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Topical Versus Oral Metronidazole After Excisional Hemorrhoidectomy: A Double-Blind Randomized Controlled Trial. Dis Colon Rectum 2022; 65:1362-1372. [PMID: 34897211 DOI: 10.1097/dcr.0000000000002163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both topical and oral metronidazole have been shown to reduce pain after excisional hemorrhoidectomy. Although recent meta-analyses have demonstrated efficacy against placebo, there has been no comparison between the 2 routes. OBJECTIVE This study aims to investigate whether topical or oral metronidazole provides the most analgesic properties after excisional hemorrhoidectomy. DESIGN A prospective, double-blind, randomized controlled trial was performed. SETTING This trial was conducted at 2 hospitals in New Zealand between March 2019 and February 2020. PATIENTS Adults undergoing elective excisional hemorrhoidectomy for grade III/IV hemorrhoids were randomized. INTERVENTIONS Participants were randomized to receive either topical metronidazole ointment and an oral placebo versus oral metronidazole with a placebo ointment for 7 days. MAIN OUTCOME MEASURES The primary outcome was daily pain scores for 7 days, estimated using a generalized linear mixed model fitted with time and treatment arm and tested for interaction with time and treatment arm. Secondary outcomes included additional analgesia, return to normal activity, recovery scores, and adverse effects. RESULTS A total of 120 participants were included, with 60 in each group. A unimodal peak of pain was recorded with the maximum at days 3 and 4, but there was no significant difference in resting pain scores, with a mean difference at day 3 of 0.47 (-0.48, 1.42). There were no significant differences for secondary outcomes. Fourteen (11.7%) participants were readmitted, without significant difference between groups. Fifty-nine percent of participants preferred topical analgesic compared with 31% who preferred oral and 9.7% who had no preference. LIMITATIONS This was a pragmatic study in which we could not have stopped participants seeking other analgesics and with less than perfect complete compliance. CONCLUSION Postoperative oral and topical metronidazole provide similar analgesia after excisional hemorrhoidectomy. The route should depend on patient preference, with topical administration potentially benefiting from improved antimicrobial stewardship and having less effect on the gut microbiome. See Video Abstract at http:/links.lww.com/DCR/B853 .METRONIDAZOL TÓPICO VERSUS ORAL DESPUÉS DE UNA HEMORROIDECTOMÍA POR ESCISIÓN: UN ENSAYO CONTROLADO ALEATORIO DOBLE CIEGO. ANTECEDENTES Se ha demostrado que tanto el metronidazol tópico como el oral reducen el dolor después de una hemorroidectomía por escisión. Aunque los metaanálisis más recientes han demostrado eficacia frente al placebo, no ha habido comparación entre las dos vías. OBJETIVO Este estudio tiene como objetivo investigar si el metronidazol tópico u oral proporciona las propiedades más analgésicas después de una hemorroidectomía por escisión. DISEO Se realizó un ensayo prospectivo, controlado, aleatorio, a doble ciego. AJUSTE Este ensayo fue realizado en dos hospitales de Nueva Zelanda entre marzo de 2019 y febrero de 2020. PACIENTES Se asignaron al azar pacientes adultos sometidos a hemorroidectomía por escisión electiva por hemorroides de grado III / IV. INTERVENCIONES Los participantes fueron asignados al azar para recibir un ungüento de metronidazol tópico y un placebo oral versus metronidazol oral con un ungüento de placebo durante siete días. PRINCIPALES MEDIDAS DE RESULTADO El resultado primario fueron las puntuaciones diarias de dolor durante siete días, estimadas mediante un modelo lineal mixto generalizado ajustado tanto con el tiempo y el brazo de tratamiento y probado para la interacción con el tiempo y el brazo de tratamiento. Los resultados secundarios incluyen analgesia adicional, retorno a la actividad normal, puntuaciones de recuperación y efectos adversos. RESULTADOS Se incluyó un total de 120 participantes, 60 en cada grupo. Se registró un pico de dolor unimodal con el máximo en los días 3 y 4, pero no hubo diferencias significativas en las puntuaciones de dolor en reposo, con una diferencia media en el día 3 de 0,47 (-0,48, 1,42). No hubo diferencias significativas para los resultados secundarios. Catorce (11,7%) participantes fueron readmitidos, sin diferencias significativas entre los grupos. El cincuenta y nueve por ciento de los participantes prefirió el tópico, en comparación con el 31% por vía oral y el 9,7% sin preferencia. LIMITACIONES Este fue un estudio pragmático en el que no pudimos haber impedido que los participantes buscaran otros analgésicos, con un cumplimiento completo menos que perfecto. CONCLUSINES El metronidazol posoperatorio por vía oral o tópica proporciona una analgesia similar después de una hemorroidectomía por escisión. La vía debe depender de la preferencia del paciente, y la administración tópica se beneficia potencialmente por una mejor protección de los antimicrobianos y un menor efecto sobre el microbioma intestinal. Consulte Video Resumen en http://links.lww.com/DCR/B853 . (Traducción-Dr Osvaldo Gauto).
