1
|
Nguyen C, Kuceki G, Birdsall M, Sahni DR, Sahni VN, Hull CM. Rosacea: Practical Guidance and Challenges for Clinical Management. Clin Cosmet Investig Dermatol 2024; 17:175-190. [PMID: 38283794 PMCID: PMC10821660 DOI: 10.2147/ccid.s391705] [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: 06/22/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
Rosacea is a common chronic dermatosis. Clinically, rosacea can present with flushing, erythema, papules, pustules, telangiectasias, phymatous changes, pruritus, burning, and stinging. In 2017, the National Rosacea Society Expert Committee recommended a phenotype-based classification for therapy. In this review, we identify monotherapies and multimodal treatment approaches for the clinical management of rosacea including topical, systemic, laser and light, alternative, and combination therapies.
Collapse
Affiliation(s)
- Cassidy Nguyen
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | - Dev Ram Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vikram Nath Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| | - Christopher M Hull
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| |
Collapse
|
2
|
Ring HC, Zachariae C, Thomsen SF, Thyssen JP, Egeberg A. Severe papulopustular rosacea successfully treated with a combination of oral azithromycin and isotretinoin. J DERMATOL TREAT 2022; 33:3205-3207. [PMID: 36165496 DOI: 10.1080/09546634.2022.2129953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
3
|
Lam NSK, Long XX, Li X, Yang L, Griffin RC, Doery JCG. Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 PMCID: PMC10317738 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
Collapse
Affiliation(s)
- Nelson Siu Kei Lam
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Pathology, Monash Medical Centre, Clayton, Victoria, Australia
- Department of General Medicine, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Pharmacy, Monash Medical Centre, Clayton, Victoria, Australia
- Faculty of Health and Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xin Xin Long
- Faculty of Health and Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xuegang Li
- Department of Rheumatology, The Fifth affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong province, China
| | - Li Yang
- Department of Dermatology, The Fifth affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong province, China
| | - Robert C Griffin
- Consultant Emeritus of The Canberra Hospital, Woden Valley, Canberra, Australian Capital Territory, Australia
| | - James CG Doery
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| |
Collapse
|
4
|
Kardeh S, Saki N, Jowkar F, Kardeh B, Moein SA, Khorraminejad-Shirazi MH. Efficacy of Azithromycin in Treatment of Acne Vulgaris: A Mini Review. World J Plast Surg 2019; 8:127-134. [PMID: 31309049 PMCID: PMC6620802 DOI: 10.29252/wjps.8.2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antibiotics are commonly used in the treatment of acne vulgaris. Considering the rise of antibiotic resistance, alternative medications may be used in the main anti-acne armamentarium. The aim of this study was to investigate the efficacy of oral azithromycin in the treatment of acne vulgaris. METHODS Database searches were performed in PubMed and Scopus using the keywords “azithromycin” and “acne”. RESULTS Azithromycin 500 mg once daily for 3 days per week or in cycles of 10 days for 12 weeks are the most commonly used regimens. CONCLUSION Available experimental data suggest that oral azithromycin is an effective and well-tolerated option for treatment of acne vulgaris.
Collapse
Affiliation(s)
- Sina Kardeh
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Burn and Wound Healing Research Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Saki
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farideh Jowkar
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Kardeh
- Bone and Joint Diseases Research Center, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Arman Moein
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Khorraminejad-Shirazi
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
5
|
Lova Navarro M, Sánchez-Pedreño Guillen P, Victoria Martínez A, Martínez Menchón T, Corbalán Vélez R, Frías Iniesta J. Papulopustular Rosacea: Response to Treatment with Oral Azithromycin. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
6
|
Lova Navarro M, Sánchez-Pedreño Guillen P, Victoria Martínez A, Martínez Menchón T, Corbalán Vélez R, Frías Iniesta J. Rosácea papulopustulosa: respuesta al tratamiento con azitromicina oral. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:529-535. [DOI: 10.1016/j.ad.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/22/2018] [Accepted: 02/04/2018] [Indexed: 10/17/2022] Open
|
7
|
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
|
8
|
|
9
|
Abstract
Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies.
Collapse
Affiliation(s)
- Allison P Weinkle
- 1School of Medicine, University of California San Diego, La Jolla, CA. 2Dermatology Department, St John's, Episcopal Hospital, Queens, NY. 3Spalding Drive Plastic Surgery and Dermatology, Beverly Hills, CA, USA
| | | | | |
Collapse
|
10
|
Abstract
Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies.
Collapse
Affiliation(s)
- Allison P Weinkle
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Vladyslava Doktor
- Dermatology Department, St John's Episcopal Hospital, Queens, NY, USA
| | - Jason Emer
- Spalding Drive Plastic Surgery and Dermatology, Beverly Hills, CA, USA
| |
Collapse
|
11
|
Abstract
Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.
Collapse
|
12
|
Mantelli F, Di Zazzo A, Sacchetti M, Dianzani C, Lambiase A, Bonini S. Topical azithromycin as a novel treatment for ocular rosacea. Ocul Immunol Inflamm 2013; 21:371-7. [PMID: 23875944 DOI: 10.3109/09273948.2013.801991] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Acne rosacea is a common dermatological conditions associated with blepharitis. Current treatments include artificial tears, lid hygiene, and systemic doxycycline. In this study the authors evaluate the effectiveness of topical azithromycin in ocular rosacea. METHODS The authors enrolled 37 ocular rosacea patients: 12 were treated with systemic doxycycline, 16 with azithromycin eyedrops, and 9 did not receive medical treatments. Ocular signs and symptoms and side effects were evaluated at baseline and at 1-month follow-up. RESULTS A significant improvement in TF-BUT, meibomian gland plugging, and Oxford score associated with symptom reduction was reported by all patients after 1 month. All treatments were well tolerated, with mild gastro-intestinal symptoms in 33% of the doxycycline group and mild burning after instillation in the azithromycin group. CONCLUSIONS Topical azithromycin may represent an additional treatment for ocular rosacea, with a shorter duration of treatment and absence of gastrointestinal side effects as compared to systemic doxycycline.
Collapse
|
13
|
|
14
|
Macrolides in chronic inflammatory skin disorders. Mediators Inflamm 2012; 2012:159354. [PMID: 22685371 PMCID: PMC3362991 DOI: 10.1155/2012/159354] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/10/2012] [Accepted: 03/15/2012] [Indexed: 12/30/2022] Open
Abstract
Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents.
Collapse
|
15
|
Generali JA, Cada DJ. Azithromycin (Oral): Rosacea. Hosp Pharm 2012. [DOI: 10.1310/hpj4703-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@kumc.edu .
Collapse
Affiliation(s)
- Joyce A. Generali
- Hospital Pharmacy, and Drug Information Center, Kansas University Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160
| | | |
Collapse
|