Promoting public skin health through a national continuing medical education project on cosmetic and dermatologic sciences: a 15-year experience

Background

The developments in cosmetic sciences and technologies have generated a gap between the cosmetics and their users. Users including regular customers, clinicians, industry personnel, researchers, testing agencies, beauty salon workers, and mass media hardly possess the ability to distinguish truth from falsehood. The gap remained as one major reason for inappropriate cosmetics usage, insufficient efficacy, and even cosmetics adverse reactions (CARs).

Methods

Aiming at enhancing the relevant practitioners' cosmetic and dermatologic sciences, we launched a cosmetic and dermatologic sciences continuing medical education (CME) since 2008. The objective of the current study was to evaluate the effectiveness of the CME. We summarized and analyzed the project for the last 15 years. Meanwhile, an online survey consisted of three parts was performed to evaluate the CME and to collect the trainees' comments.

Results

A total of 3,923 trainees have participated in the CME project from 2008 to 2022. The trainees included clinicians, industry staffs, biomedical researchers, third-party cosmetics testing staffs, beauty salon staffs, students, and media staffs. The trainees had theory courses on cosmetic and dermatologic sciences, cosmetics DIY practice & video watching, and an optional guided tour during the 4.5-day CME. Eight hundred and twenty-three trainees and 586 control subjects responded to the online survey. The comprehensive test in the second part of the survey demonstrated that compared with the control group, the CME project significantly enhanced the trainees' perception and knowledge regarding the cosmetics formula sciences, basic dermatologic sciences, cosmetics usage, noninvasive measurements, new advances, CARs, and laws (p = 0.000). Trainees of all occupations ranked "basic dermatologic sciences and skin diseases" as the most significant sections. Trainees of all occupations believed the CME has contributed most in "understand the function & efficacy of cosmetics." We noticed the occupational variances. Over 97% of trainees were willing to recommend the CME to the others.

Conclusion

The CME project significantly enhanced the trainees' cosmetic and dermatologic sciences, which bridged the gap between cosmetics and public skin health. This multidisciplinary CME also contributed to establishing an interdisciplinary interaction and cooperation platform for the multiple occupations involved in the public skin health maintenance and promotion.

Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems

Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.

The Role of Cosmetology in an Effective Treatment of Rosacea: A Narrative Review

Rosacea is a chronic inflammatory facial skin disease usually occurring in middle-aged patients. It manifests itself as an inflammatory condition with perivascular infiltrate, dilated blood vessels, lymphoedema, hyperplasia of sebaceous glands, and disorders of connective tissue structures brought on by fibrosis. Rosacea is characterized by multifactorial inflammatory mechanisms, and therefore it requires an interdisciplinary approach including adequate skin care, topical and/or systemic therapy, and physical modalities to successfully treat the various symptoms and disease subtypes. However, data regarding the possible role of cosmetologists in rosacea remains scanty and equivocal. The objectives of cosmetology therapy include restoration and regeneration, anti-inflammatory effects, the strengthening of blood vessels and regulation of their permeability, and the regulation of keratinization. Vascular abnormalities can be targeted with specific light and laser devices. Therefore, the present paper aims to review the latest advances and summarize different aspects concerning skin care in rosacea. Particular attention has been paid to the co-operation of cosmetologists with other specialists in order to bring about the interdisciplinary management of rosacea. It is also important to keep in mind that it is usually necessary to combine various methods of treatment, as this approach is more effective than monotherapy for attaining satisfactory cosmetic results in rosacea patients.

Expert consensus on holistic skin care routine: Focus on acne, rosacea, atopic dermatitis, and sensitive skin syndrome

BACKGROUND

Treatment, cleansing, moisturizing, and photoprotection are four major components of holistic skin care for dermatological conditions. While treatment (T) is recognized as a key component in the management of dermatological conditions, there is a lack of practical guidance on the adjunctive role of cleansing, moisturizing, and photoprotection ("CMP"). Limited patient knowledge, confusion over product selection, and lack of guidance on how to choose and use CMP skin care products (in conjunction with pharmacological therapy) are the main barriers to establishing a holistic skin care routine for dermatological conditions.

AIMS

This study aimed to review current clinical evidence, identify gaps, and provide practical guidance on conceptualization and implementation of CMP routine in the management of sensitive skin due to underlying acne, atopic dermatitis, or rosacea, including conditions with idiopathic causes referred to as idiopathic sensitive skin syndrome.

METHODS

An expert panel comprising of 10 dermatologists from Australia, China, Hong Kong, Taiwan, India, Indonesia, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements on holistic skin care in acne, rosacea, atopic dermatitis, and idiopathic sensitive skin syndrome using the Delphi approach.