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Yang Y, Qu L, Mijakovic I, Wei Y. Advances in the human skin microbiota and its roles in cutaneous diseases. Microb Cell Fact 2022; 21:176. [PMID: 36038876 PMCID: PMC9422115 DOI: 10.1186/s12934-022-01901-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Skin is the largest organ in the human body, and the interplay between the environment factors and human skin leads to some skin diseases, such as acne, psoriasis, and atopic dermatitis. As the first line of human immune defense, skin plays significant roles in human health via preventing the invasion of pathogens that is heavily influenced by the skin microbiota. Despite being a challenging niche for microbes, human skin is colonized by diverse commensal microorganisms that shape the skin environment. The skin microbiota can affect human health, and its imbalance and dysbiosis contribute to the skin diseases. This review focuses on the advances in our understanding of skin microbiota and its interaction with human skin. Moreover, the potential roles of microbiota in skin health and diseases are described, and some key species are highlighted. The prevention, diagnosis and treatment strategies for microbe-related skin diseases, such as healthy diets, lifestyles, probiotics and prebiotics, are discussed. Strategies for modulation of skin microbiota using synthetic biology are discussed as an interesting venue for optimization of the skin-microbiota interactions. In summary, this review provides insights into human skin microbiota recovery, the interactions between human skin microbiota and diseases, and the strategies for engineering/rebuilding human skin microbiota.
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Affiliation(s)
- Yudie Yang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450051, China.,Laboratory of Synthetic Biology, Zhengzhou University, Zhengzhou, 450051, China
| | - Lingbo Qu
- Laboratory of Synthetic Biology, Zhengzhou University, Zhengzhou, 450051, China.,College of Chemistry, Zhengzhou University, Zhengzhou, China
| | - Ivan Mijakovic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden.,The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | - Yongjun Wei
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450051, China. .,Laboratory of Synthetic Biology, Zhengzhou University, Zhengzhou, 450051, China.
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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Elwan NM, Salah SM, Abdelsalam SF, Elfar NN. Role of ferritin in pathogenesis of rosacea and its value in efficacy of 595 nm pulsed dye laser in treatment of different variants of rosacea: a clinical and immunohistochemical study. J COSMET LASER THER 2020; 22:130-136. [PMID: 32441163 DOI: 10.1080/14764172.2020.1761549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Current rosacea treatment focused on symptom suppression to improve patient's quality of life, prevent progression, and sustain remission. The progress of laser therapy has brought about a paradigm shift in the world of treating erythema and telangiectasia. We appraised role of ferritin in pathogenesis of rosacea and consider its value in efficacy of 595 nm pulsed dye laser (PDL) in treatment of rosacea. MATERIALS/METHODS 20 patients had rosacea were treated with PDL; received 4 sessions, 4 weeks apart. They were assessed before and after treatment by rosacea grading scale and skin biopsies were taken to detect changes in ferritin expression before and after treatment. RESULTS Ferritin expression in lesional skin was positively expressed in all patients proportional to severity of rosacea that showed statistically significant reduction of ferritin expression after PDL. There was a statistically significant reduction in rosacea grading scale after PDL (p value = .005*); the highest efficacy was in phymatous then papulopustular and erythrotelangiectatic types. CONCLUSIONS The reduction of ferritin expression after PDL opens a new era for antioxidant agents to be added as a relevant approach for the therapy of rosacea via attenuation of oxidative stress.
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Affiliation(s)
- Nagwa Mohamed Elwan
- Dermatology and Venereology Department, Tanta University Faculty of Medicine , Tanta, Egypt
| | - Salwa Mohamed Salah
- Dermatology and Venereology Department, Tanta University Faculty of Medicine , Tanta, Egypt
| | - Shady F Abdelsalam
- Dermatology and Venereology Department, Tanta University Faculty of Medicine , Tanta, Egypt
| | - Nashwa Naeem Elfar
- Dermatology and Venereology Department, Tanta University Faculty of Medicine , Tanta, Egypt
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Juliandri J, Wang X, Liu Z, Zhang J, Xu Y, Yuan C. Global rosacea treatment guidelines and expert consensus points: The differences. J Cosmet Dermatol 2019; 18:960-965. [PMID: 30809947 DOI: 10.1111/jocd.12903] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Juliandri Juliandri
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Xiaoyan Wang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Zijing Liu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jiawen Zhang
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yang Xu
- Department of Dermatology; The First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Chao Yuan
- Department of Skin & Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
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Schaller M, Pietschke K. Successful therapy of ocular rosacea with topical ivermectin. Br J Dermatol 2018. [PMID: 29527668 DOI: 10.1111/bjd.16534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Schaller
- Department of Dermatology, Eberhard Karls University Tünalebingen, Tüebingen, Germany
| | - K Pietschke
- Department of Dermatology, Eberhard Karls University Tünalebingen, Tüebingen, Germany
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Kresken J, Kindl U, Wigger-Alberti W, Clanner-Engelshofen B, Reinholz M. Dermocosmetics for Use in Rosacea: Guideline of the Society for Dermopharmacy. Skin Pharmacol Physiol 2018; 31:147-154. [DOI: 10.1159/000486688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
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Gonser LI, Gonser CE, Schaller M. [Pathogenesis, clinical picture, and current therapy of rosacea]. DER HAUTARZT 2016; 67:69-82; quiz 83-4. [PMID: 26669873 DOI: 10.1007/s00105-015-3735-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rosacea is a common chronic inflammatory disease, especially in patients with fair skin and positive family history. Typical locations are forehead, nose, cheeks and chin; the periorbital region is usually not involved. Clinical features can be very heterogeneous. Besides different subtypes (erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea), which often overlap, various special forms of rosacea exist. Up to 60% of patients with cutaneous rosacea suffer from ocular rosacea. In Germany, brimonidine, metronidazol, azelaic acid, and ivermectin are approved for topical therapy of rosacea; for systemic therapy, doxycycline at a subantimicrobial dose (40 mg/day) is the only approved substance. In case of resistance to this therapy, contraindications or side effects, various alternative therapies are available, however off-label.
