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Trave I, Cozzani E, Salvi I, Parodi A. Follicular scales, scalp and ocular involvement in patients with papulopustular rosacea: prevalence and association with Demodex mite proliferation. Dermatol Reports 2024; 16:9798. [PMID: 38585499 PMCID: PMC10993653 DOI: 10.4081/dr.2023.9798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 04/09/2024] Open
Abstract
Facial follicular scales, dandruff, scalp itching and ocular alterations are lesser-known signs of rosacea and demodicosis. The aim of this prospective original study was to investigate the presence of these signs and symptoms in patients with almost-clear, mild and moderate papulopustular rosacea (PPR) and to study the differences between Demodex-positive (D+) and Demodex-negative (D-) rosacea. Twenty-seven out of 60 patients (45%) presented follicular scales, 24 (40%) ocular involvement and 22 (36.67%) scalp involvement. Follicular scales were more frequently observed in mild and moderate than in almost-clear rosacea (P<0.001). Itching of the scalp was more frequently reported in patients with moderate rosacea than in those with mild disease (P=0.05). Follicular scales (P=0.002) and scalp itching (P=0.05) were more frequently reported in D+ than in D- patients. Among D+ patients, scalp itching was more frequently reported in mild than in almost clear rosacea (P=0.01) and ocular symptoms associated to scalp itching were more frequently reported in moderate than in almost-clear rosacea (P=0.05). We suggest looking for these signs and symptoms in all patients with PPR, because they can be a sign of a more severe form of rosacea or of demod-icosis.
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Affiliation(s)
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences, University of Genoa; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Xiao W, Chen M, Wang B, Huang Y, Zhao Z, Deng Z, Xie H, Li J, Tang Y. Efficacy and safety of antibiotic agents in the treatment of rosacea: a systemic network meta-analysis. Front Pharmacol 2023; 14:1169916. [PMID: 37251342 PMCID: PMC10210163 DOI: 10.3389/fphar.2023.1169916] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Antibiotics are considered the backbone of rosacea management, especially for controlling inflammatory papules and pustules. We aim to evaluate the efficacy and safety of varied prescriptions and doses of antibiotics in treating rosacea by network meta-analysis. Methods: In this study, we compared all available randomized controlled trials (RCTs) that have studied systemic and topical antibiotics and placebo in rosacea therapy. We searched databases such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PubMed, Web of Science, and LILACS for published and unpublished RCTs on ClinicalTrials.gov before April 2023. The primary outcome was the improvement of the Investigator's Global Assessment (IGA) scores, and the secondary outcomes consisted of the improvement of the Patient's Global Assessment (PaGA) scores, Clinician's Erythema Assessment (CEA) scores, and adverse events (AEs). We used Bayesian random effects models for multiple treatment comparisons. Results: We identified 1,703 results through these databases. Thirty-one randomized trials with 8,226 patients were included. The heterogeneity and inconsistency between the trials were low, with a low risk of bias of all trials. Oral doxycycline 40 mg, minocycline 100 mg, and minocycline 40 mg, as well as topical ivermectin and metronidazole 0.75%, were effective in treating papules and pustules, thereby decreasing IGA in rosacea. Among these, minocycline 100 mg ranked top in efficacy. As for improving the PaGA scores, topical ivermectin, metronidazole 1%, and systemic oxytetracycline were effective, of which oxytetracycline worked the best. Both doxycycline 40 mg and metronidazole 0.75% presented no therapeutic effect for erythema. Considering the safety of the agents, systemic application of azithromycin and doxycycline 100 mg significantly increase the risk of AEs. Conclusion: Our review suggests that a high dosage of systemic minocycline is the most effective in treating rosacea phenotypes with papules and pustules with a low risk of AEs. However, there were no sufficient evidence-based data in exploring the influence of antibiotics on erythema. The phenotype of rosacea should be taken into consideration along with benefit and safety when making prescriptions due to AEs. Clinical Trial Registration: NCT(2016): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/962/CN-01506962/frame.html NCT(2017): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/764/CN-01565764/frame.html.
