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Hofmeyer S, Weber F, Gerds S, Emmert S, Thiem A. A Prospective Randomized Controlled Pilot Study to Assess the Response and Tolerability of Cold Atmospheric Plasma for Rosacea. Skin Pharmacol Physiol 2023; 36:205-213. [PMID: 37490882 PMCID: PMC10652650 DOI: 10.1159/000533190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. METHODS In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 s/area) for 6 weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after 6 weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p values were calculated using the Wilcoxon signed-rank test. RESULTS Twelve subjects (ETR, n = 3; ETR and PPR, n = 9) completed the study. DLQI was significantly improved after 6 weeks (p = 0.007). On the CAP-treated side, lesions (p = 0.007) and erythema size (p = 0.041) were significantly reduced compared to the control. IGA (p = 0.2) and skin redness intensity (p = 0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. CONCLUSION CAP is a promising new treatment of rosacea, especially for PPR.
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Affiliation(s)
- Stella Hofmeyer
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Frank Weber
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medical Center Rostock, Rostock, Germany
| | - Sandra Gerds
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Thiem
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
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2
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Abd-Elmawla MA, Ghaiad HR, Gad ES, Ahmed KA, Abdelmonem M. Suppression of NLRP3 inflammasome by ivermectin ameliorates bleomycin-induced pulmonary fibrosis. J Zhejiang Univ Sci B 2023; 24:723-733. [PMID: 37551558 PMCID: PMC10423969 DOI: 10.1631/jzus.b2200385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/11/2022] [Indexed: 07/11/2023]
Abstract
Ivermectin is a US Food and Drug Administration (FDA)-approved antiparasitic agent with antiviral and anti-inflammatory properties. Although recent studies reported the possible anti-inflammatory activity of ivermectin in respiratory injuries, its potential therapeutic effect on pulmonary fibrosis (PF) has not been investigated. This study aimed to explore the ability of ivermectin (0.6 mg/kg) to alleviate bleomycin-induced biochemical derangements and histological changes in an experimental PF rat model. This can provide the means to validate the clinical utility of ivermectin as a treatment option for idiopathic PF. The results showed that ivermectin mitigated the bleomycin-evoked pulmonary injury, as manifested by the reduced infiltration of inflammatory cells, as well as decreased the inflammation and fibrosis scores. Intriguingly, ivermectin decreased collagen fiber deposition and suppressed transforming growth factor-β1 (TGF-β1) and fibronectin protein expression, highlighting its anti-fibrotic activity. This study revealed for the first time that ivermectin can suppress the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome, as manifested by the reduced gene expression of NLRP3 and the apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), with a subsequent decline in the interleukin-1β (IL-1β) level. In addition, ivermectin inhibited the expression of intracellular nuclear factor-κB (NF-κB) and hypoxia‑inducible factor‑1α (HIF-1α) proteins along with lowering the oxidative stress and apoptotic markers. Altogether, this study revealed that ivermectin could ameliorate pulmonary inflammation and fibrosis induced by bleomycin. These beneficial effects were mediated, at least partly, via the downregulation of TGF-β1 and fibronectin, as well as the suppression of NLRP3 inflammasome through modulating the expression of HIF‑1α and NF-κB.
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Affiliation(s)
- Mai A Abd-Elmawla
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt.
| | - Heba R Ghaiad
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt.
| | - Enas S Gad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Sinai University, Ismailia 45511, Egypt
| | - Kawkab A Ahmed
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Cairo 12211, Egypt
| | - Maha Abdelmonem
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
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3
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Chernyshov PV, Finlay AY, Tomas-Aragones L, Steinhoff M, Manolache L, Pustisek N, Dessinioti C, Svensson A, Marron SE, Bewley A, Salavastru C, Dréno B, Suru A, Koumaki D, Linder D, Evers AWM, Abeni D, Augustin M, Salek SS, Nassif A, Bettoli V, Szepietowski JС, Zouboulis CC. Quality of life measurement in rosacea. Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2023; 37:954-964. [PMID: 36744752 DOI: 10.1111/jdv.18918] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient-Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa (ARHS) do not recommend the use of any generic instrument as a single method of Health Related (HR) QoL assessment in rosacea, except when comparing quimp (quality of life impairment) in rosacea patients with that in other non-dermatologic skin diseases and/or healthy controls. The EADV TFs on QoL and Patient-Oriented Outcomes and ARHS recommend the use of the dermatology-specific HRQoL instrument the Dermatology Life Quality Index (DLQI) and the rosacea-specific HRQoL instrument RosaQoL in rosacea patients. The DLQI minimal clinically important difference may be used as a marker of clinical efficacy of the treatment and DLQI score banding of 0 or 1 corresponding to no effect on patients' HRQoL could be an important treatment goal. This information may be added to consensuses and guidelines for rosacea.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,School of Medicine, Weill Cornell University, New York, New York, USA
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - C Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - B Dréno
- INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes Université, Univ Angers, Nantes, France
| | - A Suru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - A W M Evers
