinical trials of rosacea treatments since January 1, 1985. Results In all, 32 clinical trials met inclusion criteria. Assessment methodologies were highly variable, and standardized assessment methodologies were used in only 3 studies. The various manifestations of rosacea were assessed inconsistently. Limitations Eighteen articles could not be included as a result of lack of access to the full text. Conclusions The diverse methodologies make the assessment of novel treatments and comparison of treatments difficult. A valid and reliable assessment tool is needed to properly assess novel treatments to improve the management of rosacea.
Article
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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.
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.
Chapter
The skin is the interfacing barrier to the external environment. Its integrity is required for protection and health. The cells are continuously being replaced in response to both intrinsic and extrinsic forces. Diet and lifestyle affect the skin health. Genetic makeup, including microRNA, also impacts the degree of skin disease. The incorporation of adequate protein, essential fatty acids, low-glycemic carbohydrates, fermented foods, water, minerals, vitamins, and phytonutrient-rich vegetables modulate the endocrine and immunologic systems of the skin, providing the best opportunity for health. Nutritional requirements for this organ system vary widely depending on its state of health or condition. Common skin ailments are impacted by medical nutrition therapies that can alter the severity of the condition. The application of food and dietary choices, the modified elimination diet, and nutrient or bioactive supplementation may impact the root causes of the skin condition. Dermatologic conditions are common in clinical practice. Common conditions may be a result of underlying metabolic dysfunction (acanthosis nigricans); immunologic epigenetic perturbations (psoriasis and pemphigus); the gut-brain-skin axis dysfunction (acne vulgaris and acne rosacea); genetic or acquired deficiency (zinc and acrodermatitis enteropathica, follicular hyperkeratosis); food-triggered hypersensitivity (dermatitis herpetiformis); a multifactorial imbalance of genetic, environmental, innate, and acquired immune dysfunction (atopic dermatitis); and frank deficiency (pellagra, scurvy). These conditions may respond to targeted medical nutrition therapy. The therapeutic opportunities for each common condition are reviewed.
Article
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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.
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.
Chapter
Rosacea is a multifactorial disease with a variable course. Although most patients can be treated by standard therapy, the search for new treatment modalities is going on. Some of the nonclassical treatments discussed in this chapter highlight the neurophysiological background of rosacea.
Article
This literature review detines the biological role ot zinc in the human body, immune homeostasis and skin physiology as well as pathophysiology ot skin diseases. It describes the current range ot systemic and topical zinc preparations and their pharmacological characteristics. The review also describes skin diseases that may be treated with the use ot zinc preparations on a grounded basis, and discloses the clinical experience ot the use ot these drugs described in the world literature. It sets out certain recommendations tor using zinc preparations in clinical practice.
Chapter
Zinc is a micronutrient that plays an integral part in the normal functioning of the human body. Recent studies have elucidated the intricate physiology of zinc homeostasis. It has been shown to have immunomodulatory, anti-oxidant and anti-inflammatory roles. However, the application of this new understanding of zinc homeostasis to chronic inflammatory, infectious and auto-immune dermatological conditions is lacking. Evidence based support to the value of using oral zinc supplementation in various diseases is limited. Literature searches showed a paucity of prospective randomized controlled trials. Most literature on the use of zinc in dermatological conditions is largely anecdotal, based on small case series, or individual case reports. Diseases clearly linked to defective zinc absorption or nutritional deficiencies such as acrodermatitis enteropathica and other acquired zinc deficiency states respond rapidly to oral zinc supplementation. As a consequence, oral zinc supplementation remains a first line agent for these conditions. On the other hand, for most other conditions linked to mild to moderate deficiencies of zinc, its use remains limited as a second line agent or as a last measure in certain patients in whom conventional treatment has failed. Further research and adequate double blinded randomized control trials are needed in future. These should evaluate the efficacy of treatment with oral zinc in patients as compared to conventional treatments and would help to reveal the clinical value of using zinc supplementation.