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Affiliation(s)
- Wenqin Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, 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
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ben Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yingxue Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, 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
- Hunan Key Laboratory of Aging Biology, 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
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, 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
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Aging Biology, 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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3
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Viodé C, Rouquier A, Mias C, Questel E, Bessou-Touya S, Duplan H. Specific protection of sensitive skin against environmental stress by maintenance and improvement of barrier function. J Eur Acad Dermatol Venereol 2022; 36 Suppl 5:13-20. [PMID: 35315151 DOI: 10.1111/jdv.17910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sensitive skin is a common condition that can severely impact quality of life. Several mechanisms are thought to be involved, including those affecting the skin barrier function, hydration and skin innervation. OBJECTIVES To investigate the benefit of cream and balm formulations dedicated to sensitive skin and containing Aquaphilus dolomiae extract-G3 (ADE-G3) on skin barrier functions (lipid composition, pH, TEWL), as well as protective responses to dry and pollution stresses. METHODS In vitro sensitized (using histamine) reconstructed human epidermis (RHE) were subjected to dehydration and pollution stress in the absence and presence of the formulations. Endpoint measurements included transepithelial electric resistance (TEER), stratum corneum protein expression and lipid contents. Clinical measurements included transepithelial water loss (TEWL), skin pH and the lipid index. RESULTS When applied in cream and balm formulations, ADE-G3, increased the TEER in sensitized RHEs. In non-sensitized dehydrated RHEs, both formulations increased recovery of skin barrier integrity after dehydration, evident as a return of the ratios of filaggrin/profilaggrin and caspase-14/procaspase-14 to values measured in control non-stressed RHEs, as well as reducing the 'natural moisturizing factor' to control levels. In clinical studies performed on dry human skin, the formulations helped to maintain and improve the skin barrier function. This was evident as an intense and sustained moisturization (total lipids and lipid esters were increased), an increase in pH and a decrease in the TEWL by both formulations. When exposed to pollution stress by treating the models with benzo[a]pyrene and airborne particulate matter (PM10), application of both formulations prior to exposure attenuated the induction of CYP1A1, CYP1B1 and UGT1A7 expression, indicating a protective effect. CONCLUSIONS ADE-G3 cream and balm formulations increased the hydration of the skin but also protected and improved the skin barrier integrity of sensitive skin exposed to dry and cold and airborne pollutant-induced stress environments.
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Affiliation(s)
- C Viodé
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - A Rouquier
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - C Mias
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - E Questel
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - S Bessou-Touya
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - H Duplan
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
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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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5
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Cribier B. Rosacea: Treatment targets based on new physiopathology data. Ann Dermatol Venereol 2021; 149:99-107. [PMID: 34893359 DOI: 10.1016/j.annder.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
Over the past 15 years, numerous clinical, epidemiological and physiopathological articles have been published on rosacea. There is now increasing evidence that rosacea is an inflammatory disease characterised by abnormal innate immune response, major vascular changes, and increased colonisation by Demodex mites, along with a genetic predisposition and multiple external aggravating factors. It is thus possible to define treatment targets and possible treatments: 1) permanent vascular changes (medical and instrumental treatments); 2) flushing (betablockers, botulinum toxin); 3) innate immunity (antibiotics, nonspecific antioxidants and anti-inflammatory molecules); 4) a neurovascular component (analgesics, antidepressants); 5) Demodex (antiparasitic drugs); 6) microbiome; 7) skin barrier impairment (cosmetics and certain systemic drugs); 8) sebaceous glands (isotretinoin, surgery); 9) environmental factors (alcohol, coffee, UV exposure). Treatment recommendations are now available in many countries and benefit from the new phenotypic approach to rosacea, in which every sign or symptom is considered separately rather than having to deal with overlapping subtypes. Since the 2000s, many good quality clinical trials have been published in the field of rosacea and many others are still ongoing. Rosacea is a complex disease involving many different mechanisms and with numerous possible treatments, but there are still some important unmet needs with regard to optimal care.
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Affiliation(s)
- B Cribier
- Clinique Dermatologique, Hôpitaux Universitaires et Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France.