- Institute of Psychology, Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - J С Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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4
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Delans K, Kelly K, Feldman SR. Treatment strategies, including antibiotics, to target the immune component of rosacea. Expert Rev Clin Immunol 2022; 18:1239-1251. [PMID: 36137266 DOI: 10.1080/1744666x.2022.2128334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Recent advances in the understanding of the pathophysiology of rosacea have led to increased focus on the disease's immunologic etiology and to the development of immunologically based treatments. With many patients suffering from incomplete control, addressing the immune components of the disease process may provide a more effective treatment option for rosacea patients that may improve quality of life. AREAS COVERED This review will provide a brief overview of the pathophysiology of rosacea, as well as specific immunologic contributions to the disease state. Current standard-of-care treatments will be described, including anti-parasitic, anti-inflammatory agents, and antibiotics. Emphasis will be placed on treatments that target the immune components of the disease process. EXPERT OPINION Rosacea remains a difficult dermatologic disease to treat, partially due to an incomplete understanding of the disease pathophysiology. The immune pathophysiology of rosacea, particularly the key role of inflammation, has been clarified over the past decade. Identification of specific molecules, including cytokines and nuclear transcription factors, may allow for the development of targeted rosacea-specific biologic and topical treatments. However, medication nonadherence is a limiting factor to achieving symptomatic control among rosacea patients. Focusing on the development of oral or injectable forms of therapy may circumvent poor adherence.
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Affiliation(s)
- Kristen Delans
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Katherine Kelly
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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5
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Trave I, Micalizzi C, Cozzani E, Gasparini G, Parodi A. Papulopustular Rosacea Treated With Ivermectin 1% Cream: Remission of the Demodex Mite Infestation Over Time and Evaluation of Clinical Relapses. Dermatol Pract Concept 2022; 12:e2022201. [PMID: 36534532 PMCID: PMC9681206 DOI: 10.5826/dpc.1204a201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Topical ivermectin is an anti-inflammatory and anti-Demodex drug for papulopustular rosacea. Rosacea is a relapsing disease and the time between recurrences should be considered alongside efficacy. OBJECTIVES The aims of this study were to assess the time of first relapse and relapse rates of Demodex mite infestation and papulopustular rosacea. METHODS We conducted a prospective study of subjects affected by different degrees of papulopustular rosacea. Patients that achieved a complete response after treatment were monitored every 4 weeks and up to 32 additional weeks. For each patient, we evaluated recording the time to first relapse and relapse rate of Demodex mite infestation and rosacea. RESULTS The overall success rate on Demodex infestation was 87.5% only 12.5% relapse. Ivermectin leads to complete response in 70% of patients. Median time to relapse was 140 days, the mean time was 152 days. The global success rate was 54.76%. CONCLUSIONS Topical ivermectin keeps a remission of Demodex infestation and clinical remission for long time. We proposed a twice weekly ivermectin maintenance therapy to reduce recurrences.
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Affiliation(s)
- Ilaria Trave
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Micalizzi
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
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6
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Maldonado-Gómez W, Guevara-Sánchez E, Guevara-Vásquez G, Mera-Villasis K, Munayco C. [Translated article] Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:758-764. [DOI: 10.1016/j.ad.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
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8
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Forton FM. Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review. J Eur Acad Dermatol Venereol 2022; 36:987-1002. [DOI: 10.1111/jdv.18049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
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9
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Jeffreys LN, Pennington SH, Duggan J, Caygill CH, Lopeman RC, Breen AF, Jinks JB, Ardrey A, Donnellan S, Patterson EI, Hughes GL, Hong DW, O'Neill PM, Aljayyoussi G, Owen A, Ward SA, Biagini GA. Remdesivir-ivermectin combination displays synergistic interaction with improved in vitro activity against SARS-CoV-2. Int J Antimicrob Agents 2022; 59:106542. [PMID: 35093538 PMCID: PMC8801767 DOI: 10.1016/j.ijantimicag.2022.106542] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
Abstract
A key element for the prevention and management of coronavirus disease 2019 is the development of effective therapeutics. Drug combination strategies offer several advantages over monotherapies. They have the potential to achieve greater efficacy, to increase the therapeutic index of drugs and to reduce the emergence of drug resistance. We assessed the in vitro synergistic interaction between remdesivir and ivermectin, both approved by the US Food and Drug Administration, and demonstrated enhanced antiviral activity against severe acute respiratory syndrome coronavirus-2. Whilst the in vitro synergistic activity reported here does not support the clinical application of this combination treatment strategy due to insufficient exposure of ivermectin in vivo, the data do warrant further investigation. Efforts to define the mechanisms underpinning the observed synergistic action could lead to the development of novel treatment strategies.
