1
|
Avraham S, Khaslavsky S, Kashetsky N, Starkey SY, Zaslavsky K, Lam JM, Mukovozov I. Treatment of ocular rosacea: a systematic review. J Dtsch Dermatol Ges 2024; 22:167-174. [PMID: 38243868 DOI: 10.1111/ddg.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/28/2023] [Indexed: 01/22/2024]
Abstract
Rosacea is a common chronic skin disease distributed primarily around the central face. Ocular manifestations of rosacea are poorly studied, and estimates of prevalence vary widely, ranging from 6% to 72% in the rosacea population. Treatment options for ocular rosacea include lid hygiene, topical and oral antibiotics, cyclosporine ophthalmic emulsion, oral vitamin A derivatives, and intense pulsed light; however, a direct comparison of treatment methods for ocular rosacea is lacking. This review aims to compare treatment efficacy and adverse events for different treatment modalities in ocular rosacea. We performed a systematic review by searching Cochrane, MEDLINE and Embase. Title, abstract, full text screening, and data extraction were done in duplicate. Sixty-six articles met the inclusion criteria, representing a total of 1,275 patients. The most effective treatment modalities were topical antimicrobials and oral antibiotics, which achieved complete or partial response in 91% (n = 82/90) and 89% (n = 525/580) of patients respectively, followed by intense pulsed light (89%, n = 97/109 partial response), cyclosporine ophthalmic emulsion (87% n = 40/46), and lid hygiene (65%, n = 67/105). Combination treatments achieved a complete or partial response in 90% (n = 69/77). Results suggest that topical antimicrobials, oral antibiotics, intense pulsed light. and cyclosporine were the most efficacious single modality treatments.
Collapse
Affiliation(s)
| | | | - Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Samantha Y Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kirill Zaslavsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Avraham S, Khaslavsky S, Kashetsky N, Starkey SY, Zaslavsky K, Lam JM, Mukovozov I. Therapie der okulären Rosazea: Eine systematische Literatur-Übersicht: Treatment of ocular rosacea: a systematic review. J Dtsch Dermatol Ges 2024; 22:167-176. [PMID: 38361192 DOI: 10.1111/ddg.15290_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/28/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungDie Rosazea ist eine häufige chronische Hauterkrankung, die sich hauptsächlich im mittleren Bereich des Gesichtes manifestiert. Die okulären Manifestationen der Rosazea wurden bisher nur unzureichend untersucht und bereits die Schätzungen der Prävalenz schwanken erheblich zwischen 6% und 72% der Gesamtpopulation aller Rosazea‐Patienten. Zu den Behandlungsmöglichkeiten der okuläre Rosazea gehören die Lidhygiene, topisch anwendbare antimikrobielle Substanzen, topisch oder oral verabreichte Antibiotika und Vitamin‐A‐Derivate, Cisclosporin‐haltige Emulsionen speziell für das Auge und IPL‐Behandlungen (intense pulsed light). Direkte Vergleiche zwischen den verschiedenen Therapieoptionen fehlen jedoch. Ziel dieser Literatur‐Übersicht ist es, die Wirksamkeit und Nebenwirkungen der verschiedenen Behandlungsmöglichkeiten der okulären Rosazea zu vergleichen. Dazu wurden systematische Datenbankrecherchen in Cochrane, MEDLINE und Embase durchgeführt. Titel, Abstrakt, Volltext und Daten wurden jeweils doppelt durchgesehen. Insgesamt erfüllten 66 Artikel mit einer kumulierten Patientenzahl von 1275 Patienten die Einschlusskriterien. Zu den wirksamsten Behandlungsoptionen zählten topisch anwendbare antimikrobielle Substanzen und die orale Gabe von Antibiotika. Damit konnte bei 91% (n = 82/90) bzw. 89% (n = 525/580) der Patienten ein vollständiges oder partielles Ansprechen erzielt werden. Es folgten die IPL‐Behandlung (89%, n = 97/109 partielles Ansprechen), die Ciclosporin‐Augen‐Emulsion (87% n = 40/46) und die Lidhygiene (65%, n = 67/105). Kombinationsbehandlungen führten in 90% der Fälle (n = 69/77) zu einem vollständigen bzw. partiellen Ansprechen. Diese Ergebnisse deuten darauf hin, dass eine topische Therapie mit antimikrobiellen Substanzen, Antibiotika per os, IPL und Ciclosporin‐haltige Emulsionen die effektivsten Einzelmaßnahmen zur Behandlung der okulären Rosazea darstellen.
Collapse
Affiliation(s)
| | | | - Nadia Kashetsky
- Medizinische Fakultät, Memorial University of Newfoundland, St. John's, NL, Kanada
| | - Samantha Y Starkey
- Medizinische Fakultät, Universität British Columbia, Vancouver, BC, Kanada
| | - Kirill Zaslavsky
- Abteilung Ophthalmologie und Wissenschaft des Sehens, Universität Toronto, Toronto, ON, Kanada
| | - Joseph M Lam
- Abteilung Dermatologie und Wissenschaft der Haut, Universität British Columbia, Vancouver, BC, Kanada
- Kinderkrankenhaus British Columbia, Vancouver, BC, Kanada
| | - Ilya Mukovozov
- Abteilung Dermatologie und Wissenschaft der Haut, Universität British Columbia, Vancouver, BC, Kanada
| |
Collapse
|
3
|
Kılıççıoğlu A, Oncel D, Celebi ARC. Autoimmune Disease-Related Dry Eye Diseases and Their Placement Under the Revised Classification Systems: An Update. Cureus 2023; 15:e50276. [PMID: 38196419 PMCID: PMC10775916 DOI: 10.7759/cureus.50276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
Dry eye disease (DED) is a chronic and progressive disorder involving the ocular surface, characterized by disturbances in tear film composition, instability of the tear film, and inflammation of the ocular surface. There are two forms of DED: aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE). Autoimmune diseases are systemic disorders involving multiple organs, including the eyes, and have a significant impact on DED. There have been multiple studies demonstrating the relation between autoimmune diseases and DED. This article reviews the current knowledge regarding the epidemiological characteristics, pathogenesis, and treatments of autoimmune disease-related DED.