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6
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Seo JI, Ham HI, Baek JH, Shin MK. An objective skin-type classification based on non-invasive biophysical parameters. J Eur Acad Dermatol Venereol 2021; 36:444-452. [PMID: 34747517 DOI: 10.1111/jdv.17793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the invention of various non-invasive bioengineering tools, skin-type analysis has largely been based on subjective assessments. However, advancements in the functional cosmetic industry and artificial intelligence-assisted dermatology are creating a greater demand for an objective skin-type classification system. OBJECTIVES To propose an objective skin-type classification system solely based on non-invasive, bioengineering devices; provide reference values applicable to the Korean population; and compare our reference values with those of published studies. METHODS Biophysical parameter measurements were obtained from the 2018 International Skin Characteristics Data Bank Project conducted by the Foundation of Korea Cosmetic Industry Institute. The participants were 434 healthy South Korean adults. Each participant was assessed using eight bioengineering devices (Tewameter® , pH-meter® , Corneometer® , Sebumeter® , Cutometer® , Spectrophotometer® , PRIMOS® lite, and Janus® ). The measurements were divided into tertiles to determine reference points. RESULTS Our objective skin-type classification consists of five main categories (sensitivity, hydration, oiliness, elasticity, and skin tone) and five corresponding subcategories (erythema, roughness, pores, wrinkles, and pigmentation, respectively). Each skin type was assigned based on the reference point of the biophysical parameter, which was established as the tertile value associated with 'unfavourable' skin characteristics. Individuals were categorized as having sensitive skin when the TEWL scores were over 18.0 g/m2 /h or the pH was over 5.45; dehydrated skin when the corneometric value measured below 47.17 A.U.; oily skin when the sebumetric value exceeded 70 μg/cm2 ; and loose skin when the cutometric R2 value was below 0.68 E/mm. CONCLUSIONS This study is the first to provide a comprehensive skin-type classification system based solely on non-invasive biophysical parameters. As measurement data accumulate, the reference points will progress to become more accurate, and they will be subdivided according to gender, age, and ethnic group. Therefore, our classification system serves as a basis for artificial intelligence-based skin-type analysis.
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Affiliation(s)
- J I Seo
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - H I Ham
- Dermapro Skin Research Center, DERMAPRO Ltd., Seoul, Republic of Korea
| | - J H Baek
- Dermapro Skin Research Center, DERMAPRO Ltd., Seoul, Republic of Korea
| | - M K Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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Kim JH, Oh YW, Kim DH, Seo BH, Suh HS, Choi YS. A Randomized, Placebo-Controlled Trial of Gamma Linolenic Acid as an Add-on Therapy to Minocycline for the Treatment of Rosacea. Ann Dermatol 2020; 32:466-472. [PMID: 33911789 PMCID: PMC7875229 DOI: 10.5021/ad.2020.32.6.466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 05/25/2020] [Indexed: 12/23/2022] Open
Abstract
Background A recent study suggested a possible role of skin barrier dysfunction in the pathogenesis of rosacea, which leads to irritation symptoms. Gamma linolenic acid (GLA) is an essential omega-6 fatty acid that is known to restore defective epidermal skin barrier. GLA supplementation has not previously been performed in rosacea patients. Objective To investigate the efficacy and safety of adding GLA to minocycline compared to minocycline alone in rosacea patients. Methods This prospective, double-blind, randomized, placebo-controlled trial enrolled 31 rosacea patients. They were randomly assigned to receive 320 mg/day of GLA (Evoprim®) (n=16) or placebo (n=15) in addition to 100 mg/day of minocycline for 8 weeks. Investigator's global assessment (IGA) and patient's global assessment (PGA) were used to assess clinical severity at weeks 0, 4, 8, and 12. Biophysical parameters including melanin index, erythema index, transepidermal water loss (TEWL), lipid concentration, and stratum corneum hydration were measured. Results In the GLA group, a higher proportion of patients achieved treatment success (IGA≤1) at week 8 (68.75% vs. 33.33%) and patient satisfaction (PGA≥3) at weeks 8 (75.0% vs. 40.0%) and 12 (81.3% vs. 46.6%). Both groups, throughout 12 weeks of treatment, revealed a trend toward improvement in erythema index, melanin index, TEWL, and stratum corneum hydration. Particularly, there was a significant difference in TEWL and stratum corneum hydration over time between the two groups (p=0.033, p=0.003, respectively). No serious adverse event was observed in both groups. Conclusion GLA is beneficial as an additional therapeutic option for rosacea patients treated with minocycline.