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10
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Tsianakas A, Pieber T, Baldwin H, Feichtner F, Alikunju S, Gautam A, Shenoy S, Singh P, Sidgiddi S. Minocycline Extended-Release Comparison with Doxycycline for the Treatment of Rosacea: A Randomized, Head-to-Head, Clinical Trial. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:16-23. [PMID: 35096250 PMCID: PMC8794488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Minocycline efficacy for the treatment of papulopustular rosacea (PPR) has not been evaluated in clinical trials at levels demonstrated to stay below the antimicrobial threshold. We assessed the efficacy, safety, and dose response of DFD-29, a minocycline extended-release oral capsule. Two studies are reported (NCT03340961). METHODS A single-center open-label, three-arm, Phase I pharmacokinetic study randomized 24 healthy subjects aged 18 to 45 years to receive 21 days of once-daily dosing with DFD-29 40 or 20mg, or doxycycline 40mg. Blood samples were collected over 24 hours on Days 1 and 21 to plot mean plasma concentration levels. A multicenter Phase II clinical trial randomized 205 subjects with mild-to-severe PPR 1:1:1:1 to receive once-daily DFD-29 40 or 20mg, doxycycline 40mg, or placebo for 16 weeks. Co-primary endpoints were the proportion of subjects achieving treatment success (IGA grade 0 or 1 and ≥2-grade improvement) at Week 16, and a reduction in total inflammatory lesion count at Week 16. RESULTS Pharmacokinetic analysis demonstrated that minocycline plasma levels of DFD-29 40mg were approximately half those of doxycycline 40mg after 21 days, with DFD-29 20mg even lower, demonstrating a dose response. In the Phase II trial, DFD-29 40mg met both co-primary endpoints, achieving IGA treatment success in 66.0 percent subjects versus 11.5 percent placebo (p<0.0001), 31.9 percent DFD-29 20mg (p=0.007), and 33.3 percent doxycycline 40mg (p<0.0010), and a mean reduction in lesion counts of -19.2 versus -7.3 placebo (p<0.0001), -12.6 DFD-29 20mg (p=0.0070), and -10.5 doxycycline 40mg (p=0.0004). LIMITATIONS MIC values and plasma concentrations shown for antibacterial threshold data are mean values; fast absorbers/slow metabolizers could exceed the threshold, causing resistance selection pressure. CONCLUSION DFD-29 40mg demonstrated significantly greater efficacy than placebo, DFD-29 20mg, and doxycycline 40mg at plasma concentrations predicted to be below the antimicrobial threshold for the treatment of PPR.
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Affiliation(s)
- Athanasios Tsianakas
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Thomas Pieber
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Hilary Baldwin
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Franz Feichtner
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Shanavas Alikunju
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Anirudh Gautam
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Srinivas Shenoy
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Preeti Singh
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
| | - Srinivas Sidgiddi
- Dr. Tsianakas is with the Department of Dermatology at Fachklinik Bad Bentheim in Bad Bentheim, Germany
- Dr. Pieber is with the Medical University of Graz in Graz, Austria. Dr. Baldwin is with The Acne Treatment and Research Center in Brooklyn, New York
- Dr. Feichtner is with the HEALTH Institute of Biomedicine and Health Sciences at Joanneum Research Forschungsgesellschaft mbH in Graz, Austria
- Dr. Alikunju is with Dr. Reddy's Laboratories in Hyderabad, India. Mr. Gautam is with Dr. Reddy's Laboratories SA in Basel, Switzerland
- Drs. Shenoy, Singh, and Sidgiddi are with Dr. Reddy's Laboratories in Princeton, New Jersey
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11
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Passeron T, Lim HW, Goh CL, Kang HY, Ly F, Morita A, Ocampo Candiani J, Puig S, Schalka S, Wei L, Dréno B, Krutmann J. Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel. J Eur Acad Dermatol Venereol 2021; 35:1460-1469. [PMID: 33764577 PMCID: PMC8252523 DOI: 10.1111/jdv.17242] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.
