A Randomized, Placebo-Controlled Trial of Gamma Linolenic Acid as an Add-on Therapy to Minocycline for the Treatment of Rosacea

Associations of serum gamma-linolenic acid levels with erythema severity and anxiety/depression status in patients with rosacea

BACKGROUND

The development of rosacea is suggested to be closely associated with lipid metabolism, inflammation, and anxiety/depression. Gamma linolenic acid (GLA) is a key factor participating in lipid metabolism, which is also confirmed to regulate the inflammatory response. However, the associations of serum GLA levels with rosacea severity and psychological status still remain unclear.

OBJECTIVE AND LIMITATIONS OF THE STUDY

The present study aimed to investigate the associations of gamma linolenic acid (GLA), a key factor participating in lipid metabolism and the inflammatory response, with rosacea severity and psychological status. The present study still had some limitations. First, this study is a cross-sectional study and does not provide longitudinal evidence about the relationship between GLA and rosacea; Second, the cohort in this study is also relatively small, and a larger cohort is needed in further investigation to reveal the potential role of lipid metabolism in the pathogenesis of rosacea.

METHODS

A total of 62 rosacea patients were consecutively recruited. Patient's Self-Assessment (PSA) scale and Clinician Erythema Assessment (CEA) as well as 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9) were conducted to evaluate the degree of erythema severity and anxiety/depression, respectively. Serum GLA levels were determined by gas chromatography mass.

RESULTS

Lower levels of serum GLA in rosacea patients were observed (p<0.001), and subgroup analysis revealed that patients with higher-level GLA had lower scores of PSA, CEA, GAD-7 and PHQ-9. Moreover, Spearman correlation analysis uncovered that serum GLA levels were negatively associated with PSA, CEA, GAD-7 as well and PHQ-9 scores, respectively. Linear regression model found that serum GLA levels at baseline were a predictive factor for prognosis of clinical outcomes after 1-month conventional treatment.

CONCLUSION

The present study indicates that lower levels of serum GLA in rosacea patients are negatively associated with the degree of erythema and anxiety/depression status.

Psychological Burden and Willingness to Pay Among Korean Rosacea Patients and Their Association With Rosacea Phenotype and Severity: A Multi-Center Cross-Sectional Study

BACKGROUND

Rosacea is a chronic inflammatory disorder that can adversely affect the patient's quality of life (QOL). However, few studies have examined the association between the psychological burden and willingness to pay (WTP) with rosacea features and severity.

OBJECTIVES

The study aimed to determine the overall psychological burden and WTP among Korean rosacea patients and identify factors that may contribute, such as patient demographics, clinical features, and rosacea severity.

METHODS

This prospective cross-sectional study recruited Koreans with rosacea. All were asked to complete a questionnaire on their demographics, rosacea-related symptoms, self-rated severity, dermatology life quality index (DLQI), and WTP. The clinical features were assessed by a board-certified dermatologist. The investigator's global assessment and global flushing severity score (GFSS) were used to determine the clinical severity of rosacea. Multiple regression analysis was conducted to identify factors contributing to the psychological burden and WTP.

RESULTS

Out of 201 rosacea patients, 147 (73.1%) were female, and 54 (26.9%) males, with a median age of 50.1 years. Their median DLQI score was 8 (interquartile range [IQR]): 4.0-13.0). The median WTP per month for the control of rosacea was $100, with relative WTP (WTP/household income per month x 100) being 3.3%. According to the multiple regression model, phymatous change (β = .153, p = .030), DLQI score (β = .152, P = .045), and GFSS (β = .154, P = .041) contributed most to the WTP.

CONCLUSION

Rosacea patients experience substantial psychological and economic burdens. More vigorous treatment should be performed for those with phyma and severe flushing whose QOL is most severely affected.