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Affiliation(s)
- L I Gonser
- Universitäts-Hautklinik Tübingen, 72076, Tübingen, Liebermeisterstraße 25, Deutschland
| | - C E Gonser
- BG Klinik Tübingen, Eberhard-Karls-Universität Tübingen, 72076, Tübingen, Schnarrenbergstraße 95, Deutschland
| | - M Schaller
- Universitäts-Hautklinik Tübingen, 72076, Tübingen, Liebermeisterstraße 25, Deutschland.
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Seo HM, Kim JI, Kim HS, Choi YJ, Kim WS. Prospective Comparison of Dual Wavelength Long-Pulsed 755-nm Alexandrite/1,064-nm Neodymium:Yttrium-Aluminum-Garnet Laser versus 585-nm Pulsed Dye Laser Treatment for Rosacea. Ann Dermatol 2016; 28:607-614. [PMID: 27746641 PMCID: PMC5064191 DOI: 10.5021/ad.2016.28.5.607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rosacea treatments including oral/topical medications and laser therapy are numerous but unsatisfactory. OBJECTIVE To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1,064-nm neodymium: yttrium-aluminum-garnet laser (LPAN) with that of 585-nm pulsed dye laser (PDL) for rosacea. METHODS This was a randomized, single-blinded, comparative study. Full face received four consecutive monthly treatments with LPAN or PDL, followed-up for 6 months after the last treatment. Erythema index was measured by spectrophotometer, and digital photographs were evaluated by consultant dermatologists for physician's global assessment. Subjective satisfaction surveys and adverse effects were recorded. RESULTS Forty-nine subjects with rosacea enrolled and 12 dropped out. There were no significant differences between LPAN and PDL in the mean reduction of the erythema index (p=0.812; 3.6% vs. 2.8%), improvement of physician's global assessment (p=1.000; 88.9% vs. 89.5%), and subject-rated treatment satisfaction (p=0.842; 77.8% vs. 84.2%). PDL showed more adverse effects including vesicles than LPAN (p=0.046; 26.3% vs. 0.0%). No other serious or permanent adverse events were observed in both treatments. CONCLUSION Both LPAN and PDL may be effective and safe treatments for rosacea.
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Affiliation(s)
- Hyun-Min Seo
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-In Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Saem Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jun Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Serk Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Taieb A, Passeron T, Ruzicka T, Berth-Jones J, Jacovella J, Huang M, Wertheimer A. Ivermectin cream improves health-related quality of life in patients with rosacea: data from a randomized trial. Br J Dermatol 2016; 175:1366-1368. [DOI: 10.1111/bjd.14665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Taieb
- Service de Dermatologie et Dermatologie Pédiatrique; Hôpital Saint-André; Bordeaux France
| | - T. Passeron
- Service de Dermatologie; Hôpital Archet 2; Nice France
| | - T. Ruzicka
- Department of Dermatology and Allergy; Ludwig-Maximilian Universität; Munich Germany
| | - J. Berth-Jones
- Department of Dermatology; University Hospital; Coventry U.K
| | | | - M.Y. Huang
- School of Pharmacy; Temple University; Philadelphia PA 19140 U.S.A
| | - A. Wertheimer
- School of Pharmacy; Temple University; Philadelphia PA 19140 U.S.A
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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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Abokwidir M, Feldman SR. Rosacea Management. Skin Appendage Disord 2016; 2:26-34. [PMID: 27843919 DOI: 10.1159/000446215] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. PURPOSE To review the different kinds of management for all subtypes. METHODS We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. RESULTS Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. CONCLUSION There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.
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Affiliation(s)
- Manal Abokwidir
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, N.C., USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, N.C., USA
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Del Rosso JAMESQ. Cutaneous rosacea: a thorough overview of pathogenesis, clinical presentations, and current recommendations on management. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-32-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The review summarizes and systemizes available international data on the pathogenesis, clinical manifestations and current recommendations for the management of rosacea patients.