Collapse
Affiliation(s)
- Alara Kılıççıoğlu
- Neurology, Szeged University, Szeged, HUN
- Ophthalmology, Acibadem University, Istanbul, TUR
| | - Deniz Oncel
- Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Chicago, USA
| | | |
Collapse
|
4
|
Zhang Y, Zhou Y, Humbert P, Yuan D, Yuan C. Effect on the Skin Microbiota of Oral Minocycline for Rosacea. Acta Derm Venereol 2023; 103:adv10331. [PMID: 37787419 PMCID: PMC10561103 DOI: 10.2340/actadv.v103.10331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 10/04/2023] Open
Abstract
In the rosacea an unstable skin microbiota is significant for disease progression. However, data on the influence on the skin microbiota of treatment with systemic antibiotics are limited. This single-arm trial recruited patients with rosacea. Oral minocycline 50 mg was administered twice daily for 6 weeks. The lesions on the cheek and nose were sampled for 16S rRNA amplicon sequencing and metagenomic sequencing at baseline, 3 weeks and 6 weeks of treatment. Physiological parameters were detected using non-invasive instruments. After treatment, distribution of the Investigator Global Assessment scores changed significantly. For the skin microbiota, a notable increase in α-diversity and a shift of structure were observed after treatment. Treatment was accompanied by a reduction in the relative abundance of Cutibacterium and Staphylococcus, indicating negative correlations with increased bacterial metabolic pathways, such as butyrate synthesis and L-tryptophan degradation. The increased butyrate and tryptophan metabolites would be conducive to inhibiting skin inflammation and promoting skin barrier repair. In addition, the abundance of skin bacterial genes related to tetracycline resistance and multidrug resistance increased notably after antibiotic treatment.
Collapse
Affiliation(s)
- Yiyi Zhang
- Department of Skin & Cosmetic Research, The Shanghai Skin Disease Hospital of Tongji Medical University, Shanghai 200433, People's Republic of China
| | - Ying Zhou
- R&D Center, Shanghai Jahwa United Co., Ltd., Shanghai 200080, People's Republic of China
| | | | - Dengfeng Yuan
- R&D Center, Shanghai Jahwa United Co., Ltd., Shanghai 200080, People's Republic of China.
| | - Chao Yuan
- Department of Skin & Cosmetic Research, The Shanghai Skin Disease Hospital of Tongji Medical University, Shanghai 200433, People's Republic of China.
| |
Collapse
|
5
|
Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
| | | |
Collapse
|
6
|
Clanner-Engelshofen BM, Bernhard D, Dargatz S, Flaig MJ, Gieler U, Kinberger M, Klövekorn W, Kuna AC, Läuchli S, Lehmann P, Nast A, Pleyer U, Schaller M, Schöfer H, Steinhoff M, Schwennesen T, Werner RN, Zierhut M, Reinholz M. S2k guideline: Rosacea. J Dtsch Dermatol Ges 2022; 20:1147-1165. [PMID: 35929658 DOI: 10.1111/ddg.14849] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022]
Abstract
This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e. V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy-resistant and severe forms of rosacea papulopustulosa. The drug of choice is low-dose doxycycline. Alternatively, low-dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.
Collapse
Affiliation(s)
| | - Dominik Bernhard
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Sonja Dargatz
- Deutsche Rosazea Hilfe e.V. (German Rosacea Aid), Hamburg, Germany
| | - Michael J Flaig
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Uwe Gieler
- Vitos Hospital for Psychosomatic Medicine, University Hospital Gießen - Dermatology, UKGM Gießen, Gießen, Germany
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Anne-Charlotte Kuna
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| | - Severin Läuchli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Percy Lehmann
- Center for Dermatology, Allergology and Dermatosurgery, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Schaller
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Helmut Schöfer
- German Clinic for Diagnostics (DKD, Deutsche Klinik für Diagnostik) Dermatology, Helios Kliniken Wiesbaden, Wiesbaden, Germany
| | - Martin Steinhoff
- Weill Cornell Medicine-Qatar, Cornell University, Ar-Rayyan, Qatar
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence- Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manfred Zierhut
- Department of Ophthalmology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Markus Reinholz
- Department and Clinic for Dermatology and Allergology, University Hospital Munich, LMU Munich, Germany
| |
Collapse
|
7
|
Clanner-Engelshofen BM, Bernhard D, Dargatz S, Flaig MJ, Gieler U, Kinberger M, Klövekorn W, Kuna AC, Läuchli S, Lehmann P, Nast A, Pleyer U, Schaller M, Schöfer H, Steinhoff M, Schwennesen T, Werner RN, Zierhut M, Reinholz M. S2k-Leitlinie: Rosazea. J Dtsch Dermatol Ges 2022; 20:1147-1167. [PMID: 35971589 DOI: 10.1111/ddg.14849_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin M Clanner-Engelshofen
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Dominik Bernhard
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | | | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Uwe Gieler
- Vitos-Klinik für Psychosomatik, Gießen - Universitäts-Hautklinik, UKGM Gießen, Gießen, Deutschland
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | | | - Anne-Charlotte Kuna
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Severin Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Zürich, Schweiz
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Helmut Schöfer
- Deutsche Klinik für Diagnostik (DKD) Dermatologie, Helios Kliniken Wiesbaden, Wiesbaden, Deutschland
| | - Martin Steinhoff
- Weill Cornell Medicine-Qatar, Cornell University, Ar-Rayyan, Qatar
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Manfred Zierhut
- Universitäts-Augenklinik, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Markus Reinholz
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, München, Deutschland
| |
Collapse
|
8
|
Damor VM, Gosai AJ, Ipli SG. The Prevalence of Ocular Manifestations in the Various Types of Common Skin Disorders at Tertiary Hospital in Ahmedabad, India. Cureus 2022; 14:e25881. [PMID: 35844330 PMCID: PMC9276872 DOI: 10.7759/cureus.25881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/08/2022] Open
Abstract
Aim The article aims to study the prevalence and ocular manifestations of the various types of common skin disorders at a tertiary hospital in Ahmedabad, India. Materials and methods Five hundred patients were studied in the ophthalmology department from September 2017 to September 2019. Results Out of the 500 patients that were included in our study, 312 were males, and 188 were females. In our study, lid involvement was seen most commonly in patients with herpes zoster ophthalmicus (HZO). Plexiform neurofibroma was seen in eight (14.5%) patients with neurofibromatosis (NF). Cicatricial ectropion was found in half of the patients with ichthyosis. Lagophthalmos was present in 10 (20.4%) patients with leprosy. Conjunctivitis was seen commonly in HZO patients. Papillary conjunctivitis was seen in half of the atopic dermatitis cases. Steven Johnson's syndrome (SJS) was associated with pseudomembranous conjunctivitis. Conjunctival xerosis was seen only in patients with Sjogren's syndrome. The cornea was most commonly involved in patients of HZO. Decreased corneal sensation was seen in leprosy and HZO. Lisch nodules were seen in NF cases. Anterior uveitis was found in seven (6.3%) patients with HZO. Glaucoma was seen most commonly in patients with Sturge Weber syndrome (SWS), followed by leprosy. Facial nerve palsy was seen in patients with leprosy. Episcleritis was seen in patients with leprosy and SWS. Conclusion We conclude that ocular involvement in skin disease is a common feature and could be a major component of the development of various systemic skin disorders.
