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Meng X, Zhong Y, Kuang X, Zhang Y, Yang L, Cai Y, Wang F, He F, Xie H, Wang B, Li J. Targeting the STAT3/IL-36G signaling pathway can be a promising approach to treat rosacea. J Adv Res 2024:S2090-1232(24)00250-9. [PMID: 38909883 DOI: 10.1016/j.jare.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/26/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Rosacea is an inflammatory skin disorder characterized by the release of inflammatory mediators from keratinocytes, which are thought to play a crucial role in its pathogenesis. Despite an incidence of approximately 5.5%, rosacea is associated with a poor quality of life. However, as the pathogenesis of rosacea remains enigmatic, treatment options are limited. OBJECTIVES To investigate the pathogenesis of rosacea and explore new therapeutic strategies. METHODS Transcriptome data from rosacea patients combined with immunohistochemical staining were used to investigate the activation of STAT3 in rosacea. The role of STAT3 activation in rosacea was subsequently explored by inhibiting STAT3 activation both in vivo and in vitro. The key molecules downstream of STAT3 activation were identified through data analysis and experiments. Dual-luciferase assay and ChIP-qPCR analysis were used to validate the direct binding of STAT3 to the IL-36G promoter. DARTS, in combination with experimental screening, was employed to identify effective drugs targeting STAT3 for rosacea treatment. RESULTS STAT3 signaling was hyperactivated in rosacea and served as a promoter of the keratinocyte-driven inflammatory response. Mechanistically, activated STAT3 directly bind to the IL-36G promoter region to amplify downstream inflammatory signals by promoting IL-36G transcription, and treatment with a neutralizing antibody (α-IL36γ) could mitigate rosacea-like inflammation. Notably, a natural plant extract (pogostone), which can interact with STAT3 directly to inhibit its activation and affect the STAT3/IL36G signaling pathway, was screened as a promising topical medication for rosacea treatment. CONCLUSIONS Our study revealed a pivotal role for STAT3/IL36G signaling in the development of rosacea, suggesting that targeting this pathway might be a potential strategy for rosacea treatment.
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Affiliation(s)
- Xin Meng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Zhong
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Xuyuan Kuang
- Department of Hyperbaric Oxygen, Xiangya Hospital, Central South University, Jiangxi, China; Department of Hyperbaric Oxygen, Xiangya Hospital, Central South University, Changsha, China
| | - Yiya Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Li Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yisheng Cai
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Fanping He
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Ben Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Geng RSQ, Sood S, Hua N, Chen J, Sibbald RG, Sibbald C. Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review. J Cutan Med Surg 2024:12034754241253195. [PMID: 38807451 DOI: 10.1177/12034754241253195] [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: 05/30/2024]
Abstract
INTRODUCTION Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the central facial region, of which papules and pustules are considered to be a major feature. The identification of effective treatments for reducing inflammatory lesions in rosacea can alleviate the psychosocial burden that many rosacea patients experience, including reduced self-esteem, anxiety, and social withdrawal. The objective of this systematic review is to determine the effectiveness of topical and systemic therapies in reducing lesion count in rosacea patients. METHODS/RESULTS Medline, Embase, and Cochrane CENTRAL databases were searched, resulting in the inclusion of 43 clinical trials reporting on a total of 18,347 rosacea patients. The most well-studied treatments include ivermectin, metronidazole, azelaic acid, minocycline, and doxycycline. Oral isotretinoin was the most effective treatment in reducing inflammatory lesions and may be recommended for severe recalcitrant cases of rosacea. CONCLUSIONS Several topical and systemic therapies have demonstrated efficacy in reducing inflammatory lesion count in rosacea patients, with mechanisms of action centred around suppressing inflammation and killing Demodex folliculorum mites. Additional research is required to determine effective combination therapies in rosacea.
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Affiliation(s)
- Ryan S Q Geng
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Siddhartha Sood
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas Hua
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Chen
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronald G Sibbald
- Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cathryn Sibbald
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Lai D, Cheng S, Zhou S, Hao J, Chen H, Jia K, Liu H, Cui Y. 755-nm picosecond laser plus topical 20% azelaic acid compared to topical 20% azelaic acid alone for the treatment of melasma: a randomized, split-face and controlled trial. Lasers Med Sci 2024; 39:113. [PMID: 38656631 DOI: 10.1007/s10103-024-04052-9] [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: 11/09/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients. METHODS A randomized, evaluator-blinded, controlled study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient's satisfaction assessments (PSA). RESULTS Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period. CONCLUSION The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100051294; 18 September 2021).
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Affiliation(s)
- Dihui Lai
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, NO.2 Yinghua East Road, Chaoyang District, Beijing, China
- Department of Dermatology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Shaowei Cheng
- Department of Dermatology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Shaona Zhou
- Department of Dermatology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Jianchun Hao
- Department of Dermatology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Hongguang Chen
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Kang Jia
- Department of Dermatology, MEIYAN Aesthetic Plastic Medical Clinic, Beijing, China
| | - Hongmei Liu
- Department of Dermatology, MEIYAN Aesthetic Plastic Medical Clinic, Beijing, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Capital Medical University, NO.2 Yinghua East Road, Chaoyang District, Beijing, China.
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Desai SR, Baldwin H, Del Rosso JQ, Gallo RL, Bhatia N, Harper JC, York JP, Gold LS. Microencapsulated Benzoyl Peroxide for Rosacea in Context: A Review of the Current Treatment Landscape. Drugs 2024; 84:275-284. [PMID: 38418773 PMCID: PMC10982091 DOI: 10.1007/s40265-024-02003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
Rosacea, a chronic skin condition affecting millions of people in the USA, leads to significant social and professional stigmatization. Effective management strategies are crucial to alleviate symptoms and improve patients' quality of life. Encapsulated benzoyl peroxide 5% (E-BPO 5%) is a newly FDA-approved topical treatment for rosacea that shows promise in enhancing therapeutic response and minimizing skin irritation. This review aims to assess the role of recently FDA approved E-BPO 5% in the current treatment landscape for rosacea management, as it is not yet included in clinical guidelines that predominantly rely on older approved therapies. The review focuses on randomized controlled trials conducted in English-speaking adults. It evaluates the efficacy, safety, and tolerability of various US Food and Drug Administration (FDA)-approved agents used for rosacea treatment, including E-BPO cream, metronidazole gel, azelaic acid gel and foam, ivermectin cream, minocycline foam, oral doxycycline, brimonidine gel, and oxymetazoline HCl cream. Existing therapies have been effective in reducing papulopustular lesions and erythema associated with rosacea for many years. E-BPO 5% offers a promising addition to the treatment options due to its microencapsulation technology, which prolongs drug delivery time and aims to improve therapeutic response while minimizing skin irritation. Further research is necessary to determine the exact role of E-BPO 5% in the therapeutic landscape for rosacea. However, based on available evidence, E-BPO 5% shows potential as a valuable treatment option for managing inflammatory lesions of rosacea, and it may offer benefits to patients including: rapid onset of action, demonstrated efficacy by Week 2, excellent tolerability, and sustained long-term results for up to 52 weeks of treatment.