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Del Rosso JAMESQ. Cutaneous rosacea: a thorough overview of pathogenesis, clinical presentations, and current recommendations on management. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-21-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Jewell JR, Myers SA. Topical Therapy Primer for Nondermatologists. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rosacea in Patients with Ulcerative Colitis and Crohn's Disease: A Population-based Case-control Study. Inflamm Bowel Dis 2016; 22:680-7. [PMID: 26717319 DOI: 10.1097/mib.0000000000000644] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cutaneous manifestations are common in patients with inflammatory bowel diseases (IBDs) (ulcerative colitis [UC] and Crohn's disease [CD]). Previous case reports described patients with IBD who developed rosacea. IBD and rosacea are inflammatory epithelial diseases, presumably associated with changes in the innate immune system. We explored the association between IBD and incident rosacea. METHODS We conducted a population-based matched (1:1) case-control analysis on the association between IBD and rosacea, stratified by IBD disease duration and severity. We used data from the UK-based Clinical Practice Research Datalink. Cases had an incident diagnosis of rosacea recorded between 1995 and 2013. RESULTS Among 80,957 rosacea cases and the same number of controls, a history of UC was associated with an increased risk of rosacea (odds ratio [OR] 1.65, 95% confidence interval [CI], 1.43-1.90), with the highest OR in those with short UC duration (OR 2.85, 95% confidence interval, 1.80-4.50 for patients with <2 years of disease history). A history of CD yielded an overall OR of 1.49 (95% CI, 1.25-1.77), which did not correlate with disease duration. Additional analyses on IBD disease severity yielded evidence for a higher risk of rosacea in those with higher UC and CD activity. CONCLUSIONS Our findings provide evidence that patients with IBD may be at increased risk of rosacea (higher in UC), particularly during phases of increased IBD-associated gastrointestinal tract inflammation.
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Bonsall A, Rajpara S. A review of the quality of life following pulsed dye laser treatment for erythemotelangiectatic rosacea. J COSMET LASER THER 2016; 18:86-90. [PMID: 26836241 DOI: 10.3109/14764172.2015.1063663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rosacea is a chronic condition, affecting up to 10% of the population. It has a negative impact on patients' quality of life (QOL), leading to loss of self-confidence, emotional distress and withdrawal from normal societal interactions. Erythemotelangiectatic (ET) rosacea is a frequent reason for consultation and difficult to treat, as vascular signs such as flushing, erythema and telangiectasia often persist despite medical therapy. Several studies have demonstrated objective improvements in vascular signs following pulsed dye laser (PDL) treatment, but very few have investigated improvement in QOL. We reviewed the current literature to find evidence for the effect of PDL on QOL in ET rosacea.
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Affiliation(s)
- Alexandra Bonsall
- a Department of Dermatology , Aberdeen Royal Infirmary , Aberdeen , UK
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Chovatiya RJ, Colegio OR. Demodicosis in Renal Transplant Recipients. Am J Transplant 2016; 16:712-6. [PMID: 26431451 DOI: 10.1111/ajt.13462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/15/2015] [Accepted: 07/19/2015] [Indexed: 01/25/2023]
Abstract
Solid organ transplant recipients have an increased incidence of skin infections resulting from immunosuppression. Common pathogens include herpes simplex virus, varicella zoster virus, Gram-positive bacteria and dermatophytes; however, the contribution of multicellular parasitic organisms to dermatologic disease in this population remains less studied. Demodex folliculorum and brevis are commensal mites that reside on human skin. Proliferation of Demodex mites, or demodicosis, is associated with rosacea and rosacea-like disorders, particularly in immunocompromised populations, although their ability to cause disease is still the subject of debate. We present a case series of four renal transplant recipients with the singular chief complaint of acne rosacea who we diagnosed with demodicosis. Although one of the four patients showed complete resolution following initial antiparasitic therapy, the other three required subsequent antibacterial treatment to fully resolve their lesions. We suggest that demodicosis may be more prevalent than once thought in solid organ transplant recipients and showed that Demodex-associated acne rosacea can be effectively treated in this population.
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Affiliation(s)
| | - O R Colegio
- Yale Transplant Dermatology Clinic, New Haven, CT
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Abstract
A representative assortment of topical therapies is discussed here with the goal of emphasizing the most commonly encountered diagnoses and treatments for nondermatologists. When using topical therapies, carefully consider the proper active ingredient, potency, vehicle, and quantity of medication. If topical therapy is ineffective, question whether the medication is being used properly, whether the diagnosis is correct, and whether the topical may be contributing to the problem. Examples of the topical contributing to the problem include tinea incognito exacerbated by topical steroid use and allergic contact dermatitis to topical steroid excipients. For some patients, even maximum topical therapy is insufficient and systemic treatment is required. At this point, consultation with a dermatologist may be helpful.