Collapse
|
9
|
Abstract
Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea.
Collapse
Affiliation(s)
- Bianka Sobolewska
- Centre for Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Martin Schaller
- Department of Dermatology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Manfred Zierhut
- Centre for Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| |
Collapse
|
10
|
Wladis EJ, Adam AP. Immune signaling in rosacea. Ocul Surf 2021; 22:224-229. [PMID: 34481075 DOI: 10.1016/j.jtos.2021.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Rosacea is a common chronic skin disease affecting mostly people aged 40 and above, with currently no cure. When it affects the eyelids and periocular skin, it leads to dry eye and potentially corneal damage. Research performed over the last decade shed light into the potential mechanisms leading to skin hypersensitivity and provided promising avenues for development of novel, rational therapeutics aimed at reducing the skin inflammatory state. In this review, we discuss the current knowledge on the mechanisms of rosacea in general and of periocular skin-affecting disease in particular, identify key questions that remain to be answered in future research, and offer a disease model that can explain the key characteristics of this disease, with particular emphasis on a potential positive feedback loop that could explain both the acute and chronic features of rosacea.
Collapse
Affiliation(s)
- Edward J Wladis
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, 1220 New Scotland Rd, Suite 302, Slingerlands, NY, 12159, United States.
| | - Alejandro P Adam
- Department of Molecular and Cellular Physiology and Department of Ophthalmology, Albany Medical College, United States
| |
Collapse
|
11
|
Abstract
BACKGROUND Posterior blepharitis is common and causes ocular surface and lid damage as well as discomfort. It affects 37% to 47% of all ophthalmology patients; its incidence increasing with age. It is a multifactorial disease associated with multiple other pathologies, such as rosacea, meibomianitis, and infections. Treatment usually focuses on reliefing the symptoms by using artificial tears, lid scrubs, and warm compresses. The condition may be notoriously difficult to manage adequately once it becomes chronic. One such management approach for chronic blepharitis is the use of oral antibiotics for both their antibacterial as well as anti-inflammatory properties. There are currently no guidelines regarding the use of oral antibiotics, including antibiotic type, dosage, and treatment duration, for the treatment of chronic blepharitis. OBJECTIVES To assess the benefits and harms of oral antibiotic use for people with chronic blepharitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2020, Issue 8); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 29 August 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing oral antibiotics with placebo in adult participants with chronic blepharitis (including staphylococcal, seborrhoeic, or Meibomian Gland Dysfunction (MGD)). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and graded the certainty of the body of evidence for six outcomes using the GRADE classification. MAIN RESULTS We included two studies with 220 participants (numbers of eyes unclear). One parallel-group RCT comparing oral doxycycline (40 mg once a day) with placebo enrolled 70 participants with blepharitis and facial rosacea in the USA. Follow-up duration was three months. One three-arm RCT conducted in South Korea investigated the effect of high-dose (200 mg twice a day) and low-dose (20 mg twice a day) doxycycline versus placebo after one month of study medication. It enrolled 50 participants with chronic MGD in each study arm (i.e. 150 participants enrolled in total). The two studies did not evaluate the same outcome measurements, which precluded any meta-analysis. The evidence for the effect of oral antibiotics on subjective improvement in symptoms was very uncertain. One study suggested that there was little to no effect of oral doxycycline on subjective symptoms based on the Ocular Surface Disease Index (OSDI) scores ranging from 0 to 100 (higher score indicates worse condition) (mean difference (MD) 3.55, 95% confidence interval (CI) -4.61 to 11.71; n = 70) and bulbar conjunctival hyperemia ranging from 0 (clear) to 4 (severe) (MD -0.01, 95% CI -0.38 to 0.36; n = 70) at 12 weeks. The three-arm RCT showed that oral doxycycline may slightly improve number of symptoms (MD -0.56, 95% CI -0.95 to -0.17; n = 93 (high-dose doxycycline versus placebo); MD -0.48, 95% CI -0.86 to -0.10; n = 93 (low-dose doxycycline versus placebo)) and proportion of participants with symptom improvement (risk ratio (RR) 6.13, 95% CI 2.61 to 14.42; n = 93 (high-dose doxycycline versus placebo); RR 6.54, 95% CI 2.79 to 15.30; n = 93 (low-dose doxycycline versus placebo)) at one month, but the evidence is very uncertain. We judged the certainty of evidence for subjective symptoms as very low. One study evaluated aqueous tear production by Schirmer's test (mm/5 min) (higher score indicates better condition) and tear film stability by measuring tear film break-up time (TBUT) in seconds (higher score indicates better condition) at one month. We found very low certainty evidence that oral doxycycline may improve these clinical signs. The estimated MD in Schirmer's test score after one month of treatment was 4.09 mm (95% CI 2.38 to 5.80; n = 93) in the high-dose doxycycline group versus the placebo group and 3.76 mm (95% CI 1.85 to 5.67; n = 93) in the low-dose doxycycline group versus the placebo group. The estimated MD in TBUT after one month was 1.58 seconds (95% CI 0.57 to 2.59; n = 93) when comparing the high-dose doxycycline group with the placebo group, and 1.70 seconds (95% CI 0.96 to 2.44; n = 93) when comparing the low-dose doxycycline group with the placebo group. Although there was a noted improvement in these scores, their clinical importance remains uncertain. One study suggested that oral doxycycline may increase the incidence of serious side effects: 18 (39%) participants in the high-dose doxycycline group, 8 (17%) in the low-dose doxycycline group, and 3 (6%) out of 47 participants in the placebo group experienced serious side effects (RR 6.13, 95% CI 1.94 to 19.41; n = 93 (high-dose doxycycline versus placebo); RR 2.72, 95% CI 0.77 to 9.64; n = 93 (low-dose doxycycline versus placebo)). Additionally, one study reported that one case of migraine headache and five cases of headache were observed in the oral doxycycline group, and one case of non-Hodgkin's lymphoma was observed in the placebo group. We judged the certainty of evidence for adverse events as very low. AUTHORS' CONCLUSIONS There was insufficient evidence to draw any meaningful conclusions on the use of oral antibiotics for chronic blepharitis. Very low certainty evidence suggests that oral antibiotics may improve clinical signs, but may cause more adverse events. The evidence for the effect of oral antibiotics on subjective symptoms is very uncertain. Further trials are needed to provide high quality evidence on the use of oral antibiotics in the treatment of chronic blepharitis.