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Affiliation(s)
- T Passeron
- Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France.,INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - C-L Goh
- National Skin Centre, Singapore, Singapore
| | - H Y Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - F Ly
- Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - J Ocampo Candiani
- Department of Dermatology, Medical Faculty University Hospital of Nuevo León, Monterrey, Mexico
| | - S Puig
- Melanoma Unit, Dermatology Department, Barcelona University Hospital Clinic, Barcelona, Spain
| | - S Schalka
- Medcin Skin Research Center and Biochemistry Department, Chemistry Institute of São Paulo University, São Paulo, Brazil
| | - L Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| | - B Dréno
- Department of Dermato-Oncology, CIC 1413, CRCINA, Nantes University Hospital Center, Nantes, France
| | - J Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
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12
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Husein-ElAhmed H, Steinhoff M. Bewertung der Wirksamkeit sub‐antimikrobieller Dosierungen von Doxycyclin bei Rosacea: Systematische Auswertung von klinischen Studien und Metaanalyse. J Dtsch Dermatol Ges 2021; 19:7-18. [PMID: 33491888 DOI: 10.1111/ddg.14247_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Husein Husein-ElAhmed
- Abteilung Dermatologie und Venerologie, Granada, Spanien.,Translational Research Institute, Hamad Medical Corporation, Doha, Katar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Katar.,Abteilung Dermatologie und Venerologie Hamad Medical Corporation, Doha, Katar.,Weill Cornell Medicine Katar, College of Medicine, Doha, Katar.,Universität Katar, Medizinische Fakultät, Doha, Katar.,Weill Cornell University, College of Medicine, New York, NY, USA
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13
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Ertekin SS, Koku Aksu AE, Koçyiğit A, Güler EM, Baykara Ulusan M, Gürel MS. Carotid intima-media thickness and serum proinflammatory cytokine levels in rosacea patients without cardiovascular risk factors. Dermatol Ther 2021; 34:e14733. [PMID: 33389789 DOI: 10.1111/dth.14733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022]
Abstract
There is a growing body of evidence linking rosacea to various systemic disorders, even though data regarding the association between rosacea and cardiovascular diseases are presently controversial. We sought to investigate the potential association of rosacea with subclinical atherosclerosis and serum proinflammatory/proatherogenic markers. This study included 44 patients with rosacea and 44 age-matched and sex-matched healthy control subjects. Patients with traditional cardiovascular risk factors or a history of cardiovascular events were excluded. Demographic, clinical, and laboratory data, including serum interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) levels were assessed. Carotid intima-media thickness (CIMT) and carotid plaques were measured by carotid ultrasonography. Serum IL-1β (P < .001), IL-6 (P < .001), TNF-α (P < .001), and hs-CRP (P < .001) levels were significantly higher in the patient group compared with the control group. Mean CIMT values did not differ significantly between the patient group and control group (P > .05). Patients with moderate to severe rosacea had a significantly greater CIMT than those with mild rosacea (P = .047). Rosacea patients with eye involvement had a significantly greater CIMT than those without eye involvement (P = .008). There was no significant correlation between CIMT values and inflammation parameters. As conclusion, in the absence of other traditional cardiovascular risk factors, rosacea does not seem to affect mean CIMT value. However, specific subgroups such as patients with moderate to severe disease or with eye involvement are associated with increased subclinical atherosclerosis and may require additional attention for cardiovascular disease prevention.
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Affiliation(s)
- Sümeyre Seda Ertekin
- Department of Dermatology, İstanbul Training and Research Hospital, Health Science University, Istanbul, Turkey.,Department of Dermatology, Aksaray University, Aksaray Training and Research Hospital, Aksaray, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, İstanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Abdurrahim Koçyiğit
- Department of Biochemistry, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - Eray Metin Güler
- Department of Biochemistry, Bezmialem Vakif University Medical School, Istanbul, Turkey.,Department of Biochemistry, Hamidiye Medicine Faculty, Health Science University, Istanbul, Turkey
| | - Melis Baykara Ulusan
- Department of Radiology, İstanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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14
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Hakobyan G, Evsyukova Z, Ribakova E, Haruthyunyan A, Hovsepyan N. Evaluation of the effectiveness of neodymium laser therapies for Rosacea of the face. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Oliveira CMMD, Almeida LMC, Bonamigo RR, Lima CWGD, Bagatin E. Consensus on the therapeutic management of rosacea - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:53-69. [PMID: 33172727 PMCID: PMC7772594 DOI: 10.1016/j.abd.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/14/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. OBJECTIVE To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. METHODS The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. RESULTS The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. CONCLUSION Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.
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Affiliation(s)
| | - Luiz Mauricio Costa Almeida
- Department of Dermatology, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Hospital das Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Ediléia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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16
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The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb) 2020; 10:1229-1253. [PMID: 33095403 PMCID: PMC7649190 DOI: 10.1007/s13555-020-00458-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Rosacea is a common facial dermatosis but its definition and classification are still unclear, especially in terms of its links with demodicosis. Triggers of rosacea (ultraviolet light, heat, spicy foods, alcohol, stress, microbes) are currently considered to induce a cascading innate and then adaptive immune response that gets out of control. Recent histological and biochemical studies support the concept that this inflammatory response is a continuum, already present from the onset of the disease, even when no clinical signs of inflammation are visible. The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease. Molecular studies suggest that Demodex may induce tolerogenic dendritic cells and collaborate with vascular endothelial growth factor (VEGF) to induce T cell exhaustion and favor its own proliferation. These interactions among VEGF, Demodex, and immunity need to be explored further and the nosology of rosacea adapted accordingly. However, treating early rosacea, with only clinically visible vascular symptoms, with an acaricide may decrease early inflammation, limit potential flare-ups following laser treatment, and prevent the ultimate development of the papulopustules of rosacea. The effectiveness of this approach needs to be confirmed by prospective controlled clinical trials with long-term follow-up. Currently, the evidence suggests that patients with only vascular symptoms of rosacea should be carefully examined for the presence of follicular scales as signs of Demodex overgrowth or pityriasis folliculorum so that these patients, at least, can be treated early with an acaricidal cream.