Article
Rosacea is a common chronic inflammatory dermatosis affecting the central face, characterized by intermittent periods of exacerbation and remission. It affects both sexes, and it typically presents after 30 years of age [1-3]. Reported prevalence rates of rosacea range from 0.09 % to 10 % [4]. A Greek study reported a prevalence of 1.22 %, with 0.88 % prevalence for ETT and 0.34 % for PPR [3].
Article
Papulopustular rosacea is a stage of rosacea in which papulopustules appear on the nose and cheeks, more rarely on the forehead and chin, and exceptionally on the neck and other body areas, such as the bare skull or the back. This chapter briefly discusses incidence/prevalence and etiology/risk of the papulopustular rosacea. Typically, rosacea is a multistage disease. The stages are the flushing stage, or transitory congestive redness; the erythrosis stage, of persistent telangiectatic redness; the papulopustular stage; and the phyma stage. The chapter also discusses the effects of systemic treatments including tetracycline, doxycycline, ampicillin, clarithromycin, azithromycin, metronidazole, isotretinoin and octreotide. In addition, it discusses the effects of topical drugs such as permethrin and calcineurin inhibitors and the effects of laser and/or light-based treatments. Topical drugs are less likely to cause systemic adverse effects than systemically administered drugs, and compliance may be better. © 2003 BMJ Publishing Group, 2008, 2014 by John Wiley & Sons, Ltd.
Article
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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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Objectives: Thallium is the most suitable agent for criminal poisoning of human being as it is tasteless, colorless and odorless. It usually associated with typical dermatological features simulating that of zinc deficiency. The aim of this study was to evaluate the role of oral zinc sulphate in the treatment of patients with thallium poisoning. Patients and Methods: This clinical therapeutic trial study was conducted in Departments of Dermatology of Bagh-dad and Basrah Teaching Hospitals from February 2008-February 2010, where a total of 37 patients with thallium poisoning were enrolled. Thirty two patients were seen at Basrah Teaching Hospital while the remaining 5 patients were seen at Baghdad Teaching Hospital A detailed history was taken from all patients regarding all demographics features related to this poisoning. Complete clinical examination was performed looking for skin and hair manifestations in addition to other systemic involvements. All patients received zinc sulphate in a dose of 5 mglkg three times a day few days before confirming the diagnosis of thallium poisoning. Thallium in urine had been measured using the colorimetric method and was positive in all patients. After confirming the diagnosis of thallium poisoning, thallium antidotes Prussian blue was given to 32 patients. Results: Age range of 37 patients was 5-33 (mean, 24t5.3) years. Among all patients the dermatological findings were mainly, anagen hair loss in diffuse and patchy patterns affected the scalp and limbs. Also, dusky ecchymotic red dermatitis like rash was observed on the face especially perioral region and dorsum of hands and legs. Neurologic manifestations, mainly of peripheral neuropathy, were reported in 2L (55%) patients. All patients responded promptly to a trial of 5 mg /kg of zinc sulphate within few days, apart from two patients who presented with advanced symptoms of thallium poisoning but unfortunately died even after given oral Prussian blue. Conclusion: Oral Zinc sulphate appears to be an effective and safe treatment for thallium poisoning particularly for skin and hair features and in reducing its lethal progression and complications.
Chapter
The cause of rosacea is speculative [1, 2]. Regardless of theories about its pathogenesis, no single therapeutic strategy successfully treats all types of rosacea and all patients with rosacea [3-5]. This chapter explores the therapies in various subsets of rosacea. Evidence-based studies and other reports are cited [6]. The efficacy of these treatments often has not been supported by the highest levels of evidence, namely, randomized controlled trials and meta-analyses of randomized controlled trials.
