Effectiveness of VISIA system in evaluating the severity of rosacea

BACKGROUND

Rosacea is a facial chronic inflammatory skin disease with almost 5.5% prevalence. Although there are various scales of rosacea, they are objective and discordant among different dermatologists. Noninvasive objective measurements such as VISIA system might play essential roles in the diagnosis and evaluation of rosacea. Here, we intended to reveal the effectiveness of VISIA system in rosacea.

MATERIALS AND METHODS

A number of 563 participants diagnosed with facial rosacea were enrolled in study. They all received both full-face image-shoot by VISIA system with quantitative analysis software and physician's assessment via five different scales, including investigator global assessment (IGA), clinician erythema assessment (CEA), numerical score, the National Rosacea Society (NRS) grading system and telangiectasis.

RESULTS

Absolute score and percentile of red area had significant correlations with IGA and CEA, whereas red area had no significant correlation with numerical score, NRS and telangiectasis. Red area in erythematotelangiectatic rosacea patients demonstrated the highest correlation with IGA and CEA, especially in those aged between 51 and 60. Besides red area, pigmentation parameters in VISIA system (brown spot) also showed significant correlation with IGA and CEA.

CONCLUSION

VISIA system might be an effective measurement in the assessment of rosacea severity.

Treatment of refractory acne using selective sebaceous gland electro-thermolysis combined with non-thermal plasma

Acne is one of the most common skin diseases whose disfiguring results may cause psychological problems. Despite of the various choices in the treatment of acne, new therapy with fewer complications and lower relapse rate is still in need. In this study, we aim to evaluate the clinical efficacy of a new therapy using selective sebaceous gland electro-thermolysis and non-thermal plasma (NTP) in refractory acne patients. Treatments were given at a monthly interval for three times. The last visit was set at 3 months after the third treatment. Thirty-six moderate to very severe acne patients were enrolled. All the patients got more than 50% clearance after the third treatment. The excellent response rate was 44% at 1 month after the third treatment and 50% at 3 months after the third treatment. Porphyrin and erythema values were significantly reduced after the third treatment. No irreversible complication was reported. Selective sebaceous gland electro-thermolysis combined with NTP can be a safe and effective new option in the treatment of acne.

Erythema-directed digital photography and colorimeter scores correlate with rosacea erythema evaluation in patients under treatment with topical ivermectin

Inflammatory rosacea is clinically characterized by persistent erythema and inflammatory lesions. Its severity is generally based on clinical observation that may be cumbersome. The aim of this study was to assess if erythema-directed digital photography (EEDP) and colorimeter (COL) correlate and are concordant with clinical evaluation of erythema degree of rosacea under topical treatment. Thirty naïve patients with mild/moderate inflammatory rosacea were instructed to apply ivermectin cream for 8 weeks. Erythema degree was performed at baseline, and at 2, 4, 6, and 8 weeks by clinician erythema assessment based on 5-point severity scale (from 0 = no erythema to 4 = fiery redness), and by instrumental evaluation by EDDP using the same 5-point scale of clinical assessment and by COL using a 5-point scale (from 0 = <1 units = no erythema to 4 > 12 units = fiery redness). Concordance and correlation analysis were performed using Cohen's Kappa coefficient and Correlation Coefficient test respectively. At baseline a statistically significant concordance/correlation value between EDDP and COL was observed. At 2 weeks, the statistical concordance/correlation value between instrumentals were both increased, along with a slight significant concordance between clinical assessment and erythema-directed digital photography. At 4, 6 and 8 weeks, a statistically significant increase of concordance/correlation value among all the considered parameters from baseline was found. The results of our study showed that at baseline and during the early treatment stage both EDDP and COL were able to appreciate more accurately the erythema grade compared to clinical observation supporting the use of non-invasive techniques for a more objective evaluation of erythema in rosacea.

Inter-observer evaluation of erythema-directed photography for the assessment of erythema and telangiectasias in rosacea

BACKGROUND

Persistent centrofacial erythema associated with telangiectasias is one of the most common phenotypes of rosacea in clinical practice, and the assessment of each component is crucial as each of them may require a different approach. The aim of this study was to evaluate the inter-observer reliability of standard photography vs erythema-directed photography for the assessment of erythema and telangiectasias in rosacea.

MATERIALS AND METHODS

One hundred full-face images of 50 rosacea patients (50 standard photographs and 50 erythema-directed digital photographs) were evaluated by 8 independent experienced dermatologists using a 5-item score for erythema and telangiectasias, respectively. Inter-rater reliability, by comparing erythema and telangiectasias scores and calculating the percentage of agreement between evaluators, was assessed and the strength of agreement using the Cohen's Kappa values (95% CI) was calculated.

RESULTS

Poor and fair strength of agreement for erythema and telangiectasias using standard photography vs moderate and good strength of agreement using erythema-directed digital photography was found.

CONCLUSION

Erythema-directed digital photography may provide a better strength of agreement and higher reliability among independent observers compared to standard photography in the assessment of erythema and telangiectasias in rosacea, thus suggesting new horizons for digital appraisal of skin diseases.

Licochalcone A in Combination with Salicylic Acid as Fluid Based and Hydroxy-Complex 10% Cream for the Treatment of Mild Acne: A Multicenter Prospective Trial

Purpose

Topical cosmetic agents if correctly prescribed and used may improve outcomes in acne therapy. The aim of this study was to assess the efficacy and tolerability of a new daily cosmetic regimen in the treatment of mild facial acne.