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17
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Husein-ElAhmed H, Steinhoff M. Evaluation of the efficacy of subantimicrobial dose doxycycline in rosacea: a systematic review of clinical trials and meta-analysis. J Dtsch Dermatol Ges 2020; 19:7-17. [PMID: 32989925 DOI: 10.1111/ddg.14247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low-dose doxycycline (SDD) is an antimicrobial agent that appears to improve common inflammatory skin diseases. Few data are available regarding the overall effectiveness, appropriate length of treatment and optimal patient selection for rosacea. We therefore reviewed the efficacy of sub-antimicrobial doses of SDD in papulopustular rosacea (PPR) and aimed to determine the most suitable patients for this approach. METHODS From July to September 2019, we carried out a comprehensive search of literature from five databases, using a combination of "rosacea" AND "doxycycline". RESULTS Our search yielded 532 potentially relevant studies. Our meta-analysis showed no significant difference between SDD and a comparator (RR: 1.12, 95 % CI: 0.78-1.62, I2 = 86 %). Subgroup analysis of studies comparing doxycycline with placebo yielded a clear difference in favor of doxycycline (RR: 1.45, 95 % CI: 1.22-1.72, I2 = 31 %), while subgroup analysis of studies comparing active drugs revealed no difference between interventions (RR: 0.52, 95 % CI: 0.17-1.63, I2 = 90 %). CONCLUSIONS There is strong evidence that SDD is more effective than placebo. However, other drugs such as minocycline or isotretinoin have shown outcomes at least similar to that of SDD. We suggest that the anti-inflammatory properties of SDD may be of more value for mild cases of rosacea than for moderate to severe cases, for which higher (antimicrobial) doses of doxycycline may be a more suitable choice.
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Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar.,Qatar University, Medical School, Doha, Qatar.,Weill Cornell University, College of Medicine, New York, NY, USA
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18
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Schaller M, Almeida L, Bewley A, Cribier B, Del Rosso J, Dlova N, Gallo R, Granstein R, Kautz G, Mannis M, Micali G, Oon H, Rajagopalan M, Steinhoff M, Tanghetti E, Thiboutot D, Troielli P, Webster G, Zierhut M, van Zuuren E, Tan J. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol 2020; 182:1269-1276. [PMID: 31392722 PMCID: PMC7317217 DOI: 10.1111/bjd.18420] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups. OBJECTIVES To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development. METHODS Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded. RESULTS Delphi statements on which the panel achieved consensus of ≥ 75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements. CONCLUSIONS The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations. What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.
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Affiliation(s)
- M. Schaller
- Department of DermatologyUniversitatsklinikum TubingenTubingenBaden‐WürttembergGermany
| | - L.M.C. Almeida
- Faculdade de Ciências Médicas de Minas GeraisBelo HorizonteBrazil
| | - A. Bewley
- Department of DermatologyBarts Health (Royal London and Whipps Cross University Hospitals)LondonU.K.
| | - B. Cribier
- Department of DermatologyHopitaux Universitaires de StrasbourgStrasbourgAlsaceFrance
| | - J. Del Rosso
- JDR Dermatology Research and Thomas DermatologyLas VegasNVU.S.A.
| | - N.C. Dlova
- Department of DermatologyUniversity of KwaZulu‐Natal College of Health SciencesDurbanSouth Africa
| | - R.L. Gallo
- Department of DermatologyUniversity of California San DiegoLa JollaCAU.S.A.
| | - R.D. Granstein
- Department of DermatologyWeill Cornell Medical CollegeNew YorkNYU.S.A.
| | - G. Kautz
- Haut‐ und LaserklinikKonzGermany
| | - M.J. Mannis
- Department of Ophthalmology & Vision ScienceUniversity of California DavisDavisCAU.S.A.
| | - G. Micali
- Dermatology ClinicUniversity of CataniaCataniaItaly
| | | | | | - M. Steinhoff
- Department of Dermatology and Venereology and Translational Research InstituteWeill Cornell Medicine‐QatarHamad Medical CorporationQatar UniversityDohaQatar
- Department of DermatologyWeill Cornell UniversityNew YorkNYU.S.A.
| | - E. Tanghetti
- Center for Dermatology and Laser SurgerySacramentoCAU.S.A.
| | - D. Thiboutot
- Department of DermatologyPennsylvania State University College of MedicineHersheyPAU.S.A.
| | - P. Troielli
- Faculty of DermatologySchool of MedicineUniversity of Buenos AiresBuenos AiresArgentina
| | - G. Webster
- Department of Dermatology and Cutaneous BiologySidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPAU.S.A.