Use of Patient-Reported Outcomes in Acne Vulgaris and Rosacea Clinical Trials From 2011 to 2021: A Systematic Review

Importance

Acne and rosacea have substantial implications for quality of life, and it is therefore important to ensure the patient's voice is being captured in pivotal randomized clinical trials (RCTs). Although patient-reported outcome measures (PROMs) are a valuable tool to capture the patient perspective, little is known about use of PROMs in RCTs on acne and rosacea.

Objective

To characterize the use of PROMs in RCTs on acne and rosacea.

Evidence Review

A systematic literature search was conducted using the search terms acne vulgaris and rosacea in the following databases: MEDLINE through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. A modified search hedge for RCTs from the McGill Library was applied. All phase 2, 3, and 4 RCTs published between December 31, 2011, through December 31, 2021, that evaluated the efficacy and safety of therapies for acne and rosacea vs any comparator were eligible for inclusion.

Findings

A total of 2461 publications describing RCTs were identified, of which 206 RCTs met the inclusion criteria (163 trials [79%] on acne and 43 [21%] on rosacea). At least 1 PROM was used in 53% of trials (110) included; PROM use was more common in rosacea RCTs (67% [n = 29]) compared with acne RCTs (50% [n = 81]). At least 1 dermatology-specific (13% [n = 27]) or disease-specific (14% [n = 28]) PROM was included in the RCTs analyzed. Only 7% of trials (14) included a PROM as a primary outcome measure. There was no statistically significant increase in PROM inclusion over the study period (11 of 21 trials in 2011 vs 5 of 12 trials in 2021).

Conclusions and Relevance

In this systematic review, PROMs were included in approximately one-half of acne and rosacea RCTs performed over the study period. In addition, PROMs were rarely used as a primary outcome measure, and inclusion of PROMs has not increased substantially over the past 10 years. Increasing use of PROMs in RCTs can ensure that the patient's perspective is captured during the development of new treatments for acne and rosacea.

Emulgels Containing Perilla frutescens Seed Oil, Moringa oleifera Seed Oil, and Mixed Seed Oil: Microemulsion and Safety Assessment

P. frutescens seed oil and M. oleifera seed oil consist of fatty acids and sterols that are beneficial for skin. Mixing of these oils at 1:1 ratio has shown to increase antioxidant activity of oils. This study aims to formulate emulgels containing microemulsions of P. frutescens seed oil, M. oleifera seed oil, and mixed P. frutescens and M. oleifera seed oils. The chemical constituents of P. frutescens seed oil, M. oleifera seed oil, and mixed seed oil are analyzed by gas chromatography/mass spectrometry (GC/MS). The microemulsions are formulated by a phase titration method and characterized for the droplet size, polydispersity index, and zeta potential value using a dynamic light scattering technique. The physical and chemical stability of the microemulsions are investigated using a rheometer and UV-Visible spectrophotometer, respectively. The safety of microemulsion is evaluated on PBMC and human subjects. Emulgels containing three different types of microemulsion are formulated. The results show that P. frutescens seed oil is mainly composed of alpha-linolenic acid, linoleic acid, and oleic acid, whereas M. oleifera seed oil contains a high proportion of oleic acid. Mixed seed oil contains a comparable amount of alpha-linolenic acid and oleic acid. All types of oils are composed of β-sitosterol as the major plant sterol. Microemulsions of all types of oils are successfully prepared by using Tween 80 as a surfactant due to the largest transparent region of pseudoternary phase diagram. The size, polydispersity index, and zeta potential values of all types of microemulsion are in the acceptable range upon storage at 30 °C for 1 month. Microemulsions exhibit pseudoplastic flow behavior. The percent of remaining oils in all types of microemulsion is more than 90% after storage at 30 °C for 1 month. Emulgels containing three types of microemulsions exhibit good characteristics and no change in viscosity after storage at 4, 30, and 45 °C for 1 month. The safety results reveal that three types of microemulsion do not induce cytotoxicity to PBMC nor induce skin irritation and allergic reactions. Emulgels containing microemulsions developed in this study can be used to safely deliver P. frutescens seed oil, M. oleifera seed oil, and mixed seed oil to human skin.