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Affiliation(s)
- Jolene R Jewell
- Department of Dermatology, Duke University Medical Center, DUMC 3852, Durham, NC 27710, USA
| | - Sarah A Myers
- Department of Dermatology, Duke University Medical Center, DUMC 3852, Durham, NC 27710, 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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Braithwaite I, Hunt A, Riley J, Fingleton J, Kocks J, Corin A, Helm C, Sheahan D, Tofield C, Montgomery B, Holliday M, Weatherall M, Beasley R. Randomised controlled trial of topical kanuka honey for the treatment of rosacea. BMJ Open 2015; 5:e007651. [PMID: 26109117 PMCID: PMC4480029 DOI: 10.1136/bmjopen-2015-007651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of topical 90% medical-grade kanuka honey and 10% glycerine (Honevo) as a treatment for rosacea. DESIGN Randomised controlled trial with blinded assessment of primary outcome variable. SETTING Outpatient primary healthcare population from 5 New Zealand sites. PARTICIPANTS 138 adults aged ≥ 16, with a diagnosis of rosacea, and a baseline blinded Investigator Global Assessment of Rosacea Severity Score (IGA-RSS) of ≥ 2. 69 participants were randomised to each treatment arm. 1 participant was excluded from the Honevo group, and 7 and 15 participants withdrew from the Honevo and control groups, respectively. INTERVENTIONS Participants were randomly allocated 1:1 to Honevo or control cream (Cetomacrogol), applied twice daily for 8 weeks. MAIN OUTCOME MEASURES The primary outcome measure was the proportion of participants who had a ≥ 2 improvement in the 7-point IGA-RSS at week 8 compared to baseline. Secondary outcomes included change in IGA-RSS and subject-rated visual analogue score of change in severity (VAS-CS) on a 100 mm scale (0 mm 'much worse', 100 mm 'much improved') at weeks 2 and 8. RESULTS 24/68 (34.3%) in the Honevo group and 12/69 (17.4%) in the control group had a ≥ 2 improvement in IGA-RSS at week 8 compared to baseline (relative risk 2.03; 95% CI 1.11 to 3.72, p=0.020). The change in IGA-RSS for Honevo compared to control at week 2 minus baseline was -1 (Hodges-Lehman estimate, 95% CI -1 to 0, p=0.03), and at week 8 minus baseline was -1 (Hodges-Lehman estimate, 95% CI -1 to 0, p=0.005). The VAS-CS at week 2 was 9.1 (95% CI 3.5 to 14.7), p=0.002, and at week 8 was 12.3 (95% CI 5.7 to 18.9)¸ p<0.001 for Honevo compared to control. CONCLUSIONS Honevo is an effective treatment for rosacea. TRIAL REGISTRATION NUMBER This trial was registered in the Australian and New Zealand Clinical Trials Registry ACTRN12614000004662.
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Affiliation(s)
| | - Anna Hunt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Judith Riley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Janwillem Kocks
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Colin Helm
- Clinical Horizons, Tauranga, New Zealand
| | | | | | | | - Mark Holliday
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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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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Select treatments for rosacea based on signs, symptoms and severity. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taieb A, Ortonne JP, Ruzicka T, Roszkiewicz J, Berth-Jones J, Peirone MH, Jacovella J. Superiority of ivermectin 1% cream over metronidazole 0·75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol 2015; 172:1103-10. [PMID: 25228137 DOI: 10.1111/bjd.13408] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few therapeutic alternatives currently exist in the treatment of papulopustular rosacea (PPR). OBJECTIVES To demonstrate superiority of once-daily ivermectin 1% cream (IVM 1%) once daily vs. twice-daily metronidazole (MTZ 0·75%) cream, regarding percentage reduction of inflammatory lesions in subjects with moderate to severe PPR. METHODS In this Phase 3, investigator-blinded, randomized, parallel-group study, subjects received IVM 1% once daily, or MTZ 0·75% twice daily over 16 weeks. Efficacy assessments were inflammatory lesion counts and Investigator's Global Assessment (IGA). Safety assessments included incidence of adverse events (AEs) and local tolerance parameters. Subjects evaluated their disease following a 5-grade scale and completed questionnaires. RESULTS A total of 962 subjects were randomized to receive IVM 1% (n = 478) or MTZ 0·75% (n = 484). At week 16, IVM 1% was significantly superior to MTZ 0·75% in terms of reduction from baseline in inflammatory lesions (83·0% vs. 73·7%; P < 0.001), observed as early as week 3 (Last Observation Carried Forward, LOCF). IGA results (subjects 'clear' or 'almost clear') also favoured IVM 1%: 84·9% vs. 75·4%, respectively (P < 0.001). Incidence of AEs was comparable between groups and local tolerability was better for IVM 1%. More subjects receiving IVM rated their global improvement as 'excellent' or 'good.' CONCLUSIONS Ivermectin 1% cream was significantly superior to MTZ 0·75% cream and achieved high patient satisfaction.