| | - M. Zierhut
- Centre for OphthalmologyUniversity TübingenTübingenGermany
| | - E.J. van Zuuren
- Department of DermatologyLeiden University Medical CentreLeidenthe Netherlands
| | - J. Tan
- Windsor Clinical Research Inc and Department of MedicineUniversity of Western OntarioWindsorONCanada
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19
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Husein-ElAhmed H, Steinhoff M. Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis. Dermatol Ther 2020; 33:e13203. [PMID: 31863543 DOI: 10.1111/dth.13203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022]
Abstract
Rosacea is a chronic dermatosis which affects negatively patients' quality of life (QoL). There is shortage of high-quality evidence comparing the efficacy of ivermectin cream (IVM) 1% with other available topical choices. Besides, the well-documented impaired of self-esteem and stigmatization of rosacea patients make essential to address which treatment provides the greatest psychological and social benefit. Our objective is to critically review and appraise the efficacy of IVM 1% in PPR and the impact in patients' QoL against other options. We carried out a literature search from PubMed, MEDLINE, EMBASE, Cochrane, and clinicaltrials.gov using the following descriptors: "rosacea" AND "ivermectin." Efficacy was assessed with the Investigator Global Assessment (IGA), and the impact on QoL was based on the DLQI score. Six studies from four published articles were included. The meta-analysis estimated that more participants achieved "success" (IGA ≤ 1) and "complete clearance" (IGA = 0) with IVM1%. The overall effect estimate for IGA ≤ 1 was: 1.56 [1.23-1.97], whereas for IGA = 0, it was: 1.72 [1.40-2.11]. The rate of participants achieving lower DLQI score, and thus, better QoL was with IVM 1%. The overall effect estimate was: 1.71 [1.34-2.18] at week 16# and 1.64 [1.38-1.94] at week 52#. This meta-analysis confirms IVM 1% cream as the most effective topical treatment and it satisfies the impairment of social life with sustained better QoL. Further studies extending this period of remission are warranted, as well as researches about the potential application of this agent combined with other agents. KEY POINTS: Question: What is the current efficacy of ivermectin versus other choices in papulopustular rosacea and its impact on patients' quality of life? Findings: In this meta-analysis, ivermectin showed higher efficacy than metronidazol, azelaic acid, and placebo measured by Investigator Global Assessment. Parallely, the DLQI score highlighted that this agent was more beneficious in both short and long-term. Meaning: This meta-analysis gives strong evidence that ivermectin is the most effective topical treatment. Besides, this agent provides the greatest psychological benefit as it satisfies the stigmatization of rosacea patients as well as the impairment of social and working life with a sustained better QoL above other alternatives.
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Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.,Academic Health System, Medical School, Hamad Medical Corporation, Translational Research Institute, Doha, Qatar
| | - Martin Steinhoff
- Academic Health System, Medical School, Hamad Medical Corporation, Translational Research Institute, Doha, Qatar.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,College of Medicine, Weill Cornell University, New York, New York
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20
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Trave I, Merlo G, Cozzani E, Parodi A. Real-life experience on effectiveness and tolerability of topical ivermectin in papulopustular rosacea and antiparasitic effect on Demodex mites. Dermatol Ther 2019; 32:e13093. [PMID: 31579993 DOI: 10.1111/dth.13093] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022]
Abstract
Ivermectin is a drug approved for the treatment of papulopustular rosacea (PPR). Although clinical guidelines recommend the use of ivermectin as the first-line treatment in patients with almost clear and mild rosacea, studies concerning its use on them are lacking. This study investigated the effectiveness and the tolerability of ivermectin in almost clear to severe rosacea and assessed the antiparasitic effect on Demodex mites. This is a retrospective study based on 50 patients affected by PPR and treated with topical ivermectin 1% once daily over 16 weeks. The disease severity, the patient-examined improvement, and the safety assessment of patients were evaluated. Demodex mites were studied with the standardized skin surface biopsy. PPR to all severity achieved a therapeutic success. The number of inflammatory lesions was significantly decreased in almost clear (p < .0001), mild, moderate, and severe (p < .001) forms. A complete remission of inflammatory lesions was achieved by almost clear (p < .001) and mild (p = .005) with 82% with none-to-mild cutaneous adverse events. Thirty-two percent were positive for Demodex mites, and all of them turned negative after 16 weeks. Ivermectin is an effective treatment not only in moderate to severe PPR but also in almost clear/mild rosacea.