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Affiliation(s)
| | | | | | | | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | - Julie C Harper
- The Dermatology and Skin Care Center of Birmingham, Birmingham, AL, USA
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5
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Nguyen C, Kuceki G, Birdsall M, Sahni DR, Sahni VN, Hull CM. Rosacea: Practical Guidance and Challenges for Clinical Management. Clin Cosmet Investig Dermatol 2024; 17:175-190. [PMID: 38283794 PMCID: PMC10821660 DOI: 10.2147/ccid.s391705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
Rosacea is a common chronic dermatosis. Clinically, rosacea can present with flushing, erythema, papules, pustules, telangiectasias, phymatous changes, pruritus, burning, and stinging. In 2017, the National Rosacea Society Expert Committee recommended a phenotype-based classification for therapy. In this review, we identify monotherapies and multimodal treatment approaches for the clinical management of rosacea including topical, systemic, laser and light, alternative, and combination therapies.
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Affiliation(s)
- Cassidy Nguyen
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | - Dev Ram Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vikram Nath Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| | - Christopher M Hull
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
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6
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Geng R, Bourkas AN, Sibbald RG. Rosacea: Clinical Aspects and Treatments. Adv Skin Wound Care 2023; 36:626-634. [PMID: 37983575 DOI: 10.1097/asw.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
GENERAL PURPOSE To review the clinical presentation and treatment of rosacea. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish the clinical manifestations of rosacea subtypes.2. Identify pharmacologic and nonpharmacologic treatment options for patients who have rosacea.
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7
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King S, Campbell J, Rowe R, Daly ML, Moncrieff G, Maybury C. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. J Cosmet Dermatol 2023; 22:2650-2662. [PMID: 37550898 DOI: 10.1111/jocd.15923] [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: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Topical azelaic acid (AA) is indicated for acne and rosacea, but there is some evidence for its use for other dermatological conditions. AIMS To assess the effectiveness and safety of topical AA for acne vulgaris, rosacea, hyperpigmentation/melasma, and skin aging. METHODS RCTs of at least 6 weeks' treatment duration were eligible for inclusion. Databases including MEDLINE, Embase, CINAHL, and ClinicalTrials.gov were searched up to December 2022. Two reviewers were involved in all stages of the systematic review process. RESULTS Forty-three RCTs met the inclusion criteria. Meta-analyses within 20 rosacea studies demonstrated that erythema severity, inflammatory lesion counts, overall improvement, and treatment success (achieving skin clarity) were significantly improved with AA compared with vehicle after 12 weeks. AA was more effective than metronidazole 0.75% for improved erythema severity, overall improvement, and inflammatory lesion counts. Sixteen acne studies suggest that AA is more effective than vehicle for improving global assessments and reducing acne severity. AA 20% also significantly reduced more lesions than erythromycin gel. Within seven melasma studies, AA 20% was significantly better than vehicle for both severity and global improvement. AA 20% demonstrated significantly better results compared with hydroquinone 2% for global improvement. Very few significant differences between AA and comparators were observed for commonly reported adverse events. No eligible RCTs were found that evaluated skin aging. CONCLUSIONS AA is more effective than vehicle for rosacea, acne and melasma. Comparisons between AA and other treatments were often equivalent. Where there is equivalence, AA may be a good option for some clinical situations. RCT evidence is needed to evaluate the effectiveness of AA on skin aging.
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Affiliation(s)
- Sarah King
- Dermatica Institute of Clinical Excellence, London, UK
| | - Jo Campbell
- Dermatica Institute of Clinical Excellence, London, UK
| | - Rebecca Rowe
- Dermatica Institute of Clinical Excellence, London, UK
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8
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Clanner-Engelshofen BM, Bernhard D, Dargatz S, Flaig MJ, Gieler U, Kinberger M, Klövekorn W, Kuna AC, Läuchli S, Lehmann P, Nast A, Pleyer U, Schaller M, Schöfer H, Steinhoff M, Schwennesen T, Werner RN, Zierhut M, Reinholz M. S2k guideline: Rosacea. J Dtsch Dermatol Ges 2022; 20:1147-1165. [PMID: 35929658 DOI: 10.1111/ddg.14849] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022]
Abstract
This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e. V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy-resistant and severe forms of rosacea papulopustulosa. The drug of choice is low-dose doxycycline. Alternatively, low-dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.
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Affiliation(s)
| | - Dominik Bernhard
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Sonja Dargatz
- Deutsche Rosazea Hilfe e.V. (German Rosacea Aid), Hamburg, Germany
| | - Michael J Flaig
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Uwe Gieler
- Vitos Hospital for Psychosomatic Medicine, University Hospital Gießen - Dermatology, UKGM Gießen, Gießen, Germany
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Anne-Charlotte Kuna
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Severin Läuchli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Percy Lehmann
- Center for Dermatology, Allergology and Dermatosurgery, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Schaller
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Helmut Schöfer
- German Clinic for Diagnostics (DKD, Deutsche Klinik für Diagnostik) Dermatology, Helios Kliniken Wiesbaden, Wiesbaden, Germany
| | - Martin Steinhoff
- Weill Cornell Medicine-Qatar, Cornell University, Ar-Rayyan, Qatar
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manfred Zierhut
- Department of Ophthalmology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Markus Reinholz
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
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Clanner-Engelshofen BM, Bernhard D, Dargatz S, Flaig MJ, Gieler U, Kinberger M, Klövekorn W, Kuna AC, Läuchli S, Lehmann P, Nast A, Pleyer U, Schaller M, Schöfer H, Steinhoff M, Schwennesen T, Werner RN, Zierhut M, Reinholz M. S2k-Leitlinie: Rosazea. J Dtsch Dermatol Ges 2022; 20:1147-1167. [PMID: 35971589 DOI: 10.1111/ddg.14849_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin M Clanner-Engelshofen
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Dominik Bernhard
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | | | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Uwe Gieler
- Vitos-Klinik für Psychosomatik, Gießen - Universitäts-Hautklinik, UKGM Gießen, Gießen, Deutschland
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | | | - Anne-Charlotte Kuna
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Severin Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Zürich, Schweiz
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Helmut Schöfer
- Deutsche Klinik für Diagnostik (DKD) Dermatologie, Helios Kliniken Wiesbaden, Wiesbaden, Deutschland
| | - Martin Steinhoff
- Weill Cornell Medicine-Qatar, Cornell University, Ar-Rayyan, Qatar
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Manfred Zierhut
- Universitäts-Augenklinik, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Markus Reinholz
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
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Alqahtani AA, Aslam H, Shukrullah S, Fatima H, Naz MY, Rahman S, Mahnashi MH, Irfan M. Nanocarriers for Smart Therapeutic Strategies to Treat Drug-Resistant Tumors: A Review. Assay Drug Dev Technol 2022; 20:191-210. [DOI: 10.1089/adt.2022.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Hira Aslam
- Department of Physics, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Shazia Shukrullah
- Department of Physics, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Hareem Fatima
- Department of Physics, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Muhammad Yasin Naz
- Department of Physics, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Saifur Rahman
- Electrical Engineering Department, College of Engineering, Najran University, Najran, Saudi Arabia
| | - Mater H. Mahnashi
- Department of Pharmaceutical Chemistry, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Muhammad Irfan
- Electrical Engineering Department, College of Engineering, Najran University, Najran, Saudi Arabia
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11
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Sharma A, Kroumpouzos G, Kassir M, Galadari H, Goren A, Grabbe S, Goldust M. Rosacea Management: A Comprehensive Review. J Cosmet Dermatol 2022; 21:1895-1904. [PMID: 35104917 DOI: 10.1111/jocd.14816] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Rosacea is a chronic cutaneous disorder affecting primarily the face, characterized by erythema, transient or persistent, telangiectasia, and inflammatory lesions including papulo-pustules and swelling. The essential component of the disease is the persistent erythema of facial skin. Episodes of flushing (acute-subacute intermittent vasodilation) are common. Swelling and erythema of the nose along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, can be noted in chronic cases. Rosacea affects up to 10% of the world population and is especially noted in fair skinned individuals aged 35 to 50. Women are affected more often than men. Several treatment modalities including topical medications, systemic drugs, lasers and light-based therapies have been used for the management of rosacea with variable results. Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulphur, oral antibiotics such as tetracyclines, and oral retinoids alone or, most commonly, in combination form the mainstay of treatment. Light therapies such as intense pulsed light and pulsed dye laser are best used for the eythemato-telangiectatic type. Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimercrolimus, low-dose modified release tetracyclines and botulinum toxin are the new additions to the therapeutic armamentarium. This article provides a comprehensive review of the various therapies used for rosacea.