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Affiliation(s)
- A Taieb
- Service de Dermatologie et Dermatologie Pédiatrique, Hôpital Saint-André, 1 rue Jean Burguet, 33075, Bordeaux Cedex, France
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The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol 2014; 71:973-80. [DOI: 10.1016/j.jaad.2014.05.036] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
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Del Rosso JQ. Management of cutaneous rosacea: emphasis on new medical therapies. Expert Opin Pharmacother 2014; 15:2029-38. [DOI: 10.1517/14656566.2014.945423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.
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Abstract
Is it acne or is it not? When this question arises, we can presume that we have crossed the boundaries of "acneiform eruptions" of the face. Although acne may be considered a condition fairly easy to diagnose, it is not rare for the practicing dermatologist or the general physician to wonder when faced with an acneiform eruption before establishing a diagnosis. In this review, we address facial acneiform eruptions in children and in adults, including perioral dermatitis, granulomatous periorificial dermatitis, nevus comedonicus, acne cosmetica, rosacea, demodicosis, folliculitis, acneiform presentation of cutaneous lymphomas, and drug-induced [epidermal growth factor receptor (EGFR) inhibitors, steroids, etc.] acneiform eruptions, along with their diagnosis and therapeutic approaches. The major distinguishing factor in acneiform eruptions is that, in contrast to acne, there are no comedones (whiteheads or blackheads).
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Affiliation(s)
- Clio Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece.
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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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Salem SAM, Abdel Fattah NSA, Tantawy SMA, El-Badawy NMA, Abd El-Aziz YA. Neodymium-yttrium aluminum garnet laser versus pulsed dye laser in erythemato-telangiectatic rosacea: comparison of clinical efficacy and effect on cutaneous substance (P) expression. J Cosmet Dermatol 2014; 12:187-94. [PMID: 23992160 DOI: 10.1111/jocd.12048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Different laser systems are reported to be effective in treatment of telangiectasia and erythema, but comparative studies on 1064-nm neodymium-yttrium aluminum garnet (Nd-YAG) laser and pulsed dye laser (PDL) in treatment of erythemato-telangiectatic rosacea are lacking. Substance (P) is implicated in rosacea pathogenesis. OBJECTIVES To compare the effect of Nd-YAG laser and PDL on erythemato-telangiectatic rosacea, both clinically and immunohistochemically on cutaneous substance (P) expression. METHODS This split-face comparative study included 15 patients with erythemato-telangiectatic rosacea treated on the right side with Nd-YAG laser and on the left side with PDL: three sessions, 4 weeks apart. Evaluation of the patients was done using erythema and telangiectasia grading scores, patient's self-assessment, physicians' clinical assessment of the patient, and immunohistochemical assessment of substance (P). RESULTS One month after the three laser sessions, excellent response was achieved in 73.3% of patients after Nd-YAG and in 53.3% of patients after PDL with significantly lower substance (P) concentration after Nd-YAG laser than after PDL. Positive correlations were found between the decrease in erythema and telangiectasia grading scores and the decrease in substance (P) concentration. CONCLUSIONS The use of Nd-YAG laser and PDL appears to be safe and effective measures in treatment of erythemato-telangiectatic rosacea. Both types of laser decrease the concentration of substance (P) in the skin. This effect is more pronounced with Nd-YAG laser.
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Affiliation(s)
- Samar Abdallah M Salem
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Luger T, Peukert N, Rother M. A multicentre, randomized, placebo-controlled trial establishing the treatment effect of TDT 068, a topical formulation containing drug-free ultra-deformable phospholipid vesicles, on the primary features of erythematotelangiectatic rosacea. J Eur Acad Dermatol Venereol 2014; 29:283-290. [PMID: 24754379 DOI: 10.1111/jdv.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rosacea subtype 1 (erythematotelangiectatic) is an inflammatory skin disease with limited treatment options. TDT 068, a topical drug-free gel containing ultra-deformable Sequessome vesicles, is registered for use in inflammatory skin conditions, but has not been investigated in rosacea. OBJECTIVE This postmarketing study aimed to substantiate the effects of TDT 068 in rosacea subtype 1. METHODS Patients aged 18-85 scoring 6-15/30 for the primary and secondary features of the rosacea standard grading system (RSGS) were enrolled. Following stratification (four females/one male) patients were randomized (2:1) to receive TDT 068 or vehicle gel for 4 weeks. Efficacy was evaluated using the patient-rated rosacea-specific quality of life (R-QOL) instrument and investigator-rated RSGS. Adverse events (AEs) were monitored throughout. RESULTS Of the 61 randomized patients, 58 were eligible for the full analysis set per protocol. Baseline characteristics were balanced across the groups. R-QOL symptom construct scores improved slightly from baseline to Week 4 in both groups (-0.04 ± 0.51 TDT 068 vs. -0.22 ± 0.59 vehicle; P = 0.1990). Changes in R-QOL total, function and emotion construct scores at Week 4 were similar with TDT 068 and vehicle, but TDT 068 yielded numerically greater increases in total RSGS scores (-1.55 ± 1.83 vs. -0.75 ± 2.38 vehicle; P = 0.105). Non-transient erythema improved significantly with TDT 068 at Week 4 (-0.34 ± 0.63 vs. -0.05 ± 0.51 vehicle; P = 0.044), with ≥1 grade improvement in 35% of patients (vs. 15% vehicle; P = 0.039). Numerically greater improvements in transient erythema and telangiectasia were also seen with TDT 068. Three treatment-related AEs were reported but no serious AEs occurred. CONCLUSION These data, based on investigator assessment, provide evidence for the good tolerability of drug-free TDT 068 as well as modest improvements in the symptoms of erythematotelangiectatic rosacea.