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Affiliation(s)
- Ilaria Trave
- Section of Dermatology, Department of Health Science, University of Genoa, Genoa, Italy
| | - Giulia Merlo
- Section of Dermatology, Department of Health Science, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Science, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Science, University of Genoa, Genoa, Italy
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21
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Schaller M, Kemény L, Havlickova B, Jackson JM, Ambroziak M, Lynde C, Gooderham M, Remenyik E, Del Rosso J, Weglowska J, Chavda R, Kerrouche N, Dirschka T, Johnson S. A randomized phase 3b/4 study to evaluate concomitant use of topical ivermectin 1% cream and doxycycline 40-mg modified-release capsules, versus topical ivermectin 1% cream and placebo in the treatment of severe rosacea. J Am Acad Dermatol 2019; 82:336-343. [PMID: 31150711 DOI: 10.1016/j.jaad.2019.05.063] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Randomized controlled studies of combination therapies in rosacea are limited. OBJECTIVE Evaluate the efficacy and safety of combining ivermectin 1% cream (IVM) and doxycycline 40-mg modified-release capsules (ie, 30-mg immediate-release and 10-mg delayed-release beads) (DMR) versus IVM and placebo for treatment of severe rosacea. METHODS This 12-week, multicenter, randomized, investigator-blinded, parallel-group comparative study randomized adult subjects with severe rosacea (Investigator's Global Assessment [IGA] score, 4) to receive either IVM and DMR (combination arm) or IVM and placebo (monotherapy). RESULTS A total of 273 subjects participated. IVM and DMR displayed superior efficacy in reduction of inflammatory lesions (-80.3% vs -73.6% for monotherapy [P = .032]) and IGA score (P = .032). Combination therapy had a faster onset of action as of week 4; it significantly increased the number of subjects achieving an IGA score of 0 (11.9% vs 5.1% [P = .043]) and 100% lesion reduction (17.8% vs 7.2% [P = .006]) at week 12. Both treatments reduced the Clinician's Erythema Assessment score, stinging/burning, flushing episodes, Dermatology Life Quality Index score, and ocular signs/symptoms and were well tolerated. LIMITATIONS The duration of the study prevented evaluation of potential recurrences or further improvements. CONCLUSION Combining IVM and DMR can produce faster responses, improve response rates, and increase patient satisfaction in cases of severe rosacea.
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Affiliation(s)
- Martin Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany.
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | | | - J Mark Jackson
- Division of Dermatology, University of Louisville, Louisville, Kentucky; Forefront Dermatology, Louisville, Kentucky
| | | | - Charles Lynde
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Eva Remenyik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - James Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, Nevada
| | | | | | | | - Thomas Dirschka
- CentroDerm-Clinic, Wuppertal, Germany; Faculty of Health, University of Witten-Herdecke, Witten, Germany
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Forton F, De Maertelaer V. Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case-control study. Br J Dermatol 2019; 181:818-825. [PMID: 30801673 DOI: 10.1111/bjd.17817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Facial densities of Demodex mites have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions. OBJECTIVES To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other facial dermatoses. METHODS In this retrospective study, we recorded Demodex densities measured using two consecutive standardized skin surface biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules and 180 with other facial dermatoses. RESULTS Patients with ETR had higher Demodex densities (D cm-2 ) than did the healthy controls (mean ± SEM; SSSB1: 15·7 ± 6·3 vs. 1·8 ± 1·1 D cm-2 , P = 0·042; SSSB2: 38·0 ± 13·7 vs. 5·1 ± 2·1 D cm-2 , P = 0·026) and patients with other dermatoses (SSSB1: 0·4 ± 0·1 D cm-2 , P = 0·004; SSSB2: 1·3 ± 0·3 D cm-2 , P = 0·004), but lower densities than patients with demodicosis (SSSB1: 82·7 ± 4·2 D cm-2 , P = 0·008; SSSB2: 172·2 ± 7·7 D cm-2 , P = 0·001) or rosacea with papulopustules (SSSB1: 86·6 ± 7·3 D cm-2 , P = 0·027; SSSB2: 197·0 ± 12·1 D cm-2 , P = 0·002). CONCLUSIONS ETR may be associated with nonvisible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.
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Affiliation(s)
- F Forton
- Dermatologist, rue Frans Binjé 8, 1030, Brussels, Belgium
| | - V De Maertelaer
- Free University of Brussels (ULB), Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM) and Service de Biostatistique et Informatique Médicale (SBIM), Route de Lennik 808/CP602, 1070, Brussels, Belgium
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Abstract
Rosacea is a common chronic inflammatory skin disease of the central facial skin and is of unknown origin. Currently, two classifications of rosacea exist that are based on either "preformed" clinical subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) or patient-tailored analysis of the presented rosacea phenotype. Rosacea etiology and pathophysiology are poorly understood. However, recent findings indicate that genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the innate and adaptive immune system. Trigger factors also lead to the release of various mediators such as keratinocytes (for example, cathelicidin, vascular endothelial growth factor, and endothelin-1), endothelial cells (nitric oxide), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (T H1) and T H17 cells. Additionally, trigger factors can directly communicate to the cutaneous nervous system and, by neurovascular and neuro-immune active neuropeptides, lead to the manifestation of rosacea lesions. Here, we aim to summarize the recent advances that preceded the new rosacea classification and address a symptom-based approach in the management of patients with rosacea.