Collapse
Affiliation(s)
- Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Sueko M Ng
- Department of Ophthalmology, School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| |
Collapse
|
12
|
Alemu BM, Worku T. Efficacy of azithromycin 1% and 1.5% ophthalmic solutions compared to tobramycin 0.3% eye drops: A systematic review and meta-analysis. SAGE Open Med 2020; 8:2050312120958846. [PMID: 32995001 PMCID: PMC7502802 DOI: 10.1177/2050312120958846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Azithromycin 1% and 1.5% ophthalmic preparations are used widely in clinical practice for the treatment of signs and symptoms of eye diseases. The aim of this study was to render conclusive evidence by comparing the efficacy of azithromycin 1% and 1.5% over tobramycin 0.3% ophthalmic solutions for the treatment of eye diseases in a short duration in terms of bacterial resolution, the cure rate, and resolving clinical sign and symptoms. Methods: Systematic searches were performed in the electronic database (MEDLINE, Embase, Emcare, CINAHL, Scopus, PubMed, ProQuest, and Web of Science) and other sources. Multicenter randomized controlled trial studies conducted in English were identified and screened. Analysis of individual studies was conducted using the OpenMeta-analyst and Review Manager Version 5.3 software. Results: Eleven studies were included in the systematic review and meta-analysis. In clinical cure rate, azithromycin 1% and 1.5% eye drops were more effective than tobramycin 0.3% eye drops in short duration dosing (⩽5 days) with a twice-a-day regimen (relative risk = 1.13; 95% confidence interval: 1.008, 1.28), whereas on increased duration (>5 days), azithromycin is almost similarly as effective as tobramycin (relative risk = 1.007; 95% confidence interval: 0.96, 1.05). There was no significant difference in efficacy of bacterial resolution of azithromycin (1%, 1.5%) eye drops compared to tobramycin (0.3%) eye drops (relative risk = 0.99; 95% confidence interval: 0.96, 1.018). Azithromycin eye drops are effective in improving the signs and symptoms of eye disease. Conclusion: Azithromycin 1% or 1.5% is more effective in the clinical cure rate of eye disease than tobramycin 0.3% eye drops in ⩽5 days of treatment. It is also the best choice of treatment for improving the signs and symptoms of eye disease. So that we recommend clinicians to use azithromycin 1% or 1.5% eye drops. Systematic Review Registration: PROSPERO 2019 CRD42019139911
Collapse
Affiliation(s)
- Birhanu Motbaynor Alemu
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
13
|
Tao T, Tao L. Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin. Eye (Lond) 2020; 34:1797-1808. [PMID: 32346111 PMCID: PMC7608442 DOI: 10.1038/s41433-020-0876-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
To systematically review studies of managing meibomian gland dysfunction (MGD) with azithromycin and pool clinical outcomes to show its effectiveness. Eligible studies were retrieved from five main electronic databases. Symptom score was the primary outcome, while clinical signs and objective measurements were secondary outcomes. Pooled rates for adverse events were also calculated. Improvements in each outcome after administering either oral azithromycin (OA) or topical azithromycin (TA) were pooled and measured by standard mean difference (SMD) to show the overall effectiveness. Then the effectiveness was sub-grouped by TA and OA. In addition, pooled outcomes after administering TA and oral doxycycline (OD) were compared with assess their effectiveness. Finally, 18 eligible studies were included. The overall pooled symptom scores were significantly reduced after administering both TA and OA [P < 0.0001; SMD = 1.54 (95% CI: 1.15–1.92)]. Similarly, the overall combined eyelid signs, plugging of the meibomian gland, meibum quality, and tear secretion were also distinctly improved. However, significant improvements for tear break-up time (TBUT) and corneal staining (CS) were achieved by TA (TBUT: P = 0.02; CS: P = 0.02) but not by OA (TBUT: P = 0.08; CS: P = 0.14). The pooled adverse event rates for TA and OA were 25% and 7%, respectively. Moreover, TA was comparable to OD to treat MGD regarding symptom score, TBUT and tear secretion. This study showed that MGD could be treated effectively with oral or topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Topical azithromycin seemed to be superior over oral azithromycin or doxycycline in improving the quality of tear film in the short term.
Collapse
Affiliation(s)
- Tianchang Tao
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases College of Optometry, Peking University Health Science Center, Beijing, China
| | - Liming Tao
- Department of Ophthalmology, The Second Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
14
|
Marson JW, Baldwin HE. Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Int J Dermatol 2019; 59:e175-e182. [PMID: 31880327 DOI: 10.1111/ijd.14757] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022]
Abstract
Rosacea is a chronic inflammatory disorder of the central face with multiple overlapping presentations. Recent advancements are reshaping our understanding of rosacea from both a pathophysiologic perspective and clinical approach to therapy, introducing novel agents that have improved patient outcomes and reduced morbidity. In this article, we aim to outline the advancements in understanding, diagnosing, and managing rosacea and to familiarize physicians with the literature, thereby allowing us to better practice safe and effective medicine.