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Affiliation(s)
- Ji Hyun Kim
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong Woo Oh
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Hee Kim
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byeong Hak Seo
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ho Seok Suh
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yu Sung Choi
- Department of Dermatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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8
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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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9
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Guertler A, Jøntvedt NM, Clanner‐Engelshofen BM, Cappello C, Sager A, Reinholz M. Efficacy and safety results of micellar water, cream and serum for rosacea in comparison to a control group. J Cosmet Dermatol 2020; 19:2627-2633. [DOI: 10.1111/jocd.13591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Anne Guertler
- Department of Dermatology and Allergy University Hospital of Munich (LMU) Munich Germany
| | - Nora Marie Jøntvedt
- Department of Dermatology and Allergy University Hospital of Munich (LMU) Munich Germany
| | | | | | | | - Markus Reinholz
- Department of Dermatology and Allergy University Hospital of Munich (LMU) Munich Germany
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10
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Lee SG, Yoon MS, Kim DH, Shin JU, Lee HJ. Hyaluronan Oligosaccharides Improve Rosacea-Like Phenotype through Anti-Inflammatory and Epidermal Barrier-Improving Effects. Ann Dermatol 2020; 32:189-196. [PMID: 33911737 PMCID: PMC7992622 DOI: 10.5021/ad.2020.32.3.189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/29/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background Rosacea is a common skin disease associated with increased expression of cathelicidin, kallikrein 5 (KLK5), toll-like receptor (TLR) 2, and abnormal barrier function. Recently, it was reported that hyaluronan (HA) could influence immune function via various receptors and HA oligosaccharides (oligo-HAs) could suppress TLR-dependent cytokine expression. Objective We investigated if oligo-HAs could influence on inflammation and epidermal barrier induced by LL-37, which had a major role in rosacea. Methods We cultured normal human keratinocytes and treated them with LL-37 and oligo-HAs or the LL-37 alone. A rosacea-like BALB/c mouse model injected with LL-37 was used to determine the role of oligo-HAs in rosacea in vivo. Results Interleukin-8 (IL-8) and tumor necrosis factor (TNF)-α release was suppressed when keratinocytes were co-treated with oligo-HAs and LL-37 compared with keratinocytes treated with LL-37 only. Treatment with oligo-HAs resulted in decreased transepidermal water loss as well as improved redness. Decreased inflammatory cell infiltration, IL-17A and KLK5 expression and increased CD44 and filaggrin expression were also noted. Conclusion Our findings suggest that oligo-HA improves rosacea-like phenotype through anti-inflammatory and epidermal barrier improving effect.
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Affiliation(s)
- Seon Gu Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Moon Soo Yoon
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hee Jung Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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11
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Logger J, Vries F, Erp PJ, Jong E, Peppelman M, Driessen R. Noninvasive objective skin measurement methods for rosacea assessment: a systematic review. Br J Dermatol 2019; 182:55-66. [DOI: 10.1111/bjd.18151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2019] [Indexed: 12/11/2022]
Affiliation(s)
- J.G.M. Logger
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - F.M.C. Vries
- HU University of Applied Sciences Utrecht the Netherlands
| | - P.E J. Erp
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - E.M.G.J. Jong
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - R.J.B. Driessen
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
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12
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Proksch E. pH in nature, humans and skin. J Dermatol 2018; 45:1044-1052. [DOI: 10.1111/1346-8138.14489] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
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13
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Choi JE, Di Nardo A. Skin neurogenic inflammation. Semin Immunopathol 2018; 40:249-259. [PMID: 29713744 DOI: 10.1007/s00281-018-0675-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/06/2018] [Indexed: 01/12/2023]
Abstract
The epidermis closely interacts with nerve endings, and both epidermis and nerves produce substances for mutual sustenance. Neuropeptides, like substance P (SP) and calcitonin gene-related protein (CGRP), are produced by sensory nerves in the dermis; they induce mast cells to release vasoactive amines that facilitate infiltration of neutrophils and T cells. Some receptors are more important than others in the generation of itch. The Mas-related G protein-coupled receptors (Mrgpr) family as well as transient receptor potential ankyrin 1 (TRPA1) and protease activated receptor 2(Par2) have important roles in itch and inflammation. The activation of MrgprX1 degranulates mast cells to communicate with sensory nerve and cutaneous cells for developing neurogenic inflammation. Mrgprs and transient receptor potential vanilloid 4 (TRPV4) are crucial for the generation of skin diseases like rosacea, while SP, CGRP, somatostatin, β-endorphin, vasoactive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) can modulate the immune system during psoriasis development. The increased level of SP, in atopic dermatitis, induces the release of interferon (IFN)-γ, interleukin (IL)-4, tumor necrosis factor (TNF)-α, and IL-10 from the peripheral blood mononuclear leukocytes. We are finally starting to understand the intricate connections between the skin neurons and resident skin cells and how their interaction can be key to controlling inflammation and from there the pathogenesis of diseases like atopic dermatitis, psoriasis, and rosacea.