RESULTS

Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations on holistic skin care.

CONCLUSION

A dermatologist-guided holistic skin care routine is essential to improve patient confidence and reduce confusion over product selection. The consensus recommendations presented here highlight the importance of cleansing, moisturization, and photoprotection in holistic skin care and how it can be utilized as a communication tool for physicians and patients to achieve overall better patient compliance, satisfaction, and treatment outcomes.

S2k guideline: Rosacea

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.

A cream containing the sap of oat plantlets and mandarin extract soothes the symptoms of rosacea and improves the quality of life of patients

BACKGROUND

Rosacea is a chronic inflammatory disease of the facial skin that affects all skin types and occurs mostly in adults. The main clinical sign of rosacea is a characteristic and persistent form of centro-facial erythema that is prone to exacerbation and can impair quality of life (QoL). The current therapeutic approach for rosacea is to combine various treatments, use appropriate skincare products and avoid flare-up triggers.

OBJECTIVE

To evaluate the use of a facial skincare product containing protein-free sap extruded from Rhealba® oat plantlets and mandarin extract in subjects with rosacea.

METHODS

Three clinical studies were conducted in adult subjects with various rosacea phenotypes (erythematotelangiectatic or papulopustular) and treatment histories to assess the dermatological and ophthalmological tolerance of the study product, as well as its clinical effectiveness, after a twice-daily application on the whole face and neck for up to 4 weeks.

RESULTS

Tolerance of the product was rated as good to very good by dermatologists across the three studies, which involved a total of 105 evaluable subjects. Subjects with untreated erythematotelangiectatic rosacea reported fewer functional signs and symptoms of the disease and an improved QoL. The evaluation of skin biometric parameters revealed a reduction in transepidermal water loss, indicating that the study product helped to restore skin barrier integrity after 4 weeks, and a higher skin pH, indicating that the cutaneous microbiote was respected. Most subjects (93%) who had either undergone a superficial dermatological procedure for erythematotelangiectatic rosacea or were taking oral/topical treatments for papulopustular rosacea, rated the study product as very good (8/10) and felt it further relieved their symptoms.

CONCLUSION

Overall, the study product was very well tolerated and may be beneficial for subjects with rosacea as an adjunct to superficial dermatological procedures or oral/topical therapies, in line with the current recommendations for rosacea management.

Clinical clues to identify patients with ocular rosacea - a Germany-wide epidemiologic analysis

BACKGROUND AND OBJECTIVES

Ocular rosacea is a special manifestation of rosacea with unknown etiology. Eye involvement in rosacea patients is surprisingly common; however, it is often underdiagnosed, resulting in inappropriate treatment. We aimed to provide an updated epidemiologic perspective on ocular rosacea in Germany to improve patient care.

PATIENTS AND METHODS

Data of 777 rosacea patients were assessed using a detailed online questionnaire regarding ocular and skin symptoms, previous dermatological and ophthalmological consults, presence of type 1 hypersensitivities, and Demodex testing. All data were statistically analyzed.

RESULTS

Most patients reported ocular symptoms (399/777, 51.4%), including red eyes (179/399, 44.9%), itching (187/399, 46.9%), sty or chalazion (309/399, 77.4%), and dryness (108/399, 27.1%). Ocular rosacea was confirmed in 149/309 cases who consulted an ophthalmologist (45.3%). A total of 159/399 (39.8%) had no pre-existing allergies. Eye involvement was significantly associated with the presence of skin symptoms (P < 0.05), impacting patients' general well-being and overall treatment satisfaction. About half of Demodex-positive patients (21/45, 46.7%) showed ocular symptoms.

CONCLUSIONS

Eye involvement in rosacea patients was common, often presenting with unspecific symptoms.

Efficacy and tolerability of a detergent and care component for rosacea patients: A split-face, vehicle-controlled, randomized trial

BACKGROUND

The treatment of facial erythema and subjective symptoms of rosacea patients remains challenging in clinical practice. Cosmeceuticals, care components containing active ingredients such as phytochemicals, play a growing role in treatment plans. However, well-designed studies on their efficacy and limitations are widely missing.

OBJECTIVE

A foam and a cream for rosacea patients were assessed based on objective and subjective methodology. The tolerability of skin and eyes was evaluated.

METHODS

A randomized, double-blinded, split-face, and vehicle-controlled trial was conducted. At baseline and after four weeks of product use, dermatological and ophthalmological investigations were performed, employing image analysis of facial erythema, clinical assessments, and questionnaires.

