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Paiva-Santos AC, Gonçalves T, Peixoto D, Pires P, Velsankar K, Jha NK, Chavda VP, Mohammad IS, Cefali LC, Mazzola PG, Mascarenhas-Melo F, Veiga F. Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems. Mol Pharm 2023; 20:3804-3828. [PMID: 37478169 PMCID: PMC10410666 DOI: 10.1021/acs.molpharmaceut.3c00324] [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: 04/14/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.
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Affiliation(s)
- Ana Cláudia Paiva-Santos
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
- LAQV,
REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy
of the University of Coimbra, University
of Coimbra, Azinhaga
Sta. Comba, 3000-548 Coimbra, Portugal
| | - Tatiana Gonçalves
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
| | - Diana Peixoto
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
- LAQV,
REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy
of the University of Coimbra, University
of Coimbra, Azinhaga
Sta. Comba, 3000-548 Coimbra, Portugal
| | - Patrícia
C. Pires
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
- LAQV,
REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy
of the University of Coimbra, University
of Coimbra, Azinhaga
Sta. Comba, 3000-548 Coimbra, Portugal
- Health
Sciences Research Centre (CICS-UBI), University
of Beira Interior, Av.
Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - K. Velsankar
- Department
of Physics, Sri Sivasubramaniya Nadar College
of Engineering, SSN Research Centre, Kalavakkam, Tamil Nadu 603110, India
| | - Niraj Kumar Jha
- Department
of Biotechnology, School of Engineering
and Technology, Sharda University, Greater Noida, Uttar Pradesh 201310, India
- Department
of Biotechnology, School of Applied and
Life Sciences (SALS), Uttaranchal University, Dehradun, Uttarakhand 248007, India
- School
of
Bioengineering and Biosciences, Lovely Professional
University, Phagwara, Punjab 144411, India
- Department
of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, Punjab 140413, India
| | - Vivek P. Chavda
- Department
of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad, Gujarat 380008, India
| | - Imran Shair Mohammad
- Department of Radiology, City of Hope Cancer Center, 1500 East Duarte Rd., Duarte, California 91010, USA
| | - Letícia Caramori Cefali
- Institute
of Biology, University of Campinas (UNICAMP), Campinas, São Paolo 13083-862, Brazil
- Center
for Biological and Health Sciences, Mackenzie
Presbyterian University, São
Paulo, São Paulo 01302-907, Brazil
| | - Priscila Gava Mazzola
- Faculty
of Pharmaceutical Sciences, University of
Campinas (UNICAMP), Campinas, São Paolo13083-871, Brazil
| | - Filipa Mascarenhas-Melo
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
- LAQV,
REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy
of the University of Coimbra, University
of Coimbra, Azinhaga
Sta. Comba, 3000-548 Coimbra, Portugal
| | - Francisco Veiga
- Department
of Pharmaceutical Technology, Faculty of Pharmacy of the University
of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
- LAQV,
REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy
of the University of Coimbra, University
of Coimbra, Azinhaga
Sta. Comba, 3000-548 Coimbra, Portugal
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Augustin M, Sommer R, Blome C, Kirsten N, Langenbruch A. Development of a Specific Variant of Patient Benefit Index (PBI) Assessing Patient Needs, Goals and Benefits in Rosacea Treatment. Patient Prefer Adherence 2023; 17:1335-1345. [PMID: 37284248 PMCID: PMC10241185 DOI: 10.2147/ppa.s378724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Evaluation of patient-reported outcomes including health-related quality of life (HRQoL) and perceived benefits from treatment has become a fundamental component of medical decision-making. Standardized evaluation of treatment benefits in rosacea based on patient preferences is still lacking. Objective Development and validation of an instrument for recording patient-defined benefits in rosacea therapy based on the Patient Benefit Index (PBI) methodology. Patients and Methods In an open survey of n = 50 patients, potential benefits of therapy from the patient's perspective were examined. The generated item pool was combined with pre-existing PBI items for other skin conditions and reviewed by an expert panel of dermatologists, psychologists and patients. Items were condensed to n = 25 and converted into a Likert-scaled questionnaire. The validity and feasibility of the resulting Patient Benefit Index for rosacea (PBI-RO) were tested on individuals with rosacea recruited from a German rosacea patient organization. Results N = 446 patients with rosacea completed the PBI-RO. The internal consistencies measured by Cronbach's alpha were high (Patient Needs Questionnaire [PNQ] 0.94). Mean PBI-RO was 1.9 ± 1.2 (scale from 0 = no benefit to 4 = maximum benefit), 23.5% of the patients experienced a PBI-RO < 1 (no clinically relevant benefit). The PBI-RO correlated with HRQoL, health state, current extent of rosacea lesions and treatment satisfaction. The highest correlation was found between PBI-RO and satisfaction with previous treatment (r = -0.59, p < 0.001); correlation with the extent of rosacea lesions was low (r = 0.16, p < 0.001). Conclusion The PBI-RO shows satisfying internal consistency and construct validity. It offers the option of a patient-weighted evaluation of the therapeutic benefit of rosacea therapy and may add to more stringent goal orientation in therapy.