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Affiliation(s)
- T Luger
- Department of Dermatology, University Clinics, Münster, Germany
| | - N Peukert
- Dermatology, Aestheso, Münster, Germany
| | - M Rother
- IMR Partner GmbH, Munich, Germany
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Vieira AC, Mannis MJ. Ocular rosacea: common and commonly missed. J Am Acad Dermatol 2014; 69:S36-41. [PMID: 24229635 DOI: 10.1016/j.jaad.2013.04.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/21/2013] [Indexed: 12/23/2022]
Abstract
Rosacea is a prevalent disorder that may be disfiguring and cause significant ocular morbidity, if not diagnosed and managed appropriately. Ocular rosacea, in particular, is often left undiagnosed as no specific test is available to confirm the diagnosis. Accurate diagnosis is further complicated because symptoms of ocular rosacea are not always specific to the disorder alone. Other ophthalmic disorders may present with similar findings. Further challenges exist because the severity of ocular symptoms is often not related to the severity of cutaneous findings in rosacea. Isolating a disease marker may facilitate earlier diagnosis and treatment, and could also contribute to better understanding of disease pathogenesis. The glycomics of tear fluid and saliva in patients with rosacea shows promise as an initial step in the search for a biomarker specific to the disease. We have previously found potentially important disease biomarkers in roseatic tear and saliva samples. Further investigation should prove important in the early stages of developing a set of markers for accurate disease identification.
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Abstract
Rosacea is a common skin disorder with multiple symptoms. The emergence of research that furthers understanding of pathophysiological mechanisms has created new targets for disease treatment. Specifically, there is a need for new treatments that address the various erythematic symptoms associated with rosacea. Systemic and topical therapies have both yielded positive results in treating rosacea with various medications. Subantimicrobial-dose doxycycline is one such promising treatment. Development of novel products in the near future should help achieve more satisfactory outcomes for patients.
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Mantelli F, Di Zazzo A, Sacchetti M, Dianzani C, Lambiase A, Bonini S. Topical azithromycin as a novel treatment for ocular rosacea. Ocul Immunol Inflamm 2013; 21:371-7. [PMID: 23875944 DOI: 10.3109/09273948.2013.801991] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Acne rosacea is a common dermatological conditions associated with blepharitis. Current treatments include artificial tears, lid hygiene, and systemic doxycycline. In this study the authors evaluate the effectiveness of topical azithromycin in ocular rosacea. METHODS The authors enrolled 37 ocular rosacea patients: 12 were treated with systemic doxycycline, 16 with azithromycin eyedrops, and 9 did not receive medical treatments. Ocular signs and symptoms and side effects were evaluated at baseline and at 1-month follow-up. RESULTS A significant improvement in TF-BUT, meibomian gland plugging, and Oxford score associated with symptom reduction was reported by all patients after 1 month. All treatments were well tolerated, with mild gastro-intestinal symptoms in 33% of the doxycycline group and mild burning after instillation in the azithromycin group. CONCLUSIONS Topical azithromycin may represent an additional treatment for ocular rosacea, with a shorter duration of treatment and absence of gastrointestinal side effects as compared to systemic doxycycline.
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Coda AB, Hata T, Miller J, Audish D, Kotol P, Two A, Shafiq F, Yamasaki K, Harper JC, Del Rosso JQ, Gallo RL. Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. J Am Acad Dermatol 2013; 69:570-7. [PMID: 23871720 DOI: 10.1016/j.jaad.2013.05.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/13/2013] [Accepted: 05/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Excess cathelicidin and kallikrein 5 (KLK5) have been hypothesized to play a role in the pathophysiology of rosacea. OBJECTIVE We sought to evaluate the effects of azelaic acid (AzA) on these elements of the innate immune system. METHODS Gene expression and protease activity were measured in laboratory models and patients with rosacea during a 16-week multicenter, prospective, open-label study of 15% AzA gel. RESULTS AzA directly inhibited KLK5 in cultured keratinocytes and gene expression of KLK5, Toll-like receptor-2, and cathelicidin in mouse skin. Patients with rosacea showed reduction in cathelicidin and KLK5 messenger RNA after treatment with AzA gel. Subjects without rosacea had lower serine protease activity (SPA) than patients with rosacea. Distinct subsets of patients with rosacea who had high and low baseline SPA were identified, and patients with high baseline exhibited a statistically significant reduction of SPA with 15% AzA gel treatment. LIMITATIONS Study size was insufficient to predict clinical efficacy based on the innate immune response to AzA. CONCLUSIONS These results show that cathelicidin and KLK5 decrease in association with AZA exposure. Our observations suggest a new mechanism of action for AzA and that SPA may be a useful biomarker for disease activity.
