Updates in Rosacea: Epidemiology, Risk Factors, and Management Strategies

Skin Inflammation with a Focus on Wound Healing

Significance: The skin is the crucial first-line barrier against foreign pathogens. Compromise of this barrier presents in the context of inflammatory skin conditions and in chronic wounds. Skin conditions arising from dysfunctional inflammatory pathways severely compromise the quality of life of patients and have a high economic impact on the U.S. health care system. The development of a thorough understanding of the mechanisms that can disrupt skin inflammation is imperative to successfully modulate this inflammation with therapies. Recent Advances: Many advances in the understanding of skin inflammation have occurred during the past decade, including the development of multiple new pharmaceuticals. Mechanical force application has been greatly advanced clinically. Bioscaffolds also promote healing, while reducing scarring. Critical Issues: Various skin inflammatory conditions provide a framework for analysis of our understanding of the phases of successful wound healing. The large burden of chronic wounds on our society continues to focus attention on the chronic inflammatory state induced in many of these skin conditions. Future Directions: Better preclinical models of disease states such as chronic wounds, coupled with enhanced diagnostic abilities of human skin, will allow a better understanding of the mechanism of action. This will lead to improved treatments with biologics and other modalities such as the strategic application of mechanical forces and scaffolds, which ultimately results in better outcomes for our patients.

Cigarette Smoking and Risk of Incident Rosacea in Women

The relationship between smoking and rosacea is poorly understood. We aimed to conduct the first cohort study to determine the association between smoking and risk of incident rosacea. We included 95,809 women from Nurses' Health Study II (1991-2005). Information on smoking was collected biennially during follow-up. Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005. We used Cox proportional hazards models to estimate age- and multivariable-adjusted hazard ratios and 95% confidence intervals for the association between different measures of smoking and risk of rosacea. During follow-up, we identified 5,462 incident cases of rosacea. Compared with never smoking, we observed an increased risk of rosacea associated with past smoking (multivariable-adjusted hazard ratio = 1.09, 95% confidence interval: 1.03, 1.16) but a decreased risk associated with current smoking (hazard ratio = 0.65, 95% confidence interval: 0.58, 0.72). We further found that increasing pack-years of smoking was associated with an elevated risk of rosacea among past smokers (P for trend = 0.003) and with a decreased risk of rosacea among current smokers (P for trend < 0.0001). The risk of rosacea was significantly increased within 3-9 years since smoking cessation, and the significant association persisted among past smokers who had quit over 30 years before.

Alcohol intake and risk of rosacea in US women

BACKGROUND

The epidemiologic association between alcohol and rosacea is unclear and inconsistent based on the previous cross-sectional or case-control studies.

OBJECTIVE

We conducted a cohort study to determine the association between alcohol intake and the risk of rosacea in women.

METHODS

A total of 82,737 women were included from the Nurses' Health Study II (1991-2005). Information on alcohol intake was collected every 4 years during follow-up. Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005.

RESULTS

Over 14 years of follow-up, we identified 4945 cases of rosacea. Compared with never drinkers, increased alcohol intake was associated with a significantly increased risk of rosacea (P_trend <.0001). The multivariate-adjusted hazard ratios (HRs) and confidence intervals (CIs) were 1.12 (95% CI 1.05-1.20) for alcohol intake of 1-4 g/day and 1.53 (1.26-1.84) for ≥30 g/day. The associations remained consistent across categories of smoking status. Further examination of types of alcoholic beverage consumed revealed that white wine (P_trend <.0001) and liquor intake (P_trend = .0006) were significantly associated with a higher risk of rosacea.

LIMITATIONS

This was an epidemiologic study without examination into etiologic mechanisms.

CONCLUSIONS

Alcohol intake was significantly associated with an increased risk of rosacea in women.

Brimonidine for erythema caused by rosacea

Brimonidine gel (Mirvaso-Galderma) became available in February of this year for the symptomatic treatment of facial erythema associated with rosacea in adults.1 Here, we review the evidence on brimonidine gel and consider its place in the management of erythema associated with rosacea.