Collapse
Affiliation(s)
- Justin W Marson
- Department of Medicine, University of California at Irvine, Orange, CA, USA
| | - Hilary E Baldwin
- Medical Director, The Acne Treatment and Research Center, Morristown, NJ, USA.,Clinical Associate Professor of Dermatology, Rutgers Robert Wood Johnson Medical Center, Piscataway, NJ, USA
| |
Collapse
|
15
|
De Benedetti G, Vaiano AS. Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series. Indian J Ophthalmol 2019; 67:464-471. [PMID: 30900575 PMCID: PMC6446637 DOI: 10.4103/ijo.ijo_1244_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare the efficacy and safety profile of oral azithromycin with that of doxycycline over 9 months in patients experiencing failure with conservative and topical treatment for Meibomian gland dysfunction (MGD), to assess recurrence of MGD, and to determine the number of treatments required. Methods This is a randomized controlled trial with a cross-over design at a tertiary care center. In all, 115 consecutive patients underwent a complete ophthalmological examination before being randomly assigned to oral treatment with doxycline (4 g for 30 days) or azithromycin (1.25 g for 5 days). Patients were evaluated at 3, 6, and 9 months. Therapy was switched or conservative management maintained according to signs and symptoms. Results In the azithromycin group, 83.25% of the patients were stable after one treatment, 16.5% needed a further one or two treatments (some had previously been switched to doxycycline), and 5.77% did not improve despite treatment. In the doxycycline group, 33.79% of patients were stable after one treatment, 66.21% needed a further one or two treatments (some had previously switched to azithromycin), and 29.41% did not improve despite treatment (P < 0.05). Minimal gastrointestinal adverse effects (nausea, diarrhea, abdominal cramp, and decreased appetite) were reported, mostly unchanged at the follow-up visits. At the first visit, more adverse effects were reported in the doxycycline group (14/51, 24%) than in the azithromycin group (3/52, 6%; P < 0.005). Conclusion Both antibiotics were effective and safe for treating patients with persistent MGD, although azithromycin was superior when the reduced dose and the shorter course of therapy (5 days vs. 4 weeks) were taken into consideration. Given the chronic nature of the disease and the improvement in some signs with minimal adverse effects, a shorter therapy seems a safer and more logical alternative to longer regimens.
Collapse
|
16
|
Wladis EJ, Lau KW, Adam AP. Nuclear Factor Kappa-B Is Enriched in Eyelid Specimens of Rosacea: Implications for Pathogenesis and Therapy. Am J Ophthalmol 2019; 201:72-81. [PMID: 30703356 DOI: 10.1016/j.ajo.2019.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the role of nuclear factor kappa-B (NFKB) in cutaneous specimens of rosacea and unaffected tissue. METHODS Immunohistochemical staining was performed for the activated, phosphorylated variant of NFKB (pNFKB) in eyelid specimens of rosacea (n = 12) and normal, healthy tissue (n = 12). The numbers of positively staining cells/40× microscopic field were counted across 5 consecutive fields. Additionally, quantitative Western blotting was carried out for pNFKB and NFKB in specimens of rosacea (n = 15) and normal controls (n = 14). Statistical comparisons were performed via a dedicated software package. RESULTS The mean number of cells/40× microscopic field that stained positively for pNFKB was 18.4 (standard deviation = 15.3) for control patients and 39.3 (standard deviation = 16.9) for rosacea patients, and the difference between the 2 groups was statistically significant (P = .0024). On Western blotting, the mean ratios of pNFKB:NFKB for control and rosacea patients measured 0.58 (standard deviation = 0.81) and 3.11 (standard deviation = 3.53), respectively. The 2 groups were statistically significantly different (P = .0002). CONCLUSIONS The activated form of NFKB is enriched in rosacea, indicating a role for this pathway in the pathogenesis of this disease. Interference with NFKB signaling may represent a novel therapy for rosacea as clinical agents become available. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
Collapse
|
17
|
Al-Balbeesi AO, Almukhadeb EA, Halawani MR, Bin Saif GA, Al Mansouri SM. Manifestations of ocular rosacea in females with dark skin types. Saudi J Ophthalmol 2019; 33:135-141. [PMID: 31384155 PMCID: PMC6664278 DOI: 10.1016/j.sjopt.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. Objective To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. Method Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. Result Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. Conclusion Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other.
Collapse
Affiliation(s)
- Amal O Al-Balbeesi
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Eman A Almukhadeb
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mona R Halawani
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bin Saif
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samir M Al Mansouri
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Treatment of ocular rosacea. Surv Ophthalmol 2018; 63:340-346. [DOI: 10.1016/j.survophthal.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
|
19
|
Ozek D, Evren Kemer Ö, Artüz F. Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction. Ocul Immunol Inflamm 2018. [DOI: 10.1080/09273948.2018.1433305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Dilay Ozek
- Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Özlem Evren Kemer
- Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ferda Artüz
- Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Longo CM, Adam AP, Wladis EJ. Rosacea and the eye: a recent review. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christine M. Longo
- Department of Regenerative and Cancer Cell Biology, MC-165, Albany Medical College, Albany, NY, USA
| | - Alejandro P. Adam
- Department of Molecular and Cellular Physiology, MC-8, Albany Medical College, Lions Eye Institute, Albany, NY, USA
- Department of Ophthalmology, Albany Medical College, Albany, NY, USA
| | - Edward J. Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, NY, USA
| |
Collapse
|
21
|
Sakassegawa-Naves FE, Ricci HMM, Moscovici BK, Miyamoto DA, Chiacchio BB, Holzchuh R, Santo RM, Hida RY. Tacrolimus Ointment for Refractory Posterior Blepharitis. Curr Eye Res 2017; 42:1440-1444. [DOI: 10.1080/02713683.2017.1339805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fernando Eiji Sakassegawa-Naves
- Department of Ophthalmology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Helena Maria Moraes Ricci
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Bernardo Kaplan Moscovici
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Ricardo Holzchuh
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Ruth Muyuki Santo
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Richard Yudi Hida
- Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Eye Bank, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
22
|
Anzengruber F, Czernielewski J, Conrad C, Feldmeyer L, Yawalkar N, Häusermann P, Cozzio A, Mainetti C, Goldblum D, Läuchli S, Imhof L, Brand C, Laffitte E, Navarini AA. Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol 2017; 31:1775-1791. [PMID: 28833645 DOI: 10.1111/jdv.14349] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/08/2017] [Indexed: 12/28/2022]
Abstract
Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.