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Affiliation(s)
- Jae Eun Choi
- Department of Dermatology, University of California San Diego, 9500 Gilman Drive #0869, La Jolla, CA, 92093, USA
| | - Anna Di Nardo
- Department of Dermatology, University of California San Diego, 9500 Gilman Drive #0869, La Jolla, CA, 92093, USA.
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15
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Kwon HJ, Suh JH, Ko EJ, Kim BJ. Combination treatment of propranolol, minocycline, and tranexamic acid for effective control of rosacea. Dermatol Ther 2016; 30. [DOI: 10.1111/dth.12439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/09/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hyun Jung Kwon
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Joon Hyuk Suh
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Eun Jung Ko
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul South Korea
| | - Beom Joon Kim
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul South Korea
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16
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Zhou M, Xie H, Cheng L, Li J. Clinical characteristics and epidermal barrier function of papulopustular rosacea: A comparison study with acne vulgaris. Pak J Med Sci 2016; 32:1344-1348. [PMID: 28083023 PMCID: PMC5216279 DOI: 10.12669/pjms.326.11236] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To evaluate the clinical characteristics and epidermal barrier function of papulopustular rosacea by comparing with acne vulgaris. Methods: Four hundred and sixty-three papulopustular rosacea patients and four hundred and twelve acne vulgaris patients were selected for the study in Xiangya Hospital of Central South University from March 2015 to May 2016. They were analyzed for major facial lesions, self-conscious symptoms and epidermal barrier function. Results: Erythema, burning, dryness and itching presented in papulopustular rosacea patients were significantly higher than that in acne vulgaris patients (P<0.001). The clinical scores of erythema, burning, dryness and itching in papulopustular rosacea patients were significantly higher than those in acne vulgaris patients (P<0.001). The water content of the stratum cornuem and skin surface lipid level were both significantly lower in papulopustular rosacea patients than that of the acne vulgaris patients (P<0.001) and healthy subjects (P<0.001); Water content of the stratum cornuem and skin surface lipid level were higher in acne vulgaris patients in comparison with that of healthy subjects (P>0.05, P<0.001; respectively). Transepidermal water loss was significantly higher in papulopustular rosacea patients than that of acne vulgaris patients and healthy subjects (P<0.001); transepidermal water loss was lower in skin of acne vulgaris patients than that of healthy subjects (P<0.001). Conclusion: Erythema, burning, dryness and itching are the characteristics of papulopustular rosacea, which makes it different from acne vulgaris. The epidermal barrier function was damaged in papulopustular rosacea patients while not impaired in that of acne vulgaris patients.
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Affiliation(s)
- Maosong Zhou
- Maosong Zhou, Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hongfu Xie
- Hongfu Xie, Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lin Cheng
- Lin Cheng, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, Guangdong, P. R. China
| | - Ji Li
- Ji Li, Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
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Abstract
Recent studies about the cutaneous barrier demonstrated consistent evidence that
the stratum corneum is a metabolically active structure and also has adaptive
functions, may play a regulatory role in the inflammatory response with
activation of keratinocytes, angiogenesis and fibroplasia, whose intensity
depends primarily on the intensity the stimulus. There are few studies
investigating the abnormalities of the skin barrier in rosacea, but the existing
data already show that there are changes resulting from inflammation, which can
generate a vicious circle caused a prolongation of flare-ups and worsening of
symptoms. This article aims to gather the most relevant literature data about
the characteristics and effects of the state of the skin barrier in rosacea.
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18
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Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology. Indian J Dermatol 2016; 61:469-81. [PMID: 27688434 PMCID: PMC5029230 DOI: 10.4103/0019-5154.190105] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology.
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Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Poonam Kabra
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Adarsh Lata Singh
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
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Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition. Int J Mol Sci 2016; 17:ijms17091562. [PMID: 27649161 PMCID: PMC5037831 DOI: 10.3390/ijms17091562] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 01/21/2023] Open
Abstract
Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Ji Hong Lim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Dae Ho Cho
- Department of Life Science, Sookmyung Women's University, Seoul 04310, Korea.