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Affiliation(s)
- Alvin B Coda
- Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego, California
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Murillo N, Raoult D. Skin microbiota: overview and role in the skin diseases acne vulgaris and rosacea. Future Microbiol 2013; 8:209-22. [PMID: 23374126 DOI: 10.2217/fmb.12.141] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
As the first barrier to environmental exposures, human skin has developed an integrated immune system to protect the inner body from chemical, physical or microbial insults. Microorganisms inhabiting superficial skin layers are known as skin microbiota and include bacteria, viruses, archaea and fungi. The microbiota composition is crucial in the instruction and support of the skin's immune system. Changes in microbiota can be due to individual, environmental or behavioral factors, such as age, climate, hygiene or antibiotic consumption, which can cause dysbiosis. The contribution of skin microbiota to disease development is known in atopic dermatitis, where there is an increase in Staphylococcus aureus. Culture-independent studies have enabled more accurate descriptions of this complex interplay. Microbial imbalance is associated with the development of various diseases. This review focuses on microbial imbalances in acne vulgaris and rosacea.
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Affiliation(s)
- Nathalia Murillo
- Université Aix Marseille, URMITE, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
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Reinholz M, Tietze JK, Kilian K, Schaller M, Schöfer H, Lehmann P, Zierhut M, Klövekorn W, Ruzicka T, Schauber J. Rosacea - S1 Guideline. J Dtsch Dermatol Ges 2013; 11:768-80; 768-79. [DOI: 10.1111/ddg.12101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Markus Reinholz
- Clinic and Polyclinic for Dermatology and Allergology; University of Munich; Germany
| | - Julia K. Tietze
- Clinic and Polyclinic for Dermatology and Allergology; University of Munich; Germany
| | - Katharina Kilian
- Clinic and Polyclinic for Dermatology and Allergology; University of Munich; Germany
| | | | - Helmut Schöfer
- Department of Dermatology; Venereology, and Allergology; University of Frankfurt/Main; Germany
| | - Percy Lehmann
- Center for Dermatology; Allergology, and Surgical Dermatology; Helios Clinic Wuppertal; Germany
| | | | | | - Thomas Ruzicka
- Clinic and Polyclinic for Dermatology and Allergology; University of Munich; Germany
| | - Jürgen Schauber
- Clinic and Polyclinic for Dermatology and Allergology; University of Munich; Germany
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Rashid MU, Panagiotidis G, Bäckström T, Weintraub A, Nord CE. Ecological impact of doxycycline at low dose on normal oropharyngeal and intestinal microflora. Int J Antimicrob Agents 2013; 41:352-7. [PMID: 23332619 DOI: 10.1016/j.ijantimicag.2012.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022]
Abstract
This study included 34 healthy volunteers (16 male and 18 female) aged 19-37 years, of whom 17 received doxycycline 40 mg capsules orally once daily (o.d.) and 17 received placebo 40 mg capsules orally o.d. for 16 weeks. Plasma, saliva and faecal samples were collected before drug administration and at 4, 8, 16 and 20 weeks. Plasma samples were assayed for doxycycline concentrations, and saliva and faecal samples were investigated for doxycycline concentrations and microbiological analyses. Plasma concentrations of doxycycline in the doxycycline group were as follows: baseline visit (2 h), 0.20-0.61 mg/L; 4-week visit, 0.30-1.04 mg/L; 8-week visit, 0.43-1.49 mg/L; 16-week visit, 0.32-1.12 mg/L; and 20-week visit 0 mg/L. No doxycycline was detected in plasma in the placebo group. No doxycycline concentrations in the saliva samples were found in the doxycycline or placebo groups at the five visits. Faecal concentrations of doxycycline in the doxycycline group were as follows: baseline visit, 0 mg/kg; 4-week visit, 0-3.71 mg/kg; 8-week visit, 0-1.85 mg/kg; 16-week visit, 0-4.10 mg/kg; and 20-week visit, 0 mg/kg. No doxycycline faecal concentrations were detected in the placebo group. Minor effects on the aerobic and anaerobic oropharyngeal microflora were observed both in the doxycycline and placebo groups. There were minor changes in the number of enterococci and Escherichia coli in the doxycycline and placebo groups. The anaerobic intestinal microflora in the doxycycline and placebo groups was not changed, and no Clostridium difficile strains were isolated.
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Affiliation(s)
- Mamun-Ur Rashid
- Department of Laboratory Medicine, Karolinska University Hospital, Karolinska Institutet, SE-141 86 Stockholm, Sweden
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Affiliation(s)
- F C Powell
- University College Dublin, Bellfield, Dublin, Ireland Mater Misericordiae University Hospital, Dublin, Ireland.
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