Collapse
Affiliation(s)
- F Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - J Czernielewski
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - C Conrad
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - L Feldmeyer
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - N Yawalkar
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - P Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - A Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Mainetti
- Department of Dermatology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - D Goldblum
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - S Läuchli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Brand
- Department of Dermatology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - E Laffitte
- Department of Dermatology, University Hospital Geneva, Geneva, Switzerland
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
23
|
Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
|
24
|
Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. State of the art: systemic rosacea management. J Dtsch Dermatol Ges 2017; 14 Suppl 6:29-37. [PMID: 27869374 DOI: 10.1111/ddg.13141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/30/2022]
Abstract
Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.
Collapse
Affiliation(s)
- M Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany
| | - P Lehmann
- Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| |
Collapse
|
25
|
Al-Amry MA, Al-Ghadeer HA. Ocular acne rosacea in tertiary eye center in Saudi Arabia. Int Ophthalmol 2016; 38:59-65. [DOI: 10.1007/s10792-016-0420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/22/2016] [Indexed: 12/28/2022]
|
26
|
Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Aktueller Stand der systemischen Rosazea-Therapie. J Dtsch Dermatol Ges 2016; 14 Suppl 6:29-37. [DOI: 10.1111/ddg.13141_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M Schaller
- Universitäts-Hautklinik; Klinikum der Universität Tübingen; Deutschland
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie; Johann Wolfgang Goethe-Universität; Frankfurt/Main Deutschland
| | - B Homey
- Klinik für Dermatologie; Universitätsklinikum Düsseldorf; Deutschland
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie; Universitätsklinikum Gießen; Deutschland
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie; Helios Kliniken Wuppertal, Universität Witten/Herdecke; Deutschland
| | - TA Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Deutschland
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie; Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology; University Collge Dublin; Dublin Irland
| |
Collapse
|
27
|
Abstract
Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules, phymatous changes, and ocular signs and symptoms. Rosacea is generally classified into four subtypes and one variant. Subtype 1, erythematotelangiectatic rosacea, includes clinical features of flushing and persistent central facial erythema with or without telangiectasia. Subtype 2, papulopustular rosacea, is characterized by persistent central facial erythema with transient papules or pustules or both on the central face. Subtype 3, phymatous rosacea, includes thickening of the skin with irregular surface nodularities and enlargement. Subtype 4, ocular rosacea, includes inflammation of different parts of the eye and eyelid. A variant, granulomatous rosacea, is noninflammatory and is characterized by hard, brown, yellow, or red cutaneous papules or nodules of uniform size. Patients may present with more than one subtype, and each individual characteristic may fluctuate. There is debate whether rosacea progresses from one subtype over time or subtypes represent discreet entities. Defining clinical presentation and improved understanding of pathophysiology has resulted in identification of novel treatment approaches. This contribution outlines a rationale for treatment, highlights an evidence-based approach with approved treatments, and considers novel developments and off-license therapy available.
Collapse
Affiliation(s)
- Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom.
| |
Collapse
|
28
|
Liang H, Randon M, Michee S, Tahiri R, Labbe A, Baudouin C. In vivo confocal microscopy evaluation of ocular and cutaneous alterations in patients with rosacea. Br J Ophthalmol 2016; 101:268-274. [PMID: 27222243 DOI: 10.1136/bjophthalmol-2015-308110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/15/2016] [Accepted: 04/23/2016] [Indexed: 11/04/2022]
Abstract
AIMS The physiopathology of rosacea and the correlation between ocular and cutaneous rosacea remains unclear. This study analysed ocular and cutaneous rosacea with in vivo confocal microscopy (IVCM). METHODS Thirty-four eyes of 34 patients with confirmed rosacea-associated meibomian gland dysfunction-related evaporative dry eye were enrolled in the study. The ophthalmological investigations included dry eye ocular surface disease index (OSDI), the Schirmer test, tear osmolarity, tear break up time, the Oxford score, infrared meibography for meibomian gland (MG) analysis and IVCM investigation for cornea, MG and skin analysis (cheek, hand). Presences of Demodex in the MG and in the cheek were also investigated. We established scores for quantifying the MG alterations in the MG (IVCM-MG) and cheek (IVCM-Cheek), and scores for Demodex quantification in the MG and cheek (IVCM-MG-Dex and IVCM-Cheek-Dex). RESULTS IVCM was relevant for analysing the cornea and MG structures and was also suitable for cutaneous analysis. Exposed skin explorations presented the epidermal and dermal layers clearly. In patients with rosacea, the IVCM-MG alteration scores were correlated with IVCM-Cheek (R2=0.27 and p=0.0006) and IVCM-MG-Dex was correlated with IVCM-Cheek-Dex (R2=0.70 and p<0.0001). However, no correlation was found between the IVCM-MG or IVCM-Cheek and the break up time, Schirmer, Oxford and osmolarity evaluations. CONCLUSIONS IVCM could be a safe, effective and reliable tool to quantify alterations of the cornea, MG and cheek glands in patients with rosacea combined with quantification of Demodex infections. As a valuable tool for investigating the pathophysiology of the disease, it could be used to assess the effectiveness of therapy.