Patients and methods

A multicenter, prospective, observational, clinical study was conducted on 91 adult patients with mild acne. Subjects were instructed to apply a fluid containing Licochalcone A/Salicylic acid/L-Carnitine in the morning and a cream with Licochalcone A/Hydroxy-Complex 10% at bedtime for 8 weeks. The efficacy was clinically evaluated by Global Acne Grading System (GAGS) score and by comedones/papules lesions count and by instrumental assessment (Sebutape^TMand Reveal Photo Imager/VISIA-CR™ imaging) at baseline, at 4 and 8 weeks.

Results

At 4 weeks a statistically significant reduction from baseline of GAGSwas observed. In addition, the mean total count of comedones and papules was significantly reduced by 41% and 45%, respectively, from baseline along with a significant reduction of mean sebum of 47%. At 8 weeks, a further statistically significant reduction from baseline of GAGS, total count of comedones and papules (64% and 71%, respectively), along with an additional sebum reduction of about 52% was also recorded.

Conclusion

Our results suggest that the daily regimen based on Licochalcone A with Salicylic acid/L-Carnitine as fluid or with Hydroxy-Complex 10% as cream represent an interesting cosmetic approach for treating mild acne.

Multimodal Clinical Imaging Assessment of the Outcome in Mild-to-Moderate Acne: A Prospective Study

Background: The quality of outcome assessment in acne studies has been either subjective/insufficient or time consuming through the ordinary lesion counting. Objective: To evaluate the application of multimodal clinical imaging (MCI), a combination of imaging technology and computation, in the assessment of acne lesions in a clinical study setting. Methods: A prospective, monocentric, single-group open study designed to evaluate the efficacy and tolerance of a cosmetic product (IP/SG) in subjects with mild-to-moderate facial acne by classical clinical counting (CCC) – change in the total/inflammatory/noninflammatory acne lesion number compared with baseline (D0) – Investigator Global Assessment (IGA) and self-reported outcomes. Concomitantly, MCI was administered. The study was performed for 12 weeks (D84) with a 4-week follow-up (D112). Results: Mean age of patients (n = 49) was 18.2 ± 3.7 years (range 13–25). The mean acne duration was 3.8 ± 2.8 years. The total number of lesions did not differ significantly between D0/D84 by both CCC and MCI. However, the Cardiff Acne Disability Index (CADI) and uncomfortable feeling improved at D28/D0, the perception of oily skin improved at D14/D0, and the perception of sticky skin improved from D28/D0 to D56/D0. Deterioration was detected between D84/D0 and D112/D0, namely after product discontinuation. Interestingly, a change in trend was recorded for acne lesions at D14/D0 by MCI but not by CCC. Conclusion: MCI, applied for the first time in a small clinical study setting, is at least as reliable as CCC and may allow for a sensitive longitudinal evaluation of single acne lesions and their response to products, especially in conditions where clinical evaluation reaches its limits.

Clinical and erythema-directed imaging evaluation of papulo-pustular rosacea with topical ivermectin: a 32 weeks duration study

Background: Ivermectin (IVM) 1% cream represents an emerging therapy for papulo-pustular rosacea (PPR) and erythema-directed photography is a useful tool for evaluation of patient's erythema. Objective: The aim of our study was to assess the efficacy of IVM in PPR in achieving clear status at 8 weeks or at 20 weeks followed by respectively 24 and 12 weeks follow-up, using clinical/instrumental evaluation. Methods: Twenty patients with PPR were instructed to apply IVM for 8 weeks. At week 8, in case of complete response the therapy was stopped and a follow-up period up to 24 weeks was carried out, whereas in case of improvement the treatment was extended for additional 12 weeks followed by a 12 weeks follow-up. Instrumental evaluation was performed by erythema-directed digital photography (VISIA-CR^TM- RBX^TM). Results: At week 8, complete response was observed in 31.6% of cases along with a significant decrease of erythema degree. During treatment extension, additional improvement in terms of complete response, respectively at 12 (42%), 16 (47%) and 20 (58%) weeks, and reduction of erythema degree was observed. Conclusions: IVM is a valuable therapeutic option in mild/moderate PPR. Erythema-directed digital photography enhances erythema changes visualization compared to clinical observation alone.

Clinical and instrumental evaluation of a new topical non-corticosteroid antifungal/anti-inflammatory/antiseborrheic combination cream for the treatment of mild-to-moderate facial seborrheic dermatitis

PURPOSE

Topical agents play a key role in the management of facial seborrheic dermatitis (SD) by reducing inflammation and scale production. The aim of this open-label trial was to assess the efficacy and tolerability of a new non-corticosteroid, antifungal/anti-inflammatory/antiseborrheic cream containing piroctone olamine, stearyl glycyrrhetinate, and zinc PCA in the treatment of facial SD using clinical and instrumental evaluation.

PATIENTS AND METHODS

Twenty adult subjects affected by mild-to-moderate inflamed facial SD were enrolled and instructed to apply the study cream twice daily for 60 days. Efficacy was evaluated at baseline, and at days 15, 30, and 60 by measuring the grade of desquamation, erythema, and pruritus using clinical evaluation, erythema-directed digital photography, colorimetry, and subject-completed Visual Analog Scale. Additionally, an Investigator Global Assessment (IGA) was assessed using a 5-point scale: excellent response (>80% improvement); good response (50%-80% improvement); mild response (<50% improvement); no response (no change); worsening.

RESULTS

After 15 days, a statistically significant decrease from baseline was found in desquamation, erythema, colorimetric scores, and pruritus. At day 60, a significant further improvement for all evaluated parameters was recorded. Moreover, the IGA improved in 90% of patients, with an excellent response in 53% of cases. A good correlation was found between clinical and instrumental evaluations.

CONCLUSION

Our results indicate that the study facial cream represents an option to consider when dealing with mild-to-moderate SD, being effective, well-tolerated, and free of significant side effects, as confirmed by clinical and instrumental evaluation.