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Affiliation(s)
- Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University Providence, Rhode Island, Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Andy Goren
- Applied Biology, Inc, Irvine, CA, United States
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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12
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Zhao S, Wang M, Zhou Y, Yan Y. The therapeutic effects in patients with rosacea: how do we evaluate them? J Cosmet Dermatol 2022; 21:506-512. [PMID: 34982849 DOI: 10.1111/jocd.14713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rosacea is a common, chronic skin disorder with negative impacts on physical health and social function. The response to therapy plays a critical factor in determining the duration of treatment and developing new medicines. However, it is challenging to assess the efficacy due to its complicated clinical characteristics and nonspecific histopathological findings. AIMS This study aims to review the efficacy evaluation tools for rosacea. METHODS An extensive literature search was conducted using PubMed, Web of Science, and other databases for articles on efficacy evaluation methods for rosacea from 1995 to 2021. RESULTS In clinical practice and scientific research, various methods are available for assessing the curative effect. Evaluation tools based on phenotypes are the most commonly used because they are cheap and straightforward. Various questionnaires also exist to evaluate health-related quality of life. However, the inevitable subjectivity makes it challenging to compare the curative effect among different studies. By contrast, objective assessment tools are more precise and repeatable, such as consecutive standardized skin surface biopsies, computer-aided image analysis, and biophysical parameter assessments. CONCLUSION No single assessment method could balance convenience and accuracy. For improving outcomes and facilitating academic exchanges, a well-validated gold standard evaluation tool is still needed. This review provides an overview of the existing efficacy evaluation methods for rosacea and discusses the relevant details.
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Affiliation(s)
- Shasha Zhao
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Wang
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Zhou
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yan
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Schaller M, Dirschka T, Lonne-Rahm SB, Micali G, Stein Gold LF, Tan J, Del Rosso J. The Importance of Assessing Burning and Stinging when Managing Rosacea: A Review. Acta Derm Venereol 2021; 101:adv00584. [PMID: 34643244 PMCID: PMC9425614 DOI: 10.2340/actadv.v101.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rosacea, a chronic condition usually recognized by its visible presentation, can be accompanied by invisible symptoms, such as burning and stinging. The aim of this review is to gather the most recent evidence on burning and stinging, in order to further emphasize the need to address these symptoms. Inflammatory pathways can explain both the signs and symptoms of rosacea, but available treatments are still evaluated primarily on their ability to treat visible signs. Recent evidence also highlights the adverse impact of symptoms, particularly burning and stinging, on quality of life. Despite an increasing understanding of symptoms and their impact, the management of burning and stinging as part of rosacea treatment has not been widely investigated. Clinicians often underestimate the impact of these symptoms and do not routinely include them as part of management. Available therapies for rosacea have the potential to treat beyond signs, and improve burning and stinging symptoms in parallel. Further investigation is needed to better understand these benefits and to optimize the management of rosacea.
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Affiliation(s)
- Martin Schaller
- Department of Dermatology, Universitatsklinikum Tuebingen, Tuebingen, Baden-Württemberg, Germany .
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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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Wang Z, Xiang H, Dong P, Zhang T, Lu C, Jin T, Chai KY. Pegylated azelaic acid: Synthesis, tyrosinase inhibitory activity, antibacterial activity and cytotoxic studies. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2020.129234] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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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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Abstract
Azelaic acid has numerous pharmacological uses in dermatology. Its anti-inflammatory and anti-oxidant properties are thought to correlate with its efficacy in papulopustular rosacea and acne vulgaris, amongst other cutaneous conditions. We conducted a review of the literature on the use of azelaic acid in dermatology using key terms 'acne', 'azelaic acid', 'dermatology', 'melasma', 'rosacea', searching databases such as MEDLINE, EMBASE and PubMed. Only articles in English were chosen. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Center of Evidence-Based Medicine 2011 guidance.This review found the strongest evidence supporting the use of azelaic acid in rosacea, followed by its use off-label in melasma followed by acne vulgaris. Weaker evidence is currently available to support the use of azelaic acid in several other conditions such as hidradenitis suppurativa, keratosis pilaris and male androgenic alopecia.Azelaic acid, as a monotherapy or in combination, could be an effective first-line or alternative treatment, which is well-tolerated and safe for a range of dermatological conditions.
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Affiliation(s)
- Tamara Searle
- University of Birmingham Medical School, Birmingham, UK
| | - Faisal R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital Cancer Centre, London, UK
| | - Firas Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
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18
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Jabbehdari S, Memar OM, Caughlin B, Djalilian AR. Update on the pathogenesis and management of ocular rosacea: an interdisciplinary review. Eur J Ophthalmol 2020; 31:22-33. [PMID: 32586107 DOI: 10.1177/1120672120937252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. METHODS Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. RESULTS Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. CONCLUSIONS Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea.