Collapse
Affiliation(s)
- Hong Liang
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France
| | - Matthieu Randon
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Sylvain Michee
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Rachid Tahiri
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Antoine Labbe
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Christophe Baudouin
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| |
Collapse
|
29
|
Örnek N, Karabulut AA, Örnek K, Onaran Z, Usta G. Corneal and conjunctival sensitivity in rosacea patients. Saudi J Ophthalmol 2016; 30:29-32. [PMID: 26949355 PMCID: PMC4759513 DOI: 10.1016/j.sjopt.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/20/2015] [Accepted: 09/03/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose To assess corneal and conjunctival sensitivity in rosacea patients. Methods A total of 55 patients with rosacea and 37 control subjects participated in the study. Corneal and conjunctival sensitivity was determined by Cochet-Bonnet esthesiometer. Subjective symptoms of ocular dryness were evaluated using Ocular Surface Disease Index (OSDI). Schirmer’s I test (ST), tear breakup time (tBUT) and ocular surface staining with fluorescein were carried out to measure objective signs. Results The mean corneal and conjunctival sensitivity did not differ significantly between rosacea patients and controls (all p > 0.05). Schirmer’s I test and tBUT were significantly reduced (p = 0.004 for OD and p < 0.001 for OS) and grade of ocular surface staining was significantly high (p = 0.018 for OD and p = 0.038 for OS) in rosacea patients. Corneal and conjunctival sensitivity did not show significant correlation with ST, tBUT, ocular surface staining (Oxford Schema), duration of rosacea and OSDI score. Conclusions Corneal and conjunctival sensitivity did not change significantly in rosacea.
Collapse
Affiliation(s)
- Nurgül Örnek
- Department of Opthalmology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Ayşe Anıl Karabulut
- Department of Dermatology and Venereology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Kemal Örnek
- Department of Opthalmology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Zafer Onaran
- Department of Opthalmology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Gülşah Usta
- Department of Opthalmology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| |
Collapse
|
30
|
Wladis EJ, Bradley EA, Bilyk JR, Yen MT, Mawn LA. Oral Antibiotics for Meibomian Gland-Related Ocular Surface Disease: A Report by the American Academy of Ophthalmology. Ophthalmology 2015; 123:492-6. [PMID: 26707417 DOI: 10.1016/j.ophtha.2015.10.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review the existing medical literature on the role of oral antibiotics in the management of ocular surface disease (OSD) that arises from disorders of the meibomian glands and to assess the efficacy of oral antibiotics in the management of this common ocular disease. METHODS A literature search was last conducted on August 12, 2015, in the PubMed and Cochrane databases for English-language original research investigations that evaluated the role of doxycycline, minocycline, and azithromycin in OSD among adult patients. The searches identified 87 articles, and 8 studies ultimately met the criteria outlined for this assessment. RESULTS The 8 studies identified in the search documented an improvement in meibomian gland-related OSD after treatment with these agents, although side effects were common. This search identified only 1 randomized, controlled trial to assess the efficacy of these medications. CONCLUSIONS Although oral antibiotics are used commonly in the management of OSD, there is no level I evidence to support their use. There are only a few studies that have assessed the efficacy of oral antibiotics in clinically meaningful ways in the management of OSD that arises from disorders of the meibomian glands. The current level of evidence is insufficient to conclude that antibiotics are useful in managing OSD arising from disorders of the meibomian glands. The few existing studies on the topic indicate that oral antibiotics may be an effective treatment for OSD that results from meibomian gland disease.
Collapse
Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
| | | | | | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Louise A Mawn
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
31
|
|
32
|
Arman A, Demirseren DD, Takmaz T. Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline. Int J Ophthalmol 2015; 8:544-9. [PMID: 26086005 DOI: 10.3980/j.issn.2222-3959.2015.03.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 10/09/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. METHODS One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. RESULTS Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). CONCLUSION Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.
Collapse
Affiliation(s)
- Aysegul Arman
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
| | | | - Tamer Takmaz
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
| |
Collapse
|
33
|
Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. OBJECTIVES To assess the efficacy and safety of treatments for rosacea. SEARCH METHODS We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. MAIN RESULTS We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed adverse events, although often only limited data were provided. In most comparisons there were no statistically significant differences in number of adverse events, most were mild and transient. Physician assessments including investigators' global assessments, lesion counts and erythema were evaluated in three-quarters of the studies, but time needed for improvement and duration of remission were incompletely or not reported.The quality of the body of evidence was rated moderate to high for most outcomes, but for some outcomes low to very low.Data for several outcomes could only be pooled for topical metronidazole and azelaic acid. Both were shown to be more effective than placebo in papulopustular rosacea (moderate quality evidence for metronidazole and high for azelaic acid). Pooled data from physician assessments in three trials demonstrated that metronidazole was more effective compared to placebo (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.29 to 3.02). Four trials provided data on participants' assessments, illustrating that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30 to 1.63). The results from three studies were contradictory on which of these two treatments was most effective.Two studies showed a statistically significant and clinically important improvement in favour of topical ivermectin when compared to placebo (high quality evidence). Participants' assessments in these studies showed a RR of 1.78 (95% CI 1.50 to 2.11) and RR of 1.92 (95% CI 1.59 to 2.32),which were supported by physicians' assessments. Topical ivermectin appeared to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study, for improving quality of life and participant and physician assessed outcomes (high quality evidence for these outcomes).Topical brimonidine in two studies was more effective than vehicle in reducing erythema in rosacea at all time points over 12 hours (high quality evidence). At three hours the participants' assessments had a RR of 2.21 (95% CI 1.52 to 3.22) and RR of 2.00 (95% CI 1.33 to 3.01) in favour of brimonidine. Physicians' assessments confirmed these data. There was no rebound or worsening of erythema after treatment cessation.Topical clindamycin phosphate combined with tretinoin was not considered to be effective compared to placebo (moderate quality evidence).Topical ciclosporin ophthalmic emulsion demonstrated effectiveness and improved quality of life for people with ocular rosacea (low quality evidence).Of the comparisons assessing oral treatments for papulopustular rosacea there was moderate quality evidence that tetracycline was effective but this was based on two old studies of short duration. Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99) (high quality evidence). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doxycycline, but there was evidence of fewer adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54) (low quality evidence). There was very low quality evidence from one study (assessed at high risk of bias) that doxycycline 100 mg was as effective as azithromycin. Low dose minocycline (45 mg) was effective for papulopustular rosacea (low quality evidence).Oral tetracycline was compared with topical metronidazole in four studies and showed no statistically significant difference between the two treatments for any outcome (low to moderate quality evidence).Low dose isotretinoin was considered by both the participants (RR 1.23, 95% CI 1.05 to 1.43) and physicians (RR 1.18, 95% CI 1.03 to 1.36) to be slightly more effective than doxycycline 50-100 mg (high quality evidence).Pulsed dye laser was more effective than yttrium-aluminium-garnet (Nd:YAG) laser based on one study, and it appeared to be as effective as intense pulsed light therapy (both low quality evidence). AUTHORS' CONCLUSIONS There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea. Time needed to response and response duration should be addressed more completely, with more rigorous reporting of adverse events. Further studies on treatment of ocular rosacea are warranted.