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Affiliation(s)
- Joerg Buddenkotte
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,Weill Cornell Medicine, New York, NY, USA
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Topical Ivermectin in the Treatment of Papulopustular Rosacea: A Systematic Review of Evidence and Clinical Guideline Recommendations. Dermatol Ther (Heidelb) 2018; 8:379-387. [PMID: 29943217 PMCID: PMC6109029 DOI: 10.1007/s13555-018-0249-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Rosacea is a chronic inflammatory skin disease with different phenotypes. There is accumulating evidence that the commensal Demodex mite is linked to papulopustular rosacea. Established treatment options, including topical metronidazole, azelaic acid, and tetracyclines, are thought to work through their anti-inflammatory effects. However, none of these therapies have been shown to be curative and are associated with frequent relapses. Therefore, new and improved treatment options are needed. Topical ivermectin 1.0% cream is a new option having both anti-inflammatory and acaricidal activity against Demodex mites which might pave the way to a more etiologic approach. Its use has now been widely adopted by clinical guidelines. The objective was to review the evidence and clinical guideline recommendations concerning ivermectin 1.0% cream in the treatment of papulopustular rosacea. Methods A systematic review of both medical literature and clinical guideline recommendations was conducted. Numbers needed to treat (NNT) were calculated for relevant dichotomous outcomes (e.g., relapse rate and achieving full lesion clearance) to compare ivermectin with other established treatment options for rosacea. Results The search identified three randomized trials, three extension studies, and two meta-analyses. Ivermectin has only been tested in moderate-to-severe papulopustular rosacea. Ivermectin is an effective treatment option for papulopustular rosacea and seems to be more effective than metronidazole (NNT = 10.5) at 12 weeks of treatment. Although ivermectin was numerically more effective than metronidazole at week 36 in preventing relapse (NNT = 17.5), relapse after discontinuation of treatment in both groups was common with 62.7% and 68.4% of patients relapsing. Based on limited generalizability of available evidence, clinical guidelines have yielded different treatment algorithms and, in some areas, conflicting recommendations. Conclusion Topical ivermectin is an effective option in the treatment of papulopustular rosacea. Although ivermectin seems to be more effective than topical metronidazole, with both treatment options about two-thirds of patient relapsed within 36 weeks after discontinuation of treatment. More research is needed to establish the clinical benefit of ivermectin’s acaricidal action in preventing relapse compared to other non-etiologic treatment approaches.
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25
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Abstract
In the last 10 years, numerous studies have been published that throw new light on rosacea, in all areas of the disease. This overview summarises all the key developments, based on the indexed bibliography appearing in Medline between 2007 and 2017. Recent epidemiological data show that the prevalence of the disease is doubtless greater than estimated hitherto (more than 10% of adults in some countries) and that we should not overlook rosacea in subjects with skin phototypes V or VI, a condition that exists on all continents. A new classification of rosacea by phenotype comprising major and minor signs has been put forward; it provides a more rational approach to suitable management based upon symptoms, the severity of which may be graded into 5 classes. The treatments with the best-demonstrated efficacy (updated Cochrane study) are topical metronidazole, azelaic acid and ivermectin, and oral doxycycline; isotretinoin is effective against resistant forms but is off-label. In ocular rosacea, the reference treatment is doxycycline in combination with topical therapy of the eyelids. The physiopathology is complex and involves several factors: vascular (vasodilatation, vascular growth factors), neurovascular (hypersensitivity, neuropathic pain, neuropeptides), infectious (Demodex folliculorum and its microbiota) and inflammatory (abnormal production of pro-inflammatory peptides of the innate immune system). In addition, there is a genetic predisposition as demonstrated by the weight of familial history and comparison of homozygous and heterozygous twins. There is also activation of several genes involved in immunity, inflammation and lipid metabolism; the theory of hydrolipid film anomalies has been posited once more. There has thus been a tremendous leap forward in the field of rosacea research, with therapeutic progress and improved understanding of the underlying mechanisms, which should enable the future development of more targeted treatments as well as global management of this disease, which has major social and emotional consequences on the life of patients.
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Affiliation(s)
- B Cribier
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
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26
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Webster G, Schaller M, Tan J, Jackson JM, Kerrouche N, Schäfer G. Defining treatment success in rosacea as ‘clear’ may provide multiple patient benefits: results of a pooled analysis. J DERMATOL TREAT 2017; 28:469-474. [DOI: 10.1080/09546634.2017.1343435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Guy Webster
- Department of Dermatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martin Schaller
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Jerry Tan
- University of Western Ontario, London, Ontario and Windsor Clinical Research Inc, Windsor, Ontario, Canada
| | - J. Mark Jackson
- Division of Dermatology, Forefront Dermatology, University of Louisville, KY, USA
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Ivermectin in rosacea: a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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