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According to epidemiological studies, acne is a common condition affecting 80% of young people between 12 and 18 years of age. It is also the most common reason for consultation in private dermatology practices. Yet, paradoxically, very few studies have been concerned with the profile and therapeutic treatment of acne patients. The aim of this study was to compare both the evolution of the profile of acne patients and the therapies used by dermatologists between 1996 and 2000 through a survey. Two questionnaires had to be filled in by the dermatologists for all patients consulting for acne, the first in 1996 and the second in 2000. The purpose of these questions was to obtain information about the demographic characteristics of the patients, a clinical evaluation of the patients' acne, their quality of life and finally their treatment. The statistical tests used Chi2 tests and variance analysis. The alpha risk was fixed at 0.05. Two thousand two hundred and eighty four patients were included in the survey in 1996 and 2363 in 2000. The mean age was 21 7.6 in 1996 and 20.5 7.7 in 2000, the majority of whom were female (64.4% in 1996 and 63.6% in 2000). In 1996 37.4% were students, and 52.4% in 2000. For 81.1% of the patients, the consultations were spontaneous on their own initiative both in 1996 and 2000. As regards topical treatment, a decrease of antibiotic prescriptions was noted between 1996 and 2000 associated with a decrease of benzoyl peroxyde use. Concerning the systemic treatments, an increase of doxycyclin and isotretinoin prescriptions was reported together with a decrease of minocycline treatment. Prescription of zinc salts and hormonal treatments were stable. The frequency of biological investigations remained similar and low. The repercussions of acne on the patient's quality of life were more numerous in 1996 compared to 2000 but they remained equally intense for those who reported them. The profile of acne patients evolved slightly between 1996 and 2000 and interestingly the treatments were modified to take into account the information in the literature such as bacterial resistance or severe side effects.
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Impact of Personality Disorders on Treatment Outcome in Obsessive-Compulsive Disorders – Part I: Problems Comorbid personality disorders are discussed as risk factors for a negative treatment outcome in obsessive-compulsive disorder (OCD). However, conflicting findings have emerged. As comorbidity rates between OCD and personality disorders are high the possible impact of personality disorders on treatment outcome in OCD is of major clinical relevance. Several reasons for inconsistent findings need consideration. The concept of personality disorders itself is afflicted with major inherent problems which are also responsible for a slow progress in the development of widely accepted diagnostic instruments for personality disorders. As a result, a wide range of diagnostic instruments exists, reducing comparability of results. Other studies show large methodological shortcomings limiting inferences from their results. The aim of the present paper is to discuss these methodological problems and to give recommendations to avoid or reduce them.
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Background Viral warts are common dermatological diseases; although the rate of spontaneous recovery is high, it usually takes a long time, and some patients might not show this spontaneous healing. Zinc has an important effect on the immune system and it has been used as an immunomodulator to treat a variety of skin disorders. Objective To assess whether oral zinc was effective in treating viral warts of patients evaluated between May 1999 and April 2000. Patients and methods This was a placebo-controlled clinical trial. Eighty patients with viral warts (common, plantar and plane) were all resistant to all forms of treatment. Each patient had > 15 warts. Forty patients were treated by oral zinc sulphate at a dose of 10 mg kg−1 daily up to 600 mg day−1 and followed-up for resolution of their warts and for any evidence of recurrence for 2–6 months. Another 40 patients were given a placebo oral treatment in the form of glucose, and followed-up for the same period. Results Only 23 patients of the first group (zinc treated) and 20 patients of the second group (placebo treated) completed the study. In all patients the serum level of zinc was low. In the zinc-treated group, the overall response was complete clearance of warts observed in 20 patients (86·9%) after 2 months of treatment. Fourteen patients (60·9%) showed complete disappearance of their warts after 1 month. Three patients (13·3%) failed to respond to the treatment after 2 months of therapy. The response to treatment was directly related to the increment in serum zinc level. No patient of the placebo-treated group showed any response. Conclusions We conclude that zinc sulphate at a dose of 10 mg kg−1 daily seems to be a highly efficacious therapeutic option for recalcitrant viral warts and proved to be safe with few adverse effects.
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A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the 'antioxidant system defect hypothesis' in rosacea patients.
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