Collapse
Affiliation(s)
- Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | | | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | | | - Lyn Charland
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | |
Collapse
|
34
|
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.
Collapse
|
35
|
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.
Collapse
|
36
|
|
37
|
Doan S, Gabison E, Chiambaretta F, Touati M, Cochereau I. Efficacy of azithromycin 1.5% eye drops in childhood ocular rosacea with phlyctenular blepharokeratoconjunctivitis. J Ophthalmic Inflamm Infect 2013; 3:38. [PMID: 23514194 PMCID: PMC3605085 DOI: 10.1186/1869-5760-3-38] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 01/09/2023] Open
Abstract
Background The purpose of this study is to report the efficacy of azithromycin 1.5% eye drops in children with ocular rosacea and phlyctenular blepharokeratoconjunctivitis. This retrospective study from January 2009 to March 2010 included 16 children treated with lid hygiene plus azithromycin 1.5% eye drops (Azyter®): 3-day treatments (1 drop twice a day) every 10 days, reduced based on efficacy to one treatment every 15 days and then to one treatment per month. Results Nineteen eyes of six boys and ten girls, aged 4 to 16 years (mean, 9.3 ± 4.0) were included. The disease was previously resistant to lid hygiene (all the patients), oral erythromycin (one patient), and intermittent topical steroids (six patients). The median duration of each phase of azithromycin treatment (i.e., three, two, and one treatments per month) was 2 months. Ocular inflammation was controlled by azithromycin alone in 15 patients. In one uncontrolled case, cyclosporine 2% eye drops was added at month 5. Bulbar conjunctival hyperemia resolved completely within 1 month in all eyes, whereas conjunctival phlyctenules and corneal inflammation took longer to improve, with a complete resolution within 3 to 10 months. Blepharitis grade decreased from 2.31 ± 0.79 to 1.50 ± 0.73. Treatment was stopped after a median of 6 months (from 4 to 10 months) without recurrence of corneoconjunctival inflammation (median follow-up without treatment, 11 months). Six cases of ocular irritation were reported, two of which led to treatment withdrawal. Conclusion Azithromycin 1.5% eye drops is an effective treatment for phlyctenular keratoconjunctivitis complicating childhood ocular rosacea.
Collapse
Affiliation(s)
- Serge Doan
- Department of Ophthalmology, Hôpital Bichat and Fondation A, de Rothschild, 75018, Paris, France.
| | | | | | | | | |
Collapse
|
38
|
Central corneal thickness in patients with mild to moderate rosacea. Can J Ophthalmol 2012; 47:504-8. [DOI: 10.1016/j.jcjo.2012.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/22/2012] [Accepted: 07/27/2012] [Indexed: 12/17/2022]
|
39
|
Spoendlin J, Voegel J, Jick S, Meier C. A study on the epidemiology of rosacea in the U.K. Br J Dermatol 2012; 167:598-605. [DOI: 10.1111/j.1365-2133.2012.11037.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Abstract
PURPOSE To evaluate the effects of oral azithromycin in patients with posterior blepharitis. METHODS Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. RESULTS All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. CONCLUSIONS The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.
Collapse
|
41
|
Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some patients. A range of treatment options are available but it is unclear which are the most effective. OBJECTIVES To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors. MAIN RESULTS Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'.Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76).Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54).One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes). AUTHORS' CONCLUSIONS Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.5% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
Collapse
Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
| | | | | | | | | |
Collapse
|
42
|
Lazaridou E, Fotiadou C, Ziakas N, Giannopoulou C, Apalla Z, Ioannides D. Clinical and laboratory study of ocular rosacea in northern Greece. J Eur Acad Dermatol Venereol 2011; 25:1428-31. [DOI: 10.1111/j.1468-3083.2011.03995.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
43
|
Oltz M, Check J. Rosacea and its ocular manifestations. OPTOMETRY (ST. LOUIS, MO.) 2011; 82:92-103. [PMID: 21276570 DOI: 10.1016/j.optm.2010.01.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 10/30/2009] [Accepted: 01/05/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rosacea is a chronic condition affecting the facial and ocular surface tissues. It is historically underdiagnosed and affects people of all ethnicities. The exact pathophysiology of rosacea is poorly understood. A variety of medical therapies are available to treat the various signs and symptoms of rosacea. Currently, there is no cure for the condition. METHODS This report is a literature review. RESULTS The clinical manifestations of rosacea are diverse, with periods of exacerbation and remission. Many short- and long-term treatments are available to alleviate the symptoms and effects of rosacea. Variations are common in the medications used, dosages, and durations of treatment. Current topical, oral, and surgical treatment options are presented and reviewed. As a chronic condition, rosacea treatment should be tailored toward individuals and adjusted over time. CONCLUSIONS Subtle presentations of rosacea may be overlooked by health care providers. When treating the condition, certain individuals may require both systemic and topical therapy to effectively control rosacea outbreaks. Eye care professionals need to be aware of the presence of rosacea to appropriately treat ocular surface disease that is not responding as expected to standard topical therapy. Severe facial and ocular surface damage caused by rosacea may need surgical intervention. Specific treatment protocols are elusive because of the diversity of the disease. Additional research is needed to find the exact cause of rosacea to more effectively manage the dermatologic and ocular manifestations of the disease and to find a cure.
Collapse
|
44
|
Sobottka A, Lehmann P. [Rosacea 2009 : new advances in pathophysiology, clinical staging and therapeutic strategies]. Hautarzt 2010; 60:999-1009. [PMID: 19957073 DOI: 10.1007/s00105-009-1825-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple therapeutic options.
Collapse
Affiliation(s)
- A Sobottka
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie - Kompetenzzentrum Hautkrebs, HELIOS-Klinikum Wuppertal, Heusner Str. 40, 42283, Wuppertal, Deutschland.
| | | |
Collapse
|