An empirically generated responder definition for rosacea treatment

Objectively quantifying facial erythema in rosacea aided by the ImageJ analysis of VISIA red images

BACKGROUND

Facial erythema, a prominent characteristic of rosacea, causes concern to both the patient and doctor. In clinical practice, commonly used erythema severity subjective assessment tools lack objectivity and are less comprehensive. Even with images taken by the VISIA^® system, diffused erythema is difficult to segment and evaluate fully due to the automatic threshold segmentation method. This study aimed to explore a more objective and scientific erythema quantification tool with the aid of the ImageJ software analysis of the red area images taken by the VISIA^® system.

MATERIALS AND METHODS

Patients with rosacea were enrolled and assessed for the clinical severity of their illness using various stools-the standard grading systems (SGS) for rosacea, investigator's global assessment (IGA), and clinician's erythema assessment (CEA). Facial images in the red area mode of the VISIA^® system were further analyzed by the ImageJ for the relative intensity of redness and percentage of erythema area; the correlation with the scores of the subjective grading systems was evaluated.

RESULTS

This study included 201 patients (195 females and 6 males). The relative intensity of redness was positively correlated to the SGS, IGA, and CEA scores (0.688, 0.725, and 0.718, respectively) (p < 0.001). The percentage of erythema area was positively correlated to the SGS, IGA, and CEA scores (0.615, 0.666, and 0.656, respectively) (p < 0.001).

CONCLUSION

We demonstrated a more objective and precise method of assessing the severity of facial erythema rosacea, which could comprehensively assess the severity by both the area and intensity of facial erythema.

Real-life experience on effectiveness and tolerability of topical ivermectin in papulopustular rosacea and antiparasitic effect on Demodex mites

Ivermectin is a drug approved for the treatment of papulopustular rosacea (PPR). Although clinical guidelines recommend the use of ivermectin as the first-line treatment in patients with almost clear and mild rosacea, studies concerning its use on them are lacking. This study investigated the effectiveness and the tolerability of ivermectin in almost clear to severe rosacea and assessed the antiparasitic effect on Demodex mites. This is a retrospective study based on 50 patients affected by PPR and treated with topical ivermectin 1% once daily over 16 weeks. The disease severity, the patient-examined improvement, and the safety assessment of patients were evaluated. Demodex mites were studied with the standardized skin surface biopsy. PPR to all severity achieved a therapeutic success. The number of inflammatory lesions was significantly decreased in almost clear (p < .0001), mild, moderate, and severe (p < .001) forms. A complete remission of inflammatory lesions was achieved by almost clear (p < .001) and mild (p = .005) with 82% with none-to-mild cutaneous adverse events. Thirty-two percent were positive for Demodex mites, and all of them turned negative after 16 weeks. Ivermectin is an effective treatment not only in moderate to severe PPR but also in almost clear/mild rosacea.

Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms

BACKGROUND

Patients with rosacea or demodicosis have high facial skin Demodex densities (Dds). Topical ivermectin, benzyl benzoate (BB) and crotamiton have been shown to decrease Dds in vivo, but there are few data on the clinical and acaricidal effects of BB among patients with rosacea.

OBJECTIVE

To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms of rosacea and demodicosis, and compare three BB treatment regimens.

METHODS

In this retrospective observational study, 394 patients (117 with rosacea, 277 with demodicosis) were included. Three BB (+crotamiton) treatment regimens were compared: 12% once daily, 12% twice daily and 20% once daily. Dds were measured using two consecutive standardized skin surface biopsies [superficial (SSSB1) and deep (SSSB2)] before treatment and at the first follow-up. Symptoms were evaluated using investigator global assessment. Treatment was considered effective if the Dd had normalized (SSSB1 ≤ 5 D/cm² AND SSSB2 ≤ 10 D/cm²) or symptoms had cleared and curative if the Dd had normalized and symptoms had cleared.

RESULTS

At an average of 2.7 months after treatment start, the total Dd (SSSB1 + 2) had decreased by 72.4 ± 2.6% from the initial value across the whole cohort. Dds had normalized in 139 patients (35%), and symptoms had cleared in 122 (31%). Treatment was effective in 183 (46%) patients and curative in 78 (20%). Compliance was good: 77% of patients correctly followed treatment instructions. Results were similar in patients with rosacea and those with demodicosis. The 12% once-daily regimen was less effective than the other doses and had poorer compliance than the 12% twice-daily regimen.

CONCLUSION

Topical treatment with BB (+crotamiton) may be an effective treatment for rosacea and demodicosis, indirectly supporting a key role of the mite in the pathophysiology of rosacea. The two higher dose regimens were more effective than the lower dose.