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Affiliation(s)
- Sayena Jabbehdari
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Benjamin Caughlin
- Department of Surgery/Division of Otolaryngology, Jr. Hospital of Cook County, Chicago, IL, USA.,Hospital of Cook County, Chicago, IL, USA.,Division of Facial Plastic and Reconstructive Surgery, Jesse Brown VA Medical Center, Chicago, IL, USA.,Division of Facial Plastic and Reconstructive Surgery, University of Illinois Health Hospital System, Chicago, IL, USA
| | - Ali R Djalilian
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
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Takci Z, Gunes Bilgili S, Kilic M, Oguztuzun S, Bozer B, Guler Simsek G, Akbayrak A, Yıldız Seckin H, Karadag AS. Expressions of glutathione S-transferase alpha, mu, pi, and theta in the skin samples of patients with acne rosacea. J Cosmet Dermatol 2020; 19:2070-2075. [PMID: 32433803 DOI: 10.1111/jocd.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/03/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data point to the importance of oxidative stress in rosacea. Glutathione S-transferases (GSTs) have substantial roles in a wide variety of oxidative stress-related conditions. AIM To evaluate the immunohistochemical staining characteristics of GST alpha (GSTA), mu (GSTM), pi (GSTP), and theta (GSTT) in patients with rosacea. PATIENTS/METHODS The study included 23 women and 7 men with rosacea (mean ± SD age 49 ± 11 year) and 15 healthy control subjects (10 women, 5 men; mean ± SD age 47.86 ± 10.88 year). For each patient, the average disease duration, disease subtype, ocular involvement, and severity score were recorded. A 3-mm punch biopsy was taken from the facial skin of each patient and control. Expression of GST isoenzymes was analyzed immunohistochemically. RESULTS Expressions of GSTM1, GSTP1, and GSTT1 were significantly elevated in patients with rosacea compared to those in the control group (P = .0001, P = .0002, P < .0001, respectively). In the rosacea group, GSTT1 expression was significantly stronger than GSTP1 and GSTA1 expressions (P = .019, P < .0001, respectively). There were no significant associations between expressions of GST isoenzymes and gender, age, average duration of illness, disease subtype, ocular involvement, or severity score in the patient group (all P > .05). CONCLUSIONS In rosacea, the significant increase of GSTT1, GSTP1, and GSTM1 expressions might result from activation of GST as an outcome of extreme free radical generation from triggered neutrophils or ultraviolet vulnerability. These findings support the relevance of oxidant stress in the pathogenesis of rosacea.
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Affiliation(s)
- Zennure Takci
- Department of Dermatology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Serap Gunes Bilgili
- Department of Dermatology, Faculty of Medicine, Yuzuncuyıl University, Van, Turkey
| | - Murat Kilic
- Department of Pharmacy Services, Ankara University, Vocational School of Health Services, Ankara, Turkey
| | | | - Busra Bozer
- Department of Biology, Hitit University, Corum, Turkey
| | - Gulcin Guler Simsek
- Department of Pathology, HSU Kecioren Research and Training Hospital, Ankara, Turkey
| | - Atiye Akbayrak
- Department of Dermatology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Havva Yıldız Seckin
- Department of Dermatology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology, Medical Faculty, Istanbul Medeniyet University, Göztepe Research and Training Hospital, Istanbul, Turkey
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20
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Zaid AN, Al Ramahi R. Depigmentation and Anti-aging Treatment by Natural Molecules. Curr Pharm Des 2020; 25:2292-2312. [PMID: 31269882 DOI: 10.2174/1381612825666190703153730] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
Natural molecules are becoming more accepted choices as cosmetic agents, many products in the market today claim to include natural components. Plants include many substances that could be of a value in the whitening of the skin and working as anti-aging agents. A wide range of articles related to natural skin whitening and anti-aging agents have been reviewed. Many plant-derived and natural molecules have shown to affect melanin synthesis by different mechanisms, examples include Arbutin, Ramulus mori extract, Licorice extract, Glabridin, Liquiritin, Kojic acid, Methyl gentisate, Aloesin, Azelaic acid, Vitamin C, Thioctic acid, Soya bean extracts, Niacinamide, α and β-hydroxy acids, Lactic acid, Chamomile extract, and Ellagic acid. Some of the widely used natural anti-aging products as natural antioxidants, collagen, hyaluronic acid, and coenzyme Q can counteract the effects of reactive oxygen species in skin cells and have anti-aging properties on the skin. It was concluded that many natural products including antioxidants can prevent UV-induced skin damage and have whitening and anti-aging effects. It is very important to develop and stabilize appropriate methods for the evaluation of the whitening and anti-aging capacity of natural products and their exact mechanism of action to ensure real efficacy based on evidence-based studies. The attention should be oriented on the formulations and the development of an appropriate vehicle to ensure suitable absorption of these natural products in addition to evaluating the suitable concentration of these molecules required having the desired effects without causing harmful side effects.
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Affiliation(s)
- Abdel Naser Zaid
- Pharmacy Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestinian Territory, Occupied
| | - Rowa' Al Ramahi
- Pharmacy Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestinian Territory, Occupied
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Liu T, Deng Z, Xie H, Chen M, Xu S, Peng Q, Sha K, Xiao W, Zhao Z, Li J. ADAMDEC1 promotes skin inflammation in rosacea via modulating the polarization of M1 macrophages. Biochem Biophys Res Commun 2019; 521:64-71. [PMID: 31627897 DOI: 10.1016/j.bbrc.2019.10.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Abstract
Rosacea is a chronic inflammatory cutaneous disease which mainly affects central face, leading to cosmetic disfigurement and compromised social psychology in billions of rosacea patients. Though the exact etiology of rosacea remains elusive, accumulating evidence has highlighted the dysfunction of innate immunity and inflammation in rosacea pathogenesis. Disintegrin Metalloprotease ADAM-like Decysin-1 (ADAMDEC1) is an orphan ADAM-like metalloprotease which is believed to be closely related to inflammation. Here for the first time, we reported that Adamdec1 expression was significantly increased in the skin lesions of rosacea patients and LL37-induced rosacea-like mouse models. Immunofluorescence analysis revealed co-localization of ADAMDEC1 and macrophages in patient and mouse biopsies. In cellular experiment, the expression of ADAMDEC1 was prominently elevated in M1 but not M2 macrophages. Knocking down of ADAMDEC1 significantly blunted M1 polarization in macrophages induced from human monocytes and THP-1 cell lines. Furthermore, silencing of Adamdec1 in LL-37-induced mouse model also suppressed the expression of M1 signature genes such as IL-6, iNOS and TNF-α, resulting in attenuated rosacea-like phenotype and inflammation. Taken together, our results demonstrate that ADAMDEC1 plays a pro-inflammatory role in rosacea via modulating the M1 polarization of macrophages.
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Affiliation(s)
- Tangxiele Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Zhili Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Mengting Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - San Xu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Qinqin Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ke Sha
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Wenqin Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Zhixiang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China; Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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van Zuuren E, Fedorowicz Z, Tan J, van der Linden M, Arents B, Carter B, Charland L. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol 2019; 181:65-79. [PMID: 30585305 PMCID: PMC6850438 DOI: 10.1111/bjd.17590] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping. OBJECTIVES To update our systematic review on interventions for rosacea. METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk-of-bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence. RESULTS We included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach. CONCLUSIONS For reducing temporarily persistent erythema there was high-certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low-to-moderate-certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high-certainty evidence for topical azelaic acid and topical ivermectin; moderate-to-high-certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate-certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low-certainty evidence for tetracycline and low-dose minocycline. For ocular rosacea, there was moderate-certainty evidence that oral omega-3 fatty acids were effective and low-certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.
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Affiliation(s)
- E.J. van Zuuren
- Dermatology DepartmentLeiden University Medical CentreLeiden2333 ZAthe Netherlands
| | - Z. Fedorowicz
- DynaMed PlusEBSCO Health10 Estes StreetIpswichMA01938U.S.A.
| | - J. Tan
- Department of MedicineUniversity of Western OntarioLondonCanada
| | - M.M.D. van der Linden
- Department of DermatologyAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - B.W.M. Arents
- Skin Patients Netherlands (Huidpatiënten Nederland)Nieuwegeinthe Netherlands
| | - B. Carter
- Biostatistics and Health InformaticsKing's College LondonLondonU.K
- Institute of Psychiatry, Psychology and NeuroscienceLondonU.K
| | - L. Charland
- Independent Researcher and Consumer RefereeQuebecCanada
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Patel VM, Schwartz RA, Lambert WC. Topical antibiotics in pregnancy: A review of safety profiles. Dermatol Ther 2019; 32:e12951. [PMID: 31025480 DOI: 10.1111/dth.12951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]
Abstract
Medications should be used with caution in women of childbearing age who are pregnant, or are contemplating pregnancy. Although topical medications are considered safer than oral or parenteral agents, their safety data in pregnancy must be assessed carefully. The available information on medication use in pregnancy is limited, and not always aided by the FDA pregnancy letter category system. Thus, in this article, we aggregate human studies, animal studies, and pharmacokinetics data to provide recommendations on utilizing topical antibiotics in pregnancy.
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Affiliation(s)
- Viral M Patel
- Department of Dermatology, Stony Brook University Medical Center, Stony Brook, New York
| | - Robert A Schwartz
- Departments of Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - W Clark Lambert
- Departments of Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
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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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25
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McGregor SP, Alinia H, Snyder A, Tuchayi SM, Fleischer A, Feldman SR. A Review of the Current Modalities for the Treatment of Papulopustular Rosacea. Dermatol Clin 2017; 36:135-150. [PMID: 29499797 DOI: 10.1016/j.det.2017.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Papulopustular rosacea is characterized by papules and pustules in the central facial region. We review the literature surrounding the treatment of papulopustular rosacea. PubMed, EMBASE, and Cochrane (Central) databases searches of articles published from 1980 to 2015 were performed using the MeSH terms or keywords "rosacea" and "clinical trial." Additional searches were performed to include rosacea and each treatment modality used. Topical metronidazole, azelaic acid, ivermectin, and oral doxycycline have the most robust data to support their use. Variation in assessment tools and a lack of clinical trial standardization makes comparison of therapeutic options difficult.
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Affiliation(s)
- Sean P McGregor
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
| | - Hossein Alinia
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
| | - Alyson Snyder
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
| | - Sara Moradi Tuchayi
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
| | - Alan Fleischer
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA; Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
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26
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Abstract
Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea.
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Affiliation(s)
- Abigail Cline
- Augusta University Medical Center, Augusta, GA 30912, USA
| | - Sean P McGregor
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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27
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Affiliation(s)
- Esther J van Zuuren
- From the Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
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28
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Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. DERMATO-ENDOCRINOLOGY 2017; 9:e1361574. [PMID: 29484096 PMCID: PMC5821167 DOI: 10.1080/19381980.2017.1361574] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/26/2017] [Indexed: 02/08/2023]
Abstract
Rosacea is a chronic relapsing inflammatory skin disease with a high prevalence among adults of Northern European heritage with fair skin. Symptoms present in various combinations and severity, often fluctuating between periods of exacerbation and remission. Based on morphological characteristics, rosacea is generally classified into four major subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Diverse environmental and endogenous factors have been shown to stimulate an augmented innate immune response and neurovascular dysregulation; however, rosacea's exact pathogenesis is still unclear. An evidence-based approach is essential in delineating differences between the many available treatments. Because of the diverse presentations of rosacea, approaches to treatment must be individualized based on the disease severity, quality-of-life implications, comorbidities, trigger factors, and the patient's commitment to therapy.
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Affiliation(s)
- Barbara M Rainer
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna L Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Hajra B, Sultana N, Guria C, Pathak AK, Saxena VK. Liquid Phase Selective Catalytic Oxidation of Oleic Acid to Azelaic Acid Using Air and Transition Metal Acetate Bromide Complex. J AM OIL CHEM SOC 2017. [DOI: 10.1007/s11746-017-3048-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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30
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Staedtler G, Shakery K, Endrikat J, Nkulikiyinka R, Gerlinger C. An empirically generated responder definition for rosacea treatment. Clin Cosmet Investig Dermatol 2017; 10:347-352. [PMID: 28932125 PMCID: PMC5598547 DOI: 10.2147/ccid.s139352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea. METHODS A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of "clear/minimal" were considered as responders, and those staying in the range of IGA "mild to severe" as nonresponders. The respective number of lesions was determined. RESULTS A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0-3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6-18]). The optimal cutoff point between both groups was 5.69 lesions. CONCLUSION The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea.
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Affiliation(s)
| | | | - Jan Endrikat
- Bayer AG, Radiology, Berlin.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | | | - Christoph Gerlinger
- Bayer AG, Pharmaceutical Statistics.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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31
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Anzengruber F, Czernielewski J, Conrad C, Feldmeyer L, Yawalkar N, Häusermann P, Cozzio A, Mainetti C, Goldblum D, Läuchli S, Imhof L, Brand C, Laffitte E, Navarini AA. Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol 2017; 31:1775-1791. [PMID: 28833645 DOI: 10.1111/jdv.14349] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/08/2017] [Indexed: 12/28/2022]
Abstract
Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.
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Affiliation(s)
- F Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - J Czernielewski
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - C Conrad
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - L Feldmeyer
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - N Yawalkar
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - P Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - A Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Mainetti
- Department of Dermatology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - D Goldblum
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - S Läuchli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Brand
- Department of Dermatology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - E Laffitte
- Department of Dermatology, University Hospital Geneva, Geneva, Switzerland
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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32
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Sacchidanand SA, Lahiri K, Godse K, Patwardhan NG, Ganjoo A, Kharkar R, Narayanan V, Borade D, D’souza L. Synchronizing Pharmacotherapy in Acne with Review of Clinical Care. Indian J Dermatol 2017; 62:341-357. [PMID: 28794543 PMCID: PMC5527713 DOI: 10.4103/ijd.ijd_41_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
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Affiliation(s)
| | - Koushik Lahiri
- Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Kiran Godse
- Shree Skin Centre and Pathology Laboratory, Navi Mumbai, Maharashtra, India
| | | | - Anil Ganjoo
- Dr. Ganjoo's Skin and Cosmetology Centre, New Delhi, India
| | - Rajendra Kharkar
- Consultant Dermatologist, Dr. Kharkar's Skin Clinic, Mumbai, Maharashtra, India
| | - Varsha Narayanan
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Dhammraj Borade
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Lyndon D’souza
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
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33
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosacea Management: Update on general measures and topical treatment options. J Dtsch Dermatol Ges 2017; 14 Suppl 6:17-27. [PMID: 27869379 DOI: 10.1111/ddg.13143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 02/02/2023]
Abstract
Although there is presently no cure for rosacea, there are several recommended treatment options available to control many of the symptoms and to prevent them from getting worse. In addition to self-help measures like avoidance of trigger factors and proper skin care, rosacea management should include topical medications as one of the first-line choices for patients with erythematous and mild to severe papulopustular rosacea. Since mixed forms of characteristic rosacea symptoms are more common, medical treatment must be symptom-tailored for each individual case and will often involve a combination therapy. Approved topical agents for the major symptoms of rosacea encompass brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions, all of which have shown their efficacy in numerous valid, well-controlled trials. In addition, there are several other, not approved topical treatments which are possible options that require further validation in larger well-controlled studies.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - M Hofmann
- Department of Dermatology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany
| | - P Lehmann
- Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - M Steinhoff
- Department of Dermatology and, UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
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34
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Gladko VV, Masyukova SA, Ilina IV, Sanakoyeva EG, Gorbakova EV, Zemlyakova SS. The complex therapy of acne rosacea with azelaic acid preparations. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-6-73-78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The present literature data on pathogenesis and treatment of acne rosacea are reported in the article. Research results on effectiveness of therapy with azelaic acid at patients with acne rosacea are presented. The nosotropically based standard of acne rosacea therapy is accepted in virtue of the world practice data.
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35
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen. J Dtsch Dermatol Ges 2016; 14 Suppl 6:17-28. [PMID: 27869373 DOI: 10.1111/ddg.13143_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist.
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Affiliation(s)
- M Schaller
- Universitäts-Hautklinik, Klinikum der Universität Tübingen, Deutschland
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt/Main, Deutschland
| | - B Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Deutschland
| | - M Hofmann
- Klinik für Dermatologie und Allergologie, Charité - Universitätsmedizin Berlin, Deutschland
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie, Universitätsklinikum Gießen, Deutschland
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Kliniken Wuppertal, Universität Witten/Herdecke, Deutschland
| | - T A Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster, Deutschland
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University Collge Dublin, Dublin, Irland
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36
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Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment Modalities for Acne. Molecules 2016; 21:E1063. [PMID: 27529209 PMCID: PMC6273829 DOI: 10.3390/molecules21081063] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 01/19/2023] Open
Abstract
Acne is a common inflammatory skin disease which affects the pilosebaceous units of the skin. It can have severe psychological effects and can leave the patient with severe skin scarring. There are four well-recognized pathological factors responsible for acne which is also the target for acne therapy. In this review, different treatment options are discussed, including topical (i.e., retinoids, and antibiotics) and systemic (i.e., retinoids, antibiotics, and hormonal) treatments. Since the general public has been showing an increasing interest in more natural and generally safer treatment options, the use of complementary and alternative medicines (CAM) for treating acne was also discussed. The use of physical therapies such as comedone extraction, cryoslush therapy, cryotherapy, electrocauterization, intralesional corticosteroids and optical treatments are also mentioned. Acne has been extensively researched with regards to the disease mechanism as well as treatment options. However, due to the increasing resistance of Propionibacterium acnes towards the available antibiotics, there is a need for new treatment methods. Additionally, the lack of necessary evidence on the efficacy of CAM therapies makes it necessary for researchers to investigate these treatment options further.
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Affiliation(s)
- Lizelle Fox
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Candice Csongradi
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Marique Aucamp
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Jeanetta du Plessis
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - Minja Gerber
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
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37
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The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis. SPRINGERPLUS 2016; 5:1151. [PMID: 27504249 PMCID: PMC4956638 DOI: 10.1186/s40064-016-2819-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
Background Rosacea is a common chronic skin condition that manifests as recurrent inflammatory lesions. Long-term treatment is required to control symptoms and disease progression, with topical treatments being the first-line choice. Ivermectin 1 % cream is a new once-daily (QD) topical treatment for the inflammatory lesions of rosacea, and it is important to compare the efficacy, safety, and tolerability of ivermectin with other currently available topical treatments. Methods A systematic literature review was performed from January 2011 to June 2015, with articles published prior to 2011 retrieved from a Cochrane review on rosacea. Randomized controlled trials of the topical treatment of adult patients with moderate-to-severe papulopustular rosacea were identified from electronic databases and trial registers, and supplemented with data from clinical study reports. Mixed treatment comparisons (MTCs) were conducted to compare different treatments according to Bayesian methodology. Results 57 studies were identified, with 19 providing data suitable for MTC. Ivermectin 1 % cream QD led to a significantly greater likelihood of success compared with azelaic acid 15 % gel twice-daily (BID) [relative risk (95 % credible interval): 1.25 (1.14–1.37)], and metronidazole 0.75 % cream BID [1.17 (1.08–1.29)] at 12 weeks. Ivermectin 1 % cream QD also demonstrated a significant reduction in inflammatory lesion count compared with azelaic acid 15 % gel BID [−8.04 (−12.69 to −3.43)] and metronidazole 0.75 % cream BID [−9.92 (−13.58 to −6.35)] at 12 weeks. Ivermectin 1 % cream QD led to a significantly lower risk of developing any AE or TRAE compared with azelaic acid 15 % gel BID [0.83 (0.71–0.97) and 0.47 (0.32–0.67), respectively]. Conclusions Ivermectin 1 % cream QD appears to be a more effective topical treatment than other current options for the inflammatory lesions of rosacea, with at least an equivalent safety and tolerability profile, and could provide physicians and dermatologists with an alternative first-line treatment option. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2819-8) contains supplementary material, which is available to authorized users.
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38
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Al-Marabeh S, Khalil E, Khanfar M, Al-Bakri AG, Alzweiri M. A prodrug approach to enhance azelaic acid percutaneous availability. Pharm Dev Technol 2016; 22:578-586. [PMID: 27346659 DOI: 10.1080/10837450.2016.1200614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Azelaic acid is a dicarboxylic acid compound used in treatment of acne vulgaris. However, high concentration (ca 20%) is needed to guarantee the drug availability in the skin. The latter increases the incidence of side effects such as local irritation. The prodrug strategy to enhance azelaic acid diffusion through skin was not reported before. Thus, a lipophilic prodrug of azelaic acid (diethyl azelate [DEA]) was synthesized and investigated to improve percutaneous availability of azelaic acid, with a subsequent full physical, chemical, and biological characterization. Expectedly, DEA exhibited a significant increase in diffusion compared to azelaic acid through silicone membrane. In contrast, the diffusion results through human stratum corneum (SC) displayed weaker permeation for DEA with expected retention in the SC. Therefore, a desorption study of DEA from SC was conducted to examine the reservoir behavior in SC. Results showed an evidence of sustained release behavior of DEA from SC. Consequently, enhancement of keratolytic effect is expected due to azelaic acid produced from enzymatic conversion of DEA released from SC.
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Affiliation(s)
- Sara Al-Marabeh
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Enam Khalil
- b Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Mohammad Khanfar
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Amal G Al-Bakri
- b Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy , The University of Jordan , Amman , Jordan
| | - Muhammed Alzweiri
- a Department of Pharmaceutical Sciences, Faculty of Pharmacy , The University of Jordan , Amman , Jordan.,c Faculty of Pharmacy , Al-Zaytoonah Private University of Jordan , Amman , Jordan
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Aljuffali IA, Lin CF, Chen CH, Fang JY. The codrug approach for facilitating drug delivery and bioactivity. Expert Opin Drug Deliv 2016; 13:1311-25. [DOI: 10.1080/17425247.2016.1187598] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ibrahim A. Aljuffali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Chwan-Fwu Lin
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chun-Han Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-You Fang
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Taoyuan, Taiwan
- Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C. Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg 2016; 20:432-45. [PMID: 27207355 DOI: 10.1177/1203475416650427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations.
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Affiliation(s)
- Yuka Asai
- Division of Dermatology, Queen's University, Kingston, ON, Canada
| | - Jerry Tan
- University of Western Ontario, Windsor, ON, Canada
| | | | | | | | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Danielle Marcoux
- CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Jason K Rivers
- Bearing Biomedical Consulting, Vancouver, BC, Canada Pacific DermAesthetics, Vancouver, BC, Canada
| | - Mariusz Sapijaszko
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - John Toole
- University of Manitoba, Winnipeg, MB, Canada
| | - Marcie Ulmer
- Bearing Biomedical Consulting, Vancouver, BC, Canada Carruthers & Humphrey, Vancouver, BC, Canada
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Taieb A, Stein Gold L, Feldman SR, Dansk V, Bertranou E. Cost-Effectiveness of Ivermectin 1% Cream in Adults with Papulopustular Rosacea in the United States. J Manag Care Spec Pharm 2016; 22:654-65. [PMID: 27231793 PMCID: PMC10398060 DOI: 10.18553/jmcp.2016.15210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Papulopustular rosacea is a chronic skin disease involving central facial erythema in combination with papules and pustules. Papulopustular rosacea is treated with topical, systemic, or a combination of topical and systemic therapies. Currently approved topical therapies include azelaic acid gel/cream/foam twice daily (BID) and metronidazole cream/gel/lotion BID. Ivermectin 1% cream once daily (QD) is a new topical agent for the treatment of papulopustular rosacea that has been approved for the management of inflammatory lesions of rosacea and offers an alternative to current treatments. OBJECTIVE To evaluate the cost-effectiveness of ivermectin 1% cream QD compared with current topical treatments in order to understand the cost of adding ivermectin as a treatment option that would bring additional clinical benefit for adults with papulopustular rosacea in the United States. METHODS The cost-effectiveness of ivermectin 1% cream QD was compared with metronidazole 0.75% cream BID and azelaic acid 15% gel BID for adults in the United States with moderate-to-severe papulopustular rosacea using a Markov cohort state transition structure with 2 mutually exclusive health states (rosacea and no rosacea) and 5 phases. Patients could succeed or fail to respond to treatment and experience a relapse after treatment success. The model took a health care payer perspective (direct medical costs of topical and/or systemic therapy plus health care costs for physician and specialist visits) and used a 3-year time horizon. The model was run for a cohort of 1,000 patients. Costs (2014 U.S. dollars) and benefits (disease-free days and quality-adjusted life-years [QALYs]) were discounted at a rate of 3% per annum. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER) and measured in terms of incremental cost per QALY gained (estimated from health state utilities for patients with and without rosacea). Univariate and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of model outcomes. RESULTS Compared with metronidazole 0.75% cream BID, ivermectin 1% cream QD was associated with higher costs but provided greater clinical benefit, with an ICER of $13,211 per QALY gained. For a cohort of 1,000 patients, ivermectin 1% cream QD provided an additional 72,922 disease-free days (200 years) over a 3-year period compared with metronidazole 0.75% cream BID, leading to a lower cost per disease-free day for ivermectin 1% cream QD ($4.54) compared with metronidazole 0.75% cream BID ($4.85). Ivermectin 1% cream QD was associated with lower total costs and greater clinical benefit compared with azelaic acid 15% gel BID at year 3 and dominated this treatment. After 3 years, ivermectin 1% cream QD was associated with the lowest health care costs ($62,767 compared with $73,284 for metronidazole 0.75% cream BID and $77,208 for azelaic acid 15% gel BID), reflecting a 15% reduction in physician visit costs, when compared with metronidazole 0.75% cream BID, and almost a 20% reduction, when compared with azelaic acid 15% gel BID. The univariate sensitivity analyses indicated that the results are sensitive to the time horizon selected: the longer the time horizon, the more beneficial the results for ivermectin 1% cream QD relative to the comparators, although even at 1 year, ivermectin 1% cream QD dominated azelaic acid 15% gel BID. The PSA suggested that ivermectin 1% cream QD was the most likely treatment to be cost-effective at a willingness-to-pay threshold of $15,000 and above. CONCLUSIONS Ivermectin 1% cream QD had favorable incremental cost-effectiveness when compared with metronidazole 0.75% cream BID and dominated azelaic acid 15% gel BID in the treatment of papulopustular rosacea in the United States. Therefore, ivermectin 1% cream QD may be a good first-line treatment for papulopustular rosacea, providing additional clinical benefit at no or low additional cost. DISCLOSURES This study was sponsored by Galderma Laboratories. The sponsor was involved in the design of the model structure but not in the collection of the data used to populate the model. Manuscript preparation was also funded by Galderma. Taieb is an investigator and advisor for Galderma. Gold is an investigator for Galderma. Feldman is a consultant and speaker for Galderma and has received grants from Galderma. Dansk and Bertranou received a research grant from Galderma to conduct this study. Dansk and Bertranou contributed to the design of the model structure, the sourcing and inputting of the data, and the interpretation of the results. Taieb, Feldman, and Gold contributed to the interpretation of the results. All authors reviewed draft versions of the manuscript and gave permission for the submission of the final version.
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Affiliation(s)
- Alain Taieb
- 1 Hôpital Saint-André, Service de Dermatologie et Dermatologie Pédiatrique, Bordeaux Cedex, France
| | - Linda Stein Gold
- 2 Department of Dermatology, Henry Ford Medical Center, Detroit, Michigan, United States
| | - Steven R Feldman
- 3 Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Viktor Dansk
- 4 PAREXEL Access Consulting, PAREXEL International, London, England
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Cardwell LA, Alinia H, Moradi Tuchayi S, Feldman SR. New developments in the treatment of rosacea - role of once-daily ivermectin cream. Clin Cosmet Investig Dermatol 2016; 9:71-7. [PMID: 27051311 PMCID: PMC4807898 DOI: 10.2147/ccid.s98091] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rosacea is a chronic dermatological disorder with a variety of clinical manifestations localized largely to the central face. The unclear etiology of rosacea fosters therapeutic difficulty; however, subtle clinical improvement with pharmacologic treatments of various drug categories suggests a multifactorial etiology of the disease. Factors that may contribute to disease pathogenesis include immune abnormality, vascular abnormality, neurogenic dysregulation, presence of cutaneous microorganisms, UV damage, and skin barrier dysfunction. The role of ivermectin in the treatment of rosacea may be as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema.
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Affiliation(s)
- Leah A Cardwell
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Hossein Alinia
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Sara Moradi Tuchayi
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Taieb A, Khemis A, Ruzicka T, Barańska-Rybak W, Berth-Jones J, Schauber J, Briantais P, Jacovella J, Passeron T. Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin 1% cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study. J Eur Acad Dermatol Venereol 2015; 30:829-36. [DOI: 10.1111/jdv.13537] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Taieb
- Service de Dermatologie et Dermatologie Pédiatrique; Hôpital Saint-André; Bordeaux Cedex France
| | - A. Khemis
- Dermatology Department; Centre Hospitalier Universitaire de Nice; Nice France
| | - T. Ruzicka
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - W. Barańska-Rybak
- Department of Dermatology, Venereology and Allergology; Medical University of Gdansk Poland; Gdansk Poland
| | - J. Berth-Jones
- Dermatology Clinical Research Unit; Department of Dermatology; George Eliot Hospital; Nuneaton UK
| | - J. Schauber
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | | | | | - T. Passeron
- Dermatology Department; Centre Hospitalier Universitaire de Nice; Nice France
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Jackson JM, Knuckles M, Minni JP, Johnson SM, Belasco KT. The role of brimonidine tartrate gel in the treatment of rosacea. Clin Cosmet Investig Dermatol 2015; 8:529-38. [PMID: 26566370 PMCID: PMC4627400 DOI: 10.2147/ccid.s58920] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Rosacea is a chronic cutaneous condition with a prevalence rate ranging from 9.6% to 22% in recent studies. Facial erythema (transient and permanent) is considered a common denominator that is frequently observed in all subtypes of rosacea and is estimated to affect more than 40 million people worldwide. Brimonidine tartrate is a selective α2-adrenergic receptor agonist and is the first topical treatment approved for facial erythema of rosacea. Clinical trials have demonstrated that brimonidine tartrate provided significantly greater efficacy, compared to vehicle, for the treatment of moderate to severe erythema of rosacea. In addition, brimonidine tartrate has demonstrated a rapid onset of effect, duration of action throughout the day, and good safety profile in studies of up to 1 year. This review critically discusses the role of brimonidine tartrate for the treatment of facial erythema of rosacea by examining both clinical study data and real-world dermatologist experiences across a wide spectrum of treated patients, and concludes that it is a significant therapeutic option in the management of an unmet need of this chronic condition.
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Affiliation(s)
- J Mark Jackson
- Division of Dermatology, University of Louisville, Louisville, KY, USA
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van Zuuren E, Fedorowicz Z. Interventions for rosacea: abridged updated Cochrane systematic review including GRADE assessments. Br J Dermatol 2015; 173:651-62. [DOI: 10.1111/bjd.13956] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 01/01/2023]
Affiliation(s)
- E.J. van Zuuren
- Department of Dermatology B1-Q; Leiden University Medical Centre; PO Box 9600 2300 RC Leiden 2333 ZA the Netherlands
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Abstract
The authors present current data from the literature relating to major characteristics and efficacy of methods of non-invasive diagnostics of rosacea (dermatoscopy, dopplerography, ultrasound scanning, confocal laser scanning microscopy) as well as aspects of a systemic external therapy, laser therapy and use of IPL systems in the treatment of patients suffering from rosacea.
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Rosacea. J Am Acad Dermatol 2015; 72:761-70; quiz 771-2. [DOI: 10.1016/j.jaad.2014.08.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/01/2014] [Accepted: 08/18/2014] [Indexed: 01/26/2023]
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Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. OBJECTIVES To assess the efficacy and safety of treatments for rosacea. SEARCH METHODS We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. MAIN RESULTS We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed adverse events, although often only limited data were provided. In most comparisons there were no statistically significant differences in number of adverse events, most were mild and transient. Physician assessments including investigators' global assessments, lesion counts and erythema were evaluated in three-quarters of the studies, but time needed for improvement and duration of remission were incompletely or not reported.The quality of the body of evidence was rated moderate to high for most outcomes, but for some outcomes low to very low.Data for several outcomes could only be pooled for topical metronidazole and azelaic acid. Both were shown to be more effective than placebo in papulopustular rosacea (moderate quality evidence for metronidazole and high for azelaic acid). Pooled data from physician assessments in three trials demonstrated that metronidazole was more effective compared to placebo (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.29 to 3.02). Four trials provided data on participants' assessments, illustrating that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30 to 1.63). The results from three studies were contradictory on which of these two treatments was most effective.Two studies showed a statistically significant and clinically important improvement in favour of topical ivermectin when compared to placebo (high quality evidence). Participants' assessments in these studies showed a RR of 1.78 (95% CI 1.50 to 2.11) and RR of 1.92 (95% CI 1.59 to 2.32),which were supported by physicians' assessments. Topical ivermectin appeared to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study, for improving quality of life and participant and physician assessed outcomes (high quality evidence for these outcomes).Topical brimonidine in two studies was more effective than vehicle in reducing erythema in rosacea at all time points over 12 hours (high quality evidence). At three hours the participants' assessments had a RR of 2.21 (95% CI 1.52 to 3.22) and RR of 2.00 (95% CI 1.33 to 3.01) in favour of brimonidine. Physicians' assessments confirmed these data. There was no rebound or worsening of erythema after treatment cessation.Topical clindamycin phosphate combined with tretinoin was not considered to be effective compared to placebo (moderate quality evidence).Topical ciclosporin ophthalmic emulsion demonstrated effectiveness and improved quality of life for people with ocular rosacea (low quality evidence).Of the comparisons assessing oral treatments for papulopustular rosacea there was moderate quality evidence that tetracycline was effective but this was based on two old studies of short duration. Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99) (high quality evidence). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doxycycline, but there was evidence of fewer adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54) (low quality evidence). There was very low quality evidence from one study (assessed at high risk of bias) that doxycycline 100 mg was as effective as azithromycin. Low dose minocycline (45 mg) was effective for papulopustular rosacea (low quality evidence).Oral tetracycline was compared with topical metronidazole in four studies and showed no statistically significant difference between the two treatments for any outcome (low to moderate quality evidence).Low dose isotretinoin was considered by both the participants (RR 1.23, 95% CI 1.05 to 1.43) and physicians (RR 1.18, 95% CI 1.03 to 1.36) to be slightly more effective than doxycycline 50-100 mg (high quality evidence).Pulsed dye laser was more effective than yttrium-aluminium-garnet (Nd:YAG) laser based on one study, and it appeared to be as effective as intense pulsed light therapy (both low quality evidence). AUTHORS' CONCLUSIONS There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea. Time needed to response and response duration should be addressed more completely, with more rigorous reporting of adverse events. Further studies on treatment of ocular rosacea are warranted.
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Affiliation(s)
- Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | | | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | | | - Lyn Charland
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
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