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
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Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments. Adv Ther 2016; 33:1481-501. [PMID: 27432381 PMCID: PMC5020118 DOI: 10.1007/s12325-016-0380-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Indexed: 12/21/2022]
Abstract
Rosacea is a common, chronic inflammatory skin disease that can present with a variety of signs and symptoms. The potentially simultaneous occurrence of different signs and symptoms is due to different underlying inflammatory pathways, emphasizing the need for complementary treatment approaches. Topical ivermectin cream (10 mg/g) and systemic, oral anti-inflammatory doxycycline (40 mg modified-release) are both approved for the treatment of papulopustular rosacea (PPR). Whether or not a combined therapeutic approach may be more beneficial than monotherapy for patients with PPR remains to be tested. Here, we summarize underlying inflammatory pathways implicated in rosacea and clarify the impact of these two agents on selective pathways during inflammation, due to specific characteristics of their individual mechanisms of action (MoA). Based on the complementary MoA of doxycycline modified-release and ivermectin, a scientific rationale for a combined therapy targeting inflammatory lesions in rosacea is given. We propose that topical ivermectin cream is a promising new candidate as first-line treatment to target the inflammatory lesions of rosacea, which can be used in combination with systemic doxycycline modified-release to provide an optimal treatment approach considering all inflammatory pathways involved in PPR. Funding Galderma.
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21
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Kim J, Ahn JW, Ha S, Kwon SH, Lee O, Oh C. Clinical assessment of rosacea severity: oriental score vs. quantitative assessment method with imaging and biomedical tools. Skin Res Technol 2016; 23:186-193. [PMID: 27514310 DOI: 10.1111/srt.12318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rosacea is a common chronic inflammatory disorder affecting facial skin. Currently, no accurate and objective method is available for assessing the severity of rosacea. Most studies use the National Rosacea Society Standard (NRSS) grading method, which lacks objectivity and yields varying results. METHODS Eighteen patients with rosacea were included. Clinical severity was assessed on the basis of the NRSS grade, Investigators' Global Assessment, Patients' Global Assessment, and Dermatology Quality of Life Index. A skin color analysis system was used to measure the facial area showing erythema, and biophysical parameters of facial skin (transepidermal water loss and skin surface hydration) were examined. To find statistical significant in classification severity of the rosacea, statistical analysis was performed with all parameters. RESULTS A significant correlation (P < 0.05) was found between the NRSS grade, facial area showing erythema, and biophysical parameters. The latter two factors differed significantly among patients with rosacea of different levels of severity (mild, moderate, severe; P < 0.05). CONCLUSION Color imaging systems can be useful and reliable for evaluating the severity of rosacea, in addition to biophysical parameter assessment. The combination of these two analytical methods enabled objective and quantitative evaluation of the severity of rosacea.
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Affiliation(s)
- J Kim
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea
| | - J W Ahn
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea
| | - S Ha
- Department of Nursing, School of Health, Chungbuk Health and Science University, Chungbuk, Korea
| | - S H Kwon
- Department of Dermatology, Korea University Medical School, Seoul, Korea
| | - O Lee
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Chungnam, Korea
| | - C Oh
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea.,Department of Dermatology, Korea University Medical School, Seoul, Korea
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22
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Histopathological Analysis of 226 Patients With Rosacea According to Rosacea Subtype and Severity. Am J Dermatopathol 2016; 38:347-52. [DOI: 10.1097/dad.0000000000000454] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shi VY, Leo M, Hassoun L, Chahal DS, Maibach HI, Sivamani RK. Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol 2015; 73:856-63. [DOI: 10.1016/j.jaad.2015.08.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 01/06/2023]
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Kwon OW, Venkatesan R, Do MH, Ji E, Cho DW, Lee KW, Kim SY. Dietary supplementation with a fermented barley and soybean mixture attenuates UVB-induced skin aging and dehydration in hairless mouse skin. Food Sci Biotechnol 2015. [DOI: 10.1007/s10068-015-0092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Abstract
Rosacea is a chronic relapsing inflammatory facial dermatosis. There are several known triggers but the pathogenesis remains unknown. Recent achievements in understanding this disease point to the importance of skin-environmental interactions. This includes physical and chemical factors, but also microbial factors. The impairment of the skin barrier function and the activation of the innate immune defences are major and connected pathways contributing to an ongoing inflammatory response in the affected skin. This becomes modulated by endogenous factors like neurovascular, drugs, and psychological factors. These factors offer new therapeutic targets for rosacea treatment. There is a broader range of anti-inflammatory compounds available with a favourable safety record. Only recently have persistent erythema and flushing been addressed by new drug formulations.
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