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Affiliation(s)
- Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christine Blome
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Natalia Kirsten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna Langenbruch
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Dall’Oglio F, Nasca MR, Gerbino C, Micali G. Advances in pharmacotherapy for rosacea: what is the current state of the art? Expert Opin Pharmacother 2022; 23:1845-1854. [DOI: 10.1080/14656566.2022.2142907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Carlo Gerbino
- Dermatology Clinic, University of Catania, Catania, Italy
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Abstract
Introduction: Rosacea is a common, chronic and relapsing inflammatory skin disease of the centrofacial area. Despite advancing knowledge on its pathogenesis, diagnosis, and treatment, some major unknowns still remain, including systematic evidence-based guidelines useful both for clinical assessment and therapeutic management. Topical treatment is regarded as a first-line option for mild to moderate rosacea and includes traditional and new FDA-approved prescription drugs, as well as off-label alternative topical agents.Areas covered: Since improved awareness of rosacea pathogenetic mechanisms has led to the development of new potential therapeutic agents, a search was performed on the ClinicalTrial.gov registry. The results identified several investigational topical drugs able to target one or more of the pathogenetic factors of rosacea.Expert opinion: The main unmet needs in the topical treatment of rosacea remain the management of vasomotor flushes and telangiectasias, as well as of troublesome symptoms such as burning and/or stinging. No single agent effective on all rosacea phenotypes is available so far, and preventive treatments capable of halting disease progression have not been identified yet. Finally, data on long-term efficacy and tolerability are still incomplete, especially for drugs more recently introduced in the market.
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Wang L, Li XH, Wen X, Li XX, Du D, Li Y, Jiang X. Retrospective analysis of 19 papulopustular rosacea cases treated with oral minocycline and supramolecular salicylic acid 30% chemical peels. Exp Ther Med 2020; 20:1048-1052. [PMID: 32765658 PMCID: PMC7388548 DOI: 10.3892/etm.2020.8740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
Papulopustular rosacea (PPR) is characterized by central facial erythema and transient papules and/or pustules, with or without telangiectases. The treatment of PPR is challenging due to the unclear and complex pathogenesis. In the present retrospective study, patients with PPR treated with oral minocycline and supramolecular salicylic acid (SSA) 30% chemical peels enrolled between June 2018 and June 2019 were evaluated. All patients were treated with 50 mg minocycline twice a day and SSA 30% twice a month. A total of 19 patients were enrolled and all received the therapy for 12 weeks. A significant reduction of rosacea severity was observed by Investigator Severity Assessment (ISA) after treatment; the mean score reduced from 3.32±0.6 at baseline to 0.89±0.7 (P<0.01) at 12 weeks. After 12 weeks, all patients achieved at least a ‘moderate response’ and 17 patients (89.47%) obtained ‘excellent improvement’ in the Investigator Global Assessment of efficacy. No obvious adverse reactions were observed during each patient's visit. In conclusion, the combination treatment of minocycline and SSA 30% was an effective therapy for PPR. The limitation of the present study was that it was a retrospective analysis; more high-quality, prospective, blinded, controlled clinical trials are required to evaluate the efficacy based on the current study.
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Affiliation(s)
- Lian Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiao-Hua Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiao-Xue Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Dan Du
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yong Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Dermatologic Problems Commonly Seen by the Allergist/Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:102-112. [PMID: 31351991 DOI: 10.1016/j.jaip.2019.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022]
Abstract
Allergists/immunologists see a variety of skin disorders, some of which have a known immunologic basis whereas others do not. We review the prevalence, etiology, clinical presentation, and effective and low-cost care of common dermatologic conditions seen in outpatient practices. Conditions discussed include pityriasis alba, seborrheic dermatitis, rosacea, acne, tinea infections, intertrigo, lichen planus, tinea versicolor, lichen simplex chronicus, scabies, pityriasis rosea, keratosis pilaris, and seborrheic keratosis. An understanding of frequently encountered cutaneous diseases and their therapies will help provide immediate access to treatment and improve the experience for both the affected patient and the clinician.
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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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