RESULTS

The patient cohort comprised 33 females with persistent facial erythema due to rosacea. No significant differences were found between the vehicle and the verum. According to the analysis of facial erythema, a "less pronounced" or "much less pronounced" appearance was seen in two thirds of patients comparing V1 to V0. Especially, the dryness of the skin improved by the use of the vehicle and the verum. Adverse subjective skin sensations decreased by 61.3% for the verum side and by 58.6% for the vehicle side. Subjective and objective analysis of ocular manifestation differed, with subjective manifestations reported more frequently, thus highlighting underdiagnosis of ocular rosacea.

CONCLUSIONS

As no clear differences between the verum and the vehicle were found, an optimal skin care regime itself seems to have a superior effect in the relief of facial erythema and foremost of subjective symptoms, rather than certain active ingredients.

Research of the activities of the enterprises of the perfume and cosmetic industry of Ukraine

The perfumery and cosmetic industry of Ukraine is distinguished by its dynamic development and makes a significant contribution to the country's economy. Several types of economic activities are involved in its functioning, including the development, research, production and sale of perfumery and cosmetic products, as well as the provision of cosmetic services to the population. The economic activity of each sector in the chain of creation, production and sale of cosmetic products / services determines both their individual success and the efficiency of the entire system as a whole. In this regard, the systematization and analysis of the indicators of economic activity of enterprises of each type of activity of the national cosmetic industry is an urgent task, the solution of which will reasonably determine the prospects for both the further development of this industry and the export potential of the Ukrainian economy as a whole. The aim of this work was to conduct a comprehensive study of the dynamics of the main indicators of Ukrainian enterprises of perfumery, cosmetic and related industries economic activity for the period 2010–2019 and determination of their development trends. The available data of the State Statistics Service of Ukraine, the Patent Office of Ukraine, as well as a database of scientific and professional publications publications were used as materials and methods. Retrospective, logical, research methods, as well as the method of content analysis were used. The results of a comparative analysis of the main indicators of the economic activity of business entities in the studied industry made it possible to establish trends in the development of this sector of the economy and substantiate the patterns observed at the present stage. Conclusions. The results of the study indicate that the production potential of the perfumery and cosmetic industry in Ukraine is promising, as well as significant opportunities for further development of the trade in these products and the provision of cosmetic services to the population.

Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment

Background

Pathophysiology of rosacea is not completely understood and involves a complex interaction among genetics, ultraviolet (UV) light, microorganisms, impaired skin barrier, neuronal and vascular dysfunction, and immune system disruption.

Aims

To describe the etiology of rosacea with an emphasis on the role of UV radiation and exposome, and to review the importance of non‐pharmacologic strategies focusing on photoprotection.

Methods

We conducted a narrative review of the literature. We performed literature searches with PubMed from January 1990 to November 2020 using the keywords “rosacea”, “pathogenesis”, “ultraviolet radiation”, “exposome”, “photoprotection”, “sunscreens” and “non‐pharmacologic agents”. The search was limited to English, Spanish, and French language articles.

Results

Several environmental factors such as UV light, diverse microorganisms, air pollution, tobacco smoking, nutrition, and psychological stress showed to trigger or worsen rosacea. UV radiation was reported to induce pro‐inflammatory, pro‐angiogenic, and pro‐fibrotic responses. We found 6 original articles about the impact of sunscreens on rosacea. The use of sunscreens containing ingredients with emollient, anti‐inflammatory, and/or vasoregulatory properties was shown to significantly improve symptomatology.

Conclusion

UV radiation and the exposome play a key role in the development of rosacea. UV light is implicated in all significant aspects of rosacea: skin inflammation, neoangiogenesis, telangiectasia, and fibrosis, and may even initiate rosacea. While the use of sunscreens is widely recommended, the literature on the impact of photoprotection in rosacea is scarce. Adequately formulated sunscreens could not only provide the required level of photoprotection, but may also help to mitigate the barrier dysfunction, neutralize facial redness (tinted sunscreens), and decrease inflammation and vascular dysfunction.

Rosacea Treatment: Review and Update

Rosacea is a chronic and inflammatory skin disease characterized by flushing, nontransient erythema, papules/pustules, telangiectasia, and phymatous changes. Secondary manifestations, such as itching, burning, or stinging, are often observed in patients with rosacea. In 2017, a phenotype-based approach for diagnosis and classification was recommended. With the update of the diagnosis and classification of rosacea, treatment options for patients with rosacea have attracted the attention of dermatologists. Here, we summarize the latest advances in rosacea treatment, including skin care and cosmetic treatments, topical therapies, oral therapies, laser- and light-based therapies, injection therapies, treatments for specific types of rosacea, treatments for systemic comorbidities, and combination therapies. The impact of the phenotype-based approach on rosacea treatment